1. Colon-Rectal Cancer Keith Bradley, MD National Alliance of Research Associates Programs NARAP

2. Colon-Rectal Cancer 2nd leading cause of cancer deaths in U.S.

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6. Colon-Rectal Cancer 2nd leading cause of cancer deaths in U.S. complex interactions between inherited susceptibility and environmental risk factors

7. Risk Factors Inherited Acquired

8. Inherited Risk Factors age > 40 personal hx of colon-rectal cancer Ulcerative colitis or Crohn’s disease family (parents or siblings) hx of –colon-rectal cancer or –adenomas before age 60 Familial polyposis

9. Acquired Risk Factors diet high inlow in –saturated fat- calcium –protein - folate –calories –meat (both red and white) –alcohol sedentary lifestyle smoking cigarettes

10. Decreased Risk low-fat, high-fiber diet nonsteroidal anti-inflammatory drugs post menopausal female hormone use polyp removal

11. Colon-Rectal Cancer 2nd leading cause of cancer deaths in U.S. complex interactions between inherited susceptibility and environmental risk factors number of new cases and deaths due to colon-rectal cancer has been decreasing

12. Screening fecal occult blood test flexible sigmoidoscopy colonoscopy

13. Fecal Occult Blood Test special cards are coated with a stool sample and returned to the physician or lab

16. Fecal Occult Blood Test special cards are coated with a stool sample and returned to the physician or lab fecal occult blood test performed every 1 or 2 years in people between the ages of 50-80 years decreases deaths due to colorectal cancer by 20 – 40%

17. Flexible Sigmoidoscopy a thin, lighted tube (sigmoidoscope) into rectum and only the descending colon most often done –in a doctor’s office or clinic –by a family practitioner (FP) or general internist patient remembers the procedure polyps or other abnormal tissue  removed and biopsied combined with FOBT every 3 years

19. Colonoscopy a thin, lighted tube (colonoscope) into rectum and through the entire colon most often done –in a hospital or specialized setting –by a gastroenterologist (but possibly a FP) under conscious sedation polyps or other abnormal tissue  removed and biopsied

23. Polyps adenomas = precursors for vast majority of colorectal cancer most of these adenomas are polypoid

31. Colon-Rectal Cancer Screening Fewer than 50% over age 50 get screened

32. Colon-Rectal Cancer Screening Fewer than 50% over age 50 get screened In a survey, respondents who had never had a colonoscopy said they would rather give up three months of life than have the test.

33. United States Preventive Services Task Force (USPSTF) Recommendations Adults, beginning at age 50 years and continuing until age 75 years Options –annual screening with a sensitive FOBT –flexible sigmoidoscopy every 5 years with a mid-interval sensitive FOBT –colonoscopy every 10 years