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1. American Cancer Society. Cancer facts and figures, 2000. Atlanta, Georgia: American Cancer Society, 2000; publication no. 5008.00.
2. Mandel JS, Bond JH, Church TR, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood: Minnesota Colon Cancer Control Study. N Engl J Med 1993;328:1365--71.
3. Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy: The National Polyp Study Workgroup. N Engl J Med 1993;329:1977--81.
4. Winawer SJ, Fletcher RH, Miller L, et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology 1997;112:594--642.
5. CDC. Screening for colorectal cancer---United States, 1997.
Fiber Not Protective for Colon Cancer
Colorectal Cancer Treatment Takes a Turn
A Potential Colon Cancer Culprit
Still Squeamish About Screenings?
Aspirin May Lower Colon Cancer Risk
Researchers found that a daily aspirin significantly reduced the recurrence of colon polyps among people with previous colon cancers. A weaker association was seen for patients with a history of polyps but no cancer. But it is too soon to recommend that anyone -- even those at high risk -- take aspirin or any other anti-inflammatory drug solely to lower their colon cancer risk, the researchers say.
The studies appear in the March 6, 2003 issue of The New England Journal of Medicine.
"Screening is still the most important thing that people can do to protect themselves against colorectal cancer," lead researcher Robert S. Sandler, MD, tells WebMD. "The worst thing that could happen is for people to get the idea that they don't have to get screened if they take aspirin. But these studies do suggest that aspirin helps prevent the development of colon polyps."
Each year, roughly 57,000 Americans die of colon cancer, making it the second leading cause of cancer deaths overall. The risk of developing colon cancer and the polyps that can lead to the disease increases with age. Nine out of 10 people diagnosed with colon cancer are over the age of 50.
Previous trials attempting to show a protective benefit for dietary fiber, antioxidant vitamins, and diet have proved disappointing. There is some evidence that dietary calcium protects against the formation of polyps, but the findings are not conclusive.
Animal trials and preliminary studies in humans have suggested that regular aspirin use lowers the risk of colon cancer. To further test this theory, Sandler and colleagues recruited more than 1,100 patients with a history of polyps and 635 patients with a history of colon cancer.
The colon cancer patients were treated with a regular, coated aspirin (325 mg) or placebo daily. The trial was stopped early, after roughly 31 months, because the aspirin group had significantly fewer polyps.
The study group with a history of polyps but not cancer received daily doses of low-dose aspirin (81 mg), a regular aspirin, or placebo for an average of just under three years. The patients in the two aspirin groups had a lower rate of polyp recurrence than those in the placebo group. But, inexplicably, the patients given low-dose aspirin had better responses than patients taking the higher dose of aspirin every day.
Although other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, were not tested, there is good reason to believe that they also help prevent precancerous polyps from forming. A large study is now under way assessing whether one of the newest class of NSAIDs, Cox-2 inhibitors, helps prevent colon cancer. Cox-2 inhibitors include Bextra, Celebrex, and Vioxx. The hope is that these drugs will work as well or better than aspirin but with fewer side effects. Regular use of aspirin and many other NSAIDs is associated with an increased risk for stomach or intestinal bleeding.
In an editorial accompanying the two studies, Indiana University School of Medicine Professor Thomas F. Imperiale, MD, writes that it is unlikely there will be a definitive clinical trial of aspirin or other NSAIDs for the prevention of colon cancer. He agrees that although aspirin and other NSAIDs may have a modest impact on colon cancer risk, the evidence is not strong enough to recommend their routine use for preventing the cancer.
"The bottom line is that these trials are a step in the right
direction, but we have not reached the threshold where we can change
clinical practice," he tells WebMD. "This suggests that people
already on aspirin therapy may derive an additional benefit. But the
best prevention for colorectal cancer is still regular screening once
you hit the age of 50."
Source: Salynn Boyles, The New England Journal of Medicine, March 6, 2003. Robert S. Sandler, MD, MPH, professor of medicine and epidemiology, University of North Carolina, Chapel Hill. Thomas F. Imperiale, MD, professor of medicine, Indiana University School of Medicine. my.webmd.com/content/article/61/71439.htm
Colorectal Cancer Awareness Month - March
Senate Panel OKs Colon Cancer
Many Avoid Colon Cancer Tests:
They're too embarrassed to get tested
Mutations In Gene For Rare Disease
Associated With Risk Of Colon Cancer
Mutations in the hereditary hemochromatosis gene (HFE) are associated with an increased risk of colon cancer, according to a study in the January 15, 2003 issue of the Journal of the National Cancer Institute.
Source: Journal of the National Cancer Institute, www.intelihealth.com/IH/ihtIH/EMIHC000/333/333/360079.html
Aspirin Lowers Colon Cancer Risk
Trace Proteins in Stool May Point to Colon
Current tests for colorectal cancer include colonoscopy, flexible sigmoidoscopy, and a test for traces of blood in the stool. A past study found that cancer cells sloughed off into stool could be easily detected using a DNA test. This study suggests that a simple protein test could also serve his purpose.
Coleman and his colleagues looked for minichromosome maintenance protein 2 (MCM2) expression in 40 people with symptomatic colorectal cancer and 25 people without colon cancer. The authors found the protein in 37 of the 40 people with colon cancer. In contrast, the authors did not find the protein in the control group. The authors note that the three stool samples that did not turn up MCM2 were from patients with right, or proximal, colon cancer.
Because this study was conducted in an experimental setting, these findings might have differed in a population with a higher frequency of proximal colon cancers, the authors say. However, they maintain that their approach "might ultimately prove suitable for population screening, either alone or in combination with other tests."
The complete study (Davies J. et al. Lancet 2002;359:1917-9) is available from The Lancet at www.thelancet.com
For JNCI News articles on the stool test, see "Stool Test
Identifies Markers for Colorectal Cancer, Studies Show" and "Studies
Move Closer to Genetic Test to Detect Colon Cancer".
Doctors Not Giving Colorectal Cancer
Screening Test Survey Finds
Several recent studies prove that annual use of a FOBT could prevent 33,000 deaths from colorectal cancer a year. The American Cancer Society recommends that adults over 50 use the test annually to identify hidden blood in the stool -- one of the early warning signs of colorectal cancer.
The quick and pain-free FOBT can often indicate if more invasive screening procedures are necessary. Most colon cancers develop from pre-cancerous polyps, which can actually be removed during colonoscopy screening. EZ Detect FOBTs, manufactured by Biomerica Inc. of Newport Beach, CA (NASDAQ:BMRA) are being given away free as a public service during National Colorectal Cancer Awareness Month, March 2000. Product and survey results can be found at www.ezdetect.com *326 respondents as of March 22, 2000. It was requested that respondents be over 50. Contact B.L. Ochman, 212.385.2200 or BLOchman@whatsnextonline.com or Jennifer Irani: Biomerica Corp., 800.854.3002 x 315 or firstname.lastname@example.org
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