In February of 2000, President Clinton designated March as Colorectal Cancer Awareness Month, a time dedicated to increasing awareness, screening, and prevention about the third most common cancer in men and women.
So, how are we doing? It’s clear we’re making headway (Table 1). In fact, among adults 50 years of age and older, colorectal cancer (CRC) incidence rates have declined 4.3% per year from 2007 through 2011. Unfortunately, 132,700 new CRC cases (93,090 colon and 39,610 rectal) are still expected for 2015. In addition, among adults younger than 50, the incidence rate has increased by 1.8% per year.
The trending decrease in incidence over roughly the last two decades can be explained by recent changes in risk factors as well as to an increase in screening in those aged 50 years and older. And although when men and women are considered together, CRC remains the second leading cause of cancer death, mortality rates have been decreasing since 1980 for men and since 1947 for women. In recent years this decline in CRC mortality rates has accelerated in both sexes: the overall CRC death rate has fallen 2.5% per year from 2007 through 2011. This improvement in survival has been attributed to earlier detection and advances in treatment, and also reflects the declining incidence of CRC (in other words, fewer patients developing CRC in the first place translates into fewer patients dying of the cancer in the long run).
So the message is getting out, but there’s still room for improvement. Let’s make the message ring loud and clear: CRC is one of the most easily identifiable, curable cancers, and when caught early it is also one of the most effectively treated cancers. This message really makes sense when you look at it from the perspectives of how the disease develops, how it can be identified, and how it can be treated.
CRC originates either in the colon or rectum, two sites in the lower region of the gastrointestinal system. Below the small intestine, the large intestine is mostly colon, a muscular tube approximately 5 ft long that absorbs water and salt from food and which stores waste as it passes along the digestive tract. At the end of the large intestine, remaining waste matter is collected in the rectum, the final 6 inches of the digestive system, where it is stored prior to excretion.
The tubular walls of the colon and rectum are made up of layers of tissue. Importantly, CRC takes root in the innermost tissue layer of these walls. Typically, the disease evolves from a tissue growth or tumor that develops as a noncancerous polyp on the innermost lining of the colorectal wall. Some polyps become cancerous, while others do not. Adenomatous polyps, also known as adenomas, can become cancerous, and thus all adenomas are regarded as precancerous. More than 95% of all CRCs are adenocarcinomas. Other potentially precancerous colorectal tissues exhibit dysplasia, a condition in which, after years of exposure to Crohn’s disease, ulcerative colitis, or other inflammatory bowel disease (IBD), cells appear abnormal under a microscope. These cells can go on to become cancerous.
In the event that a polyp becomes cancerous, it can eventually grow into the colorectal wall. Once cancer cells begin growing in the wall of the colon, they can proceed to grow through the further layers of tissue or spread into blood or lymph vessels. The cancer cells can travel from the lymph vessels into nearby lymph nodes and disrupt immune cells, or may metastasize to other organs such as the liver. Most CRC develops in this way — through a very slow disease process — importantly, one that typically requires several years for the cancer to fully develop. During these early stages, the disease is quite curable, and in many instances can be detected before the polyps have even become cancerous. Typically, however, early CRC shows no signs or symptoms, which is why it is important that people come to appreciate the value of a regimented screening program.
Screening for CRC is the key to reducing its incidence, according to the American Cancer Society (ACS), who state that 50% of all deaths attributable to CRC could be prevented if people would get tested regularly. In partnership with other organizations, ACS has set a goal of increasing CRC screening rates to 80%, which would save more than 7,000 lives per year. For men and women at average risk for developing CRC, screening should begin at 50 years of age. Several screening options exist, differing mainly with respect to bowel preparation, test performance and limitation, frequency, and cost. It is important to note that these tests should be thought of as preventative because not only can they detect cancer, they can be used to detect precancerous conditions, allowing elimination of the disease before it has even had a chance to develop.
The risk of CRC increases with age. In 2011, patients 50 years of age and older comprised 90% of the CRC patient population. CRC risk factors considered “controllable” (risk factors that patients themselves can control or modify) include obesity, sedentary lifestyle, moderate to heavy consumption of alcohol, long-term smoking, high consumption of red or processed meat, low calcium intake, and very low intake of whole-grain fiber, fruits, and vegetables. Hereditary and other medical factors can also increase an individual’s CRC risk. These include a family history of CRC, a personal history of polyps or of chronic IBD, certain genetic conditions such as nonpolyposis CRC, familial adenomatous polyposis, and type 2 diabetes.
CRC may be asymptomatic early on, but as the disease develops, symptoms may include rectal bleeding, passing of blood in stool, a change in bowel movement timing or stool form, a feeling that the bowel is not empty, cramping in the lower abdomen, diminished appetite, or weight loss.
Want to get aggressive about CRC prevention? Here are 8 rules you should follow:
- Get screened
- Maintain a healthy weight
- Don’t smoke
- Be physically active
- Drink only moderately, if at all
- Limit red meat consumption, especially processed meat
- Get enough calcium and vitamin D
- Consider taking a multivitamin with folate
Let’s help the American Cancer Society achieve their goal of increased CRC screening by passing the word along.
Table 1. CRC Incidence Rates Have Declined
|New CRC Cases||145,290||132,700|
|Deaths from CRC||56,290||49,700|
* Source: American Cancer Society
About the Connexion Healthcare Oncology Center of Excellence
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For further information regarding the Oncology Center of Excellence at Connexion Healthcare and how we can develop oncology communications to differentiate therapies by their unique attributes, contact:
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