1. Familial Risk And Pathological Outcomes Of Colorectal Cancer In An Asymptomatic General Population Cohort By: Michelle Medina

2. Simplified Title To find if heredity has anything to do with the actual risk of contracting colorectal cancer in patients that show no symptoms

3. What is Colorectal Cancer? Colorectal cancer, also known as colon cancer or bowel cancer, includes cancerous growths in the colon, rectum and appendix. Colorectal cancer, also known as colon cancer or bowel cancer, includes cancerous growths in the colon, rectum and appendix. Most cases begin as small benign polyps. Most cases begin as small benign polyps. It is the third most common form of cancer and the second leading cause of death in the Western World. It is the third most common form of cancer and the second leading cause of death in the Western World.

4. The colon The colon

5. Colorectal Cancer

6. Who gets colorectal cancer? Everyone is affected by colorectal cancer. Everyone is affected by colorectal cancer. People older than fifty are more susceptible to it. People older than fifty are more susceptible to it. Death rates for colorectal cancer among African Americans are about 30% higher than among Whites and more than two times higher than for Asian Americans, Pacific Islanders, American Indians, and Hispanics. Death rates for colorectal cancer among African Americans are about 30% higher than among Whites and more than two times higher than for Asian Americans, Pacific Islanders, American Indians, and Hispanics.

7. Risk Factors of Colorectal Cancer age age polyp growth polyp growth history of cancer history of cancer heredity heredity virus exposure virus exposure diabetes diabetes Crohn’s disease Crohn’s disease sclerosing cholangitis sclerosing cholangitis diet diet physical inactivity physical inactivity alcohol consumption alcohol consumption smoking smoking

8. Symptoms of Colorectal Cancer change in bowel habits change in bowel habits blood in the stool blood in the stool rectal bleeding rectal bleeding bowel obstruction bowel obstruction fatigue fatigue jaundice jaundice narrow stool narrow stool anemia anemia unexplained weight loss unexplained weight loss hepatomegaly hepatomegaly gas gas cramping cramping abdominal pain abdominal pain feeling of partially full bowel feeling of partially full bowel

9. Screening Methods for Colorectal Cancer FOBT – Fecal Occult Blood Testing FOBT – Fecal Occult Blood Testing IFOBT – Immunochemical FOBT IFOBT – Immunochemical FOBT Double-Contrast Barium Enema Double-Contrast Barium Enema Flexible Sigmoidoscopy Flexible Sigmoidoscopy Colonoscopy Colonoscopy Virtual Colonoscopy Virtual Colonoscopy

10. Purpose of Study To establish a correlation between family history of colorectal cancer and present cases. To establish a correlation between family history of colorectal cancer and present cases. To determine if race is a major risk factor for colorectal cancer susceptibility. To determine if race is a major risk factor for colorectal cancer susceptibility.

11. Eligibility Age 50-69 (40-69) Age 50-69 (40-69) –Men and women in ~ equal numbers No prior colonoscopy or recent sigmoidoscopy No prior colonoscopy or recent sigmoidoscopy No IBD, FAP, colorectal cancer No IBD, FAP, colorectal cancer No prior use of an implanted defibrillator No prior use of an implanted defibrillator No serious comorbidity No serious comorbidity –Exclusions: MI (past year) and other heart problems, anticoagulants, cancer therapy

12. Genetics Review Criteria Amsterdam II Amsterdam II –At least 3 relatives with HNPCC associated cancers (one a FDR of the other two) CRC, Endometrial, Kidney, Ovarian, Stomach, Small Bowel, Renal Pelvis/Ureter CRC, Endometrial, Kidney, Ovarian, Stomach, Small Bowel, Renal Pelvis/Ureter –At least 2 successive generations affected –At least 1 diagnosed with cancer before the age of 50 –No FAP First Degree First Degree –At least one immediate family member diagnosed with colorectal cancer prior to the age of 60. Standard Risk Standard Risk –No outstanding family history of colorectal cancer

13. Methods Patients who have already been reviewed by the genetics review committee were analyzed. Patients who have already been reviewed by the genetics review committee were analyzed. Each participants’ colonoscopy results were queried. Each participants’ colonoscopy results were queried. Those with First Degree risk and those meeting the Amsterdam II criteria were sent high risk letters advising them to go see a genetics counselor. Those with First Degree risk and those meeting the Amsterdam II criteria were sent high risk letters advising them to go see a genetics counselor. Those who were at standard risk were sent standard risk letters advising them they had no outstanding risk for colorectal cancer. Those who were at standard risk were sent standard risk letters advising them they had no outstanding risk for colorectal cancer.

14. Materials FOBT Cards: The fecal occult blood test chemically checks your stool for hidden blood. FOBT Cards: The fecal occult blood test chemically checks your stool for hidden blood.

15. Materials Cont. Flexible Sigmoidoscope: A short, flexible, lighted tube which transmits an image of the inside of the distal bowel about 60 cm into the colon. Flexible Sigmoidoscope: A short, flexible, lighted tube which transmits an image of the inside of the distal bowel about 60 cm into the colon.

16. Materials Cont. Colonoscope: A thin, lighted tube used to look all around the inside of the colon. Colonoscope: A thin, lighted tube used to look all around the inside of the colon.

17. Materials Cont. Baseline Questionnaires: Collects participants’ information. Baseline Questionnaires: Collects participants’ information.

18. Materials Cont. Family History Questionnaires: Collects patients’ family history of cancer. Family History Questionnaires: Collects patients’ family history of cancer.

19. Materials Cont. Pathology Review Form: Used by our pathologist to review colonoscopy specimens. Pathology Review Form: Used by our pathologist to review colonoscopy specimens.

20. Genetics Review Results 435401925Total 193(44)182(45)3(33)8(32) Unknown Race n(%) 55(13)50(12)1(11)4(16)Minoritiesn(%) 187(43)169(42)5(56)13(52)Caucasiann(%)Total Standard Risk Amsterdam II First Degree Familial Risk

21. Genetics Review Results Percentage of Participants Familial Risk

22. Pathology Review Results 20820(10)188(90) Non-Adenomas n(%) 514(8)47(92) Adenomas n(%) 35431323Total 51(20)4(80) Advanced Adenomas n(%) 906(7)84(93) Hyperplastic Only n(%) TotalMinorities White Non- Hispanics Polyp Classification

23. Pathology Review Results Percentage of Participants Types of Polyps Found

24. Conclusion More data is still needed for results to be conclusive. More data is still needed for results to be conclusive. The National Colonoscopy Study still has three more years before it ends therefore there is still more to be learned and much more data to be acquired. The National Colonoscopy Study still has three more years before it ends therefore there is still more to be learned and much more data to be acquired.

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26. Acknowledgments Victoria Serrano (our mentor) Victoria Serrano (our mentor) Epidemiology and Biostatistics Department Epidemiology and Biostatistics Department Dr. Sat Bhattacharya Dr. Sat Bhattacharya Harlem Children Society Harlem Children Society Memorial Sloan Kettering Cancer Center Memorial Sloan Kettering Cancer Center