National Cancer Institute®
Last Modified: May 1, 2002
UI - 11916350
AU - Calza S; Ferraroni M; La Vecchia C; Franceschi S; Decarli A
TI - Low-risk diet for colorectal cancer in Italy.
SO - Eur J Cancer Prev 2001 Dec;10(6):515-21
AD - Istituto di Statistica Medica e Biometria, Universita degli Studi di Milan, Italy. email@example.com
An innovative approach was used to define a low-risk diet for colorectal cancer from a multicentric case-control study of 1953 incident cases and 4154 hospital controls from Italy. A logistic regression model was fitted on the reported intake of five macronutrients, and the estimated coefficients were used to compute a diet-related logistic risk score (LRS). The mean of LRS within risk decile ranged from 0.89 to 1.86. Total energy intake and absolute consumption of each macronutrient increased with increasing LRS. In relative terms, however, starch intake showed an almost threefold increase across subsequent score levels, while a decline was observed for unsaturated fat, sugar and protein. Saturated fat consumption remained fairly stable in relative terms. When food groups were considered, bread and cereals dishes, cakes and desserts and refined sugar were positively associated, while the consumption of vegetables, fruit, fish, poultry and olive oils was inversely associated with LRS.
UI - 11588895
AU - Oh YJ; Sung MK
TI - Soybean saponins inhibit cell proliferation by suppressing PKC activation and induce differentiation of HT-29 human colon adenocarcinoma cells.
SO - Nutr Cancer 2001;39(1):132-8
AD - Department of Food and Nutrition, Sookmyung Women's University, Seoul, 140-742, Korea.
Soybeans are major dietary sources of saponins, which have been suggested as possible anticarcinogens. This study was performed to determine the effect of soybean saponins on cell proliferation, differentiation, and apoptosis in human colon cancer cells. HT-29 cells were incubated in various concentrations of saponins for 24, 48, and 72 hours. Cell growth and whole cell protein kinase C (PKC) activity were determined. Alkaline phosphatase activity and carcinoembryonic antigen level were measured as markers for cell differentiation. Apoptotic cells were quantified. Study results indicated that soybean saponin treatment decreased cell growth in a concentration-dependent manner, and pre-treatment of the cells with saponins significantly suppressed the 12-O-tetradecanoyl phorbol 13-acetate-stimulated PKC activity. Cells treated with 300 and 600 ppm of saponins significantly increased alkaline phosphatase activity by 146% and 242% of the control, respectively. Also, 4-10 times more carcinoembryonic antigen was produced in cells treated with saponins. However, at all the concentrations used, saponins did not induce apoptosis, although there were slight decreases in apoptotic activity in cells treated with 240 and 600 ppm of soybean saponins. These results suggest that crude soybean saponin extract effectively suppresses PKC activation and induces differentiation, which possibly mediate the growth inhibition of tumor cells. Further experiments, including preclinical efficacy studies, are required to fully evaluate soybean saponins for their chemopreventive properties.
UI - 11916153
AU - Winawer SJ; Zauber AG
TI - The advanced adenoma as the primary target of screening.
SO - Gastrointest Endosc Clin N Am 2002 Jan;12(1):1-9, v
AD - Department of Medicine, Memorial Sloan-Kettering Cancer Center, and Weill Medical College of Cornell University, New York, New York 10021, USA. firstname.lastname@example.org
The advanced adenoma bridges benign and malignant states and may be the most valid neoplastic surrogate marker for present and future colorectal cancer risk. We define the advanced adenoma as an adenoma with significant villous features (>25%), size of 1.0 cm or more, high-grade dysplasia, or early invasive cancer. Prevention studies should demonstrate a high efficacy in reducing the number of advanced adenomas. We should use the advanced adenoma in the evaluation of new screening technology, nutritional interventions, and chemoprevention agents because the advanced adenoma is a more desirable target for screening efficacy than is the more uncommon but life-threatening cancer stage or the more common but early, less significant small adenoma stage.
UI - 11916155
AU - van Stolk RU
TI - Familial and inherited colorectal cancer: endoscopic screening and surveillance.
SO - Gastrointest Endosc Clin N Am 2002 Jan;12(1):111-33
AD - Department of Medicine, Northwestern University School of Medicine, Chicago, Illinois, USA.
Familial risk of colorectal cancer is very common. The high-risk inherited syndromes are well described and much is known about the genetics and the effectiveness of registration, endoscopic surveillance, and appropriate intervention in these patients. The inherited syndromes, however, are extremely rare. There is a large group of patients in our population who can benefit from risk stratification based on the number of their relatives with colon cancer or adenomas and the age at which those relatives developed neoplasm. The GI endoscopist has a vital role in recommending and providing colonoscopic screening for this large group of patients.
UI - 11916157
AU - Wender RC
TI - Barriers to screening for colorectal cancer.
SO - Gastrointest Endosc Clin N Am 2002 Jan;12(1):145-70
AD - Department of Family Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Rapidly growing interest in colon cancer screening is a crucial first step to identifying and reducing many of the barriers that impede population screening for this common disease. Promoting screening demands health care policy change to increase the percentage of Americans with insurance coverage that includes a colon cancer screening benefit. A systematic approach to screening with invitations that come from a clinician are likely to be the most effective way to prompt more individuals to be screened. Awareness campaigns and patient educational aids, including decision tools, implemented in multiple sites, such as worksites, community centers, health care systems, and physician offices, increase the percent of eligible Americans who understand their personal risk, the need for screening, and the options available to them.
UI - 11916158
AU - Feld AD
TI - Medicolegal implications of colon cancer screening.
SO - Gastrointest Endosc Clin N Am 2002 Jan;12(1):171-9, viii-ix
AD - Group Health Cooperative of Puget Sound, and Department of Medicine, University of Washington, Seattle, USA.
The treatment of colon cancer is a significant source of malpractice liability. Physicians are justifiably concerned about malpractice exposure as personal injury attorneys investigate standard and novel malpractice theories and claims. With the general acceptance of the importance of screening for colon cancer, screening for colon cancer is now defined as the standard of care. This has opened up a previously neglected area of malpractice liability. Physicians need to understand the sources of malpractice risk and risk-management strategies related to these sources to reduce their exposure to liability suits in this area. This article outlines these sources evolving from the tort of negligence, including the duty to provide care, practicing below the standards of care, the cause of the harm, and the actual establishment of harm. The concept of vicarious liability and its relationship to the tort of negligence also are discussed. This presentation is developed within the context of a risk-management approach to assist physicians in developing a preventive approach to malpractice liability.
UI - 11916159
AU - Levin TR; Palitz AM
TI - Flexible sigmoidoscopy: an important screening option for average-risk individuals.
SO - Gastrointest Endosc Clin N Am 2002 Jan;12(1):23-40, vi
AD - Department of Gastroenterology, Kaiser Permanente Medical Center, Walnut Creek, California, USA. Theodore.Levin@kp.org
Colorectal cancer screening techniques should be effective, acceptable to patients, affordable, widely available, and safe. For average-risk adults aged more than 50 years who do not have significant colorectal symptoms, significant family history, or significant predisposing conditions, flexible sigmoidoscopy is an important option for reducing the risk for colorectal cancer, meeting all criteria for an effective and feasible screening modality. This article discusses evidence supporting flexible sigmoidoscopy, practical issues in implementation, and current controversies.
UI - 11916161
AU - Fletcher RH
TI - Rationale for combining different screening strategies.
SO - Gastrointest Endosc Clin N Am 2002 Jan;12(1):53-63
AD - Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts 02215, USA.
It is generally accepted that screening programs should be quite safe, and that the benefits should substantially outweigh the harms. As Cochrane and Holland stated: We believe that there is an ethical difference between everyday medical practice and screening. If a patient asks a medical practitioner for help, the doctor does the best he can. He is not responsible for defects in medical knowledge. If, however, the practitioner initiates screening procedures he is in a very different situation. He should, in our view, have conclusive evidence that screening alters the natural history of disease in a significant proportion of those screened. If this is so, one should recommend the combination over either test alone only if there is sufficient evidence that the combination is more effective and no more dangerous. There is a difference of opinion over whether the evidence, which is certainly not strong, is nevertheless sufficient. This poses a dilemma. Many expert groups prefer that screening for colorectal cancer be done with both FOBT and sigmoidoscopy rather than either alone. Yet, the strength of the evidence for additional effectiveness, and information on the magnitude of that effect if it is present, is substantially less than for the individual tests. This being the case, the author believes that it is premature to advocate the combination over either test alone, especially when the most pressing national priority in colorectal cancer screening is to get a large proportion of the adult population to be screened at all.
UI - 11916162
AU - Rex DK
TI - Rationale for colonoscopy screening and estimated effectiveness in clinical practice.
SO - Gastrointest Endosc Clin N Am 2002 Jan;12(1):65-75
AD - Department of Medicine, Indiana University School of Medicine and Indiana University Hospital, Indianapolis 46202, USA.
Colonoscopy screening has the highest anticipated level of effectiveness of the available colorectal cancer screening techniques. Its long-term cost-effectiveness is also comparable with or superior to other modalities. Evidence for the expected reduction in colorectal cancer incidence and mortality varies with colonoscopy screening from 50% to 90%, for reasons that are not fully understood. Maintaining a high standard of performance is critical with regard to achieving the highest level of effectiveness possible.
UI - 11916163
AU - Nelson DB
TI - Technical assessment of direct colonoscopy screening: procedural success, safety, and feasibility.
SO - Gastrointest Endosc Clin N Am 2002 Jan;12(1):77-84
AD - Minneapolis Veterans Affairs Medical Center, and the Department of Medicine, University of Minnesota, 55417, USA. email@example.com
Colonoscopy, when performed by adequately trained physicians, is a safe and effective procedure for colorectal cancer screening. To realize the benefits of colonoscopic screening of the general population for colorectal cancer, it is imperative that physicians performing this procedure receive appropriate training to maintain the highest standards of patient care.
UI - 11916164
AU - Hawes RH
TI - Does virtual colonoscopy have a major role in population-based screening?
SO - Gastrointest Endosc Clin N Am 2002 Jan;12(1):85-91
AD - Digestive Disease Center, Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, USA. firstname.lastname@example.org
In summary, technical advances in the performance of VC are occurring at a very rapid pace. These technical improvements will undoubtedly improve the polyp detection rate and reduce false-positive and false-negative examinations. The concept of VC is clearly attractive and the general public is enamored with everything that has an association with virtual reality. As other articles in this issue have revealed, there are many techniques in development to help stratify patients at risk for colon cancer. As we begin to focus our health care resources on those at highest risk, the less need there is for inexpensive, broadly based screening techniques. Clearly, those patients at high risk for having polyps are better served by colonoscopy because of its therapeutic potential. That being said, in the view of this author, if a virtual preparation can be achieved and the cost of VC can be kept relatively low, then this technique will become part of our mainstream clinical practice. If an immaculate colon preparation must be performed and if the costs reflect standard abdominal and pelvic CT rather than a special reduced cost for VC, then it is doubtful that there will be any significant impact from this technology
UI - 11916165
AU - Provenzale D
TI - Cost-effectiveness of screening the average-risk population for colorectal cancer.
SO - Gastrointest Endosc Clin N Am 2002 Jan;12(1):93-109
AD - Gastrointestinal Outcomes Research Program, Duke University Medical Center, Durham, North Carolina 27710, USA. email@example.com
This article reviews several of the recent models addressing the cost-effectiveness of colorectal cancer screening in the average-risk individual (Table 1). How can clinicians and policy makers use this information for decision making regarding colorectal cancer screening? The cost-effectiveness ratios reported by themselves do not identify cost-effective practices. They must be placed in a decision context that is expressed in one of two forms. In the first form, an explicit threshold or maximum amount that a policy maker is willing to spend is stated (e.g., $40,000 per LY gained, as has been quoted as an acceptable amount for a prevention program). In the second form of decision context, a list of medical practices and their associated cost-effectiveness ratios, also known as a league table (Table 2) is used as a basis for comparison with the practice under evaluation (e.g., colorectal cancer screening). The practice with the lowest cost-effectiveness ratio is the most cost-effective practice on the list. Practices with lower cost-effectiveness ratios are considered cost-effective compared with those with higher ratios. Table 2 lists incremental cost-effectiveness ratios for common medical practices. The models discussed in this article suggested that colorectal cancer screening using annual FOBT, flexible sigmoidoscopy at 3 or 5 years, the combination of FOBT and flexible sigmoidoscopy, barium enema, colonoscopy, and even virtual colonoscopy had incremental cost-effectiveness ratios ranging from $6300 to $92,900 per LY saved with most of the cost-effectiveness ratio ranging from $10,000 to $40,000 per LY saved. These ratios are similar to the cost of another widely accepted practice, breast cancer screening with annual mammography in women age 50 and older ($22,000 per LY gained). Colorectal cancer screening with any of the modalities discussed is considered less cost-effective than screening for hemochromatosis, which has an incremental cost-effectiveness ratio of $3665 per LY saved. Based on these ratios, however, screening for colorectal cancer is considered cost-effective compared with cervical cancer screening in women age 20 and older with pap smear every 3 years, which has an incremental cost-effectiveness ratio of $250,000 per LY gained. The clinician can use these incremental cost-effectiveness ratios to evaluate the risks and benefits of alternative practices for the individual, and the policy maker with a limited health care budget can use these ratios to set priorities for funding based on the costs and the expected gains in life expectancy for colorectal cancer screening and for alternative health care programs.
UI - 11448589
AU - Akoglu B; Faust D; Milovic V; Stein J
TI - Folate and chemoprevention of colorectal cancer: Is 5-methyl-tetrahydrofolate an active antiproliferative agent in folate-treated colon-cancer cells?
SO - Nutrition 2001 Jul-Aug;17(7-8):652-3
AD - Second Department of Medicine and Gastroenterology, Johann Wolfgang Goethe University, Frankfurt, Germany.
UI - 11935094
AU - Plesch FN; Kubicka S; Manns MP
TI - Prevention of hepatocellular carcinoma in chronic liver disease: molecular markers and clinical implications.
SO - Dig Dis 2001;19(4):338-44
AD - Department of Gastroenterology and Hepatology, Medizinische Hochschule Hannover, Germany.
The development of hepatocellular carcinoma is generally preceded by chronic liver damage leading to cirrhosis. Prevention of chronic liver diseases can decrease the incidence of hepatic cancer impressively. Many recent investigations have also explored the power of secondary and tertiary prevention in established liver cirrhosis. Screening programs for patients at high risk, antiviral treatment of patients with progressed hepatitis, and adjuvant interventions after curative resection are some of the approaches. However, the cost effectiveness and benefits of such procedures and the prognosis is also dependent on the remaining liver function, there is no consensus to date on how patients should be handled. In the future molecular markers and prognostic scores may help better define the group at risk of developing. To give a perspective to these patients, it is necessary to improve the treatment of hepatocellular carcinoma as well as cirrhosis. Copyright 2002 S. Karger AG, Basel
UI - 11977538
AU - Ishikawa H
TI - [Cancer prevention in familial cancer]
SO - Gan To Kagaku Ryoho 2002 Apr;29(4):545-9
AD - Department of Cancer Epidemiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 3-3 Nakamichi, 1-Chome, Higashinari-ku, Osaka 537-8511, Japan.
We established a protocol for and will conduct an interventional randomized controlled trial for the prevention of colorectal cancer. The subjects will be 100 patients with hereditary non-polyposis colorectal cancer. Two regimens were formulated for the prevention of colorectal cancer. Regimen A is dietary guidance and ingestion of aged garlic extract (AGE) capsules, and regimen B is dietary guidance and non-function capsules. The main end point of the trial is number and size of colorectal adenomas after 2 years. Subject recruiting was started in March, 2002. The trial will be completed in September, 2005.
UI - 11982682
AU - Jagadeesan UB
TI - An incentive to start hormone replacement: the effect of postmenopausal hormone replacement therapy on the risk of colorectal cancer.
SO - J Am Geriatr Soc 2002 Apr;50(4):768-70
AD - Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.
UI - 11952580
AU - Kubo S; Nishiguchi S; Hirohashi K; Tanaka H; Shuto T; Kinoshita H
TI - Randomized clinical trial of long-term outcome after resection of hepatitis C virus-related hepatocellular carcinoma by postoperative interferon therapy.
SO - Br J Surg 2002 Apr;89(4):418-22
AD - Second Department of Surgery, Osaka City University Medical School, Osaka, Japan. firstname.lastname@example.org
BACKGROUND: Interferon therapy seems to decrease the incidence of recurrence after resection of hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC). Effects of postoperative interferon therapy on the survival rate after resection of such HCC are still unclear. METHODS: A prospective randomized clinical trial of postoperative interferon therapy was performed. Thirty men were allocated randomly after liver resection to an interferon-alpha group (15 patients) or a control group. Patients in the interferon group received interferon-alpha 6 MIU intramuscularly every day for 2 weeks, then three times a week for 14 weeks and finally twice a week for 88 weeks. RESULTS: The response to interferon was complete in two patients, there was a biochemical response in six patients and no response in seven patients. Interferon administration was not completed in three patients because of adverse events. Liver function did not change or worsened after operation in the control group, and did not change or improved in the interferon group. The cumulative survival rate was higher in the interferon group than in the control group (P = 0.041). CONCLUSION: Postoperative interferon therapy seems to improve the outcome after resection of HCV-related HCC.
UI - 11976170
AU - Flood A; Velie EM; Chaterjee N; Subar AF; Thompson FE; Lacey JV Jr;
TI - Schairer C; Troisi R; Schatzkin A Fruit and vegetable intakes and the risk of colorectal cancer in the Breast Cancer Detection Demonstration Project follow-up cohort.
SO - Am J Clin Nutr 2002 May;75(5):936-43
AD - Division of Cancer Epidemiology and Genetics, the National Cancer Institute, Bethesda, MD 20892, USA. email@example.com
BACKGROUND: Recent findings have cast doubt on the hypothesis that high intakes of fruit and vegetables are associated with a reduced risk of colorectal cancer. OBJECTIVE: In a large prospective cohort of women, we examined the association between fruit and vegetable intakes and colorectal cancer. DESIGN: Between 1987 and 1989, 45490 women with no history of colorectal cancer satisfactorily completed a 62-item Block-National Cancer Institute food-frequency questionnaire. During 386142 person-years of follow-up, 314 women reported incident colorectal cancer, searches of the National Death Index identified an additional 106 colorectal cancers, and a match with state registries identified another 65 colorectal cancers for a total of 485 cases. We used Cox proportional hazards regression analysis to estimate the relative risks (RRs) and 95% CIs in both energy-adjusted and fully adjusted models. RESULTS: In models using the multivariate nutrient-density model of energy adjustment, RRs for increasing quintile of fruit consumption indicated no significant association with colorectal cancer [RR (95% CI)]: 1.00 (reference), 0.94 (0.70, 1.26), 0.85 (0.63, 1.15), 1.07 (0.81, 1.42), and 1.09 (0.82, 1.44). For vegetable consumption, there was also no significant association in the multivariate nutrient-density model with increasing quintiles of consumption: 1.00 (reference), 0.77 (0.58, 1.02), 0.83 (0.63, 1.10), 0.90 (0.69, 1.19), and 0.92 (0.70, 1.22). Additionally, 3 alternative models of energy adjustment showed no significant association between increases in vegetable intake and the risk of colorectal cancer. CONCLUSION: Although the limitations of our study design and data merit consideration, this investigation provides little evidence of an association between fruit and vegetable intakes and colorectal cancer.
UI - 12023992
AU - Kauff ND; Satagopan JM; Robson ME; Scheuer L; Hensley M; Hudis CA; Ellis
TI - NA; Boyd J; Borgen PI; Barakat RR; Norton L; Castiel M; Nafa K; Offit K Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 mutation.
SO - N Engl J Med 2002 May 23;346(21):1609-15
AD - Clinical Genetics Service, Memorial Sloan-Kettering Cancer Center, New York 10021, USA.
BACKGROUND: Risk-reducing salpingo-oophorectomy is often considered by carriers of BRCA mutations who have completed childbearing. However, there are limited data supporting the efficacy of this approach. We prospectively compared the effect of risk-reducing salpingo-oophorectomy with that of surveillance for ovarian cancer on the incidence of subsequent breast cancer and BRCA-related gynecologic cancers in women with BRCA mutations. METHODS: All women with BRCA1 or BRCA2 mutations identified during a six-year period were offered enrollment in a prospective follow-up study. A total of 170 women 35 years of age or older who had not undergone bilateral oophorectomy chose to undergo either surveillance for ovarian cancer or risk-reducing salpingo-oophorectomy. Follow-up involved an annual questionnaire, telephone contact, and reviews of medical records. The time to cancer in the two groups was compared by Kaplan-Meier analysis and a Cox proportional-hazards model. RESULTS: During a mean follow-up of 24.2 months, breast cancer was diagnosed in 3 of the 98 women who chose risk-reducing salpingo-oophorectomy and peritoneal cancer was diagnosed in 1 woman in this group. Among the 72 women who chose surveillance, breast cancer was diagnosed in 8, ovarian cancer in 4, and peritoneal cancer in 1. The time to breast cancer or BRCA-related gynecologic cancer was longer in the salpingo-oophorectomy group, with a hazard ratio for subsequent breast cancer or BRCA-related gynecologic cancer of 0.25 (95 percent confidence interval, 0.08 to 0.74). CONCLUSIONS: Salpingo-oophorectomy in carriers of BRCA mutations can decrease the risk of breast cancer and BRCA-related gynecologic cancer.
UI - 12023993
AU - Rebbeck TR; Lynch HT; Neuhausen SL; Narod SA; Van't Veer L; Garber JE;
TI - Evans G; Isaacs C; Daly MB; Matloff E; Olopade OI; Weber BL; The Prevention and Observation of Surgical End Points Study Group Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations.
SO - N Engl J Med 2002 May 23;346(21):1616-22
AD - Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia 19104-6021, USA. firstname.lastname@example.org
BACKGROUND: Data concerning the efficacy of bilateral prophylactic oophorectomy for reducing the risk of gynecologic cancer in women with BRCA1 or BRCA2 mutations are limited. We investigated whether this procedure reduces the risk of cancers of the coelomic epithelium and breast in women who carry such mutations. METHODS: A total of 551 women with disease-associated germ-line BRCA1 or BRCA2 mutations were identified from registries and studied for the occurrence of ovarian and breast cancer. We determined the incidence of ovarian cancer in 259 women who had undergone bilateral prophylactic oophorectomy and in 292 matched controls who had not undergone the procedure. In a subgroup of 241 women with no history of breast cancer or prophylactic mastectomy, the incidence of breast cancer was determined in 99 women who had undergone bilateral prophylactic oophorectomy and in 142 matched controls. The length of postoperative follow-up for both groups was at least eight years. RESULTS: Six women who underwent prophylactic oophorectomy (2.3 percent) received a diagnosis of stage I ovarian cancer at the time of the procedure; two women (0.8 percent) received a diagnosis of papillary serous peritoneal carcinoma 3.8 and 8.6 years after bilateral prophylactic oophorectomy. Among the controls, 58 women (19.9 percent) received a diagnosis of ovarian cancer, after a mean follow-up of 8.8 years. With the exclusion of the six women whose cancer was diagnosed at surgery, prophylactic oophorectomy significantly reduced the risk of coelomic epithelial cancer (hazard ratio, 0.04; 95 percent confidence interval, 0.01 to 0.16). Of 99 women who underwent bilateral prophylactic oophorectomy and who were studied to determine the risk of breast cancer, breast cancer developed in 21 (21.2 percent), as compared with 60 (42.3 percent) in the control group (hazard ratio, 0.47; 95 percent confidence interval, 0.29 to 0.77). CONCLUSIONS: Bilateral prophylactic oophorectomy reduces the risk of coelomic epithelial cancer and breast cancer in women with BRCA1 or BRCA2 mutations.
UI - 11992750
AU - Rex DK
TI - Screening for colon cancer and evaluation of chemoprevention with coxibs.
SO - J Pain Symptom Manage 2002 Apr;23(4 Suppl):S41-50
AD - Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Although colorectal cancer is one of the most preventable forms of visceral cancer, it remains the second leading cause of cancer death in the United States. Most colorectal cancers are believed to arise from adenomatous polyps, premalignant mucosal masses that account for up to two thirds of colorectal polyps. Early identification and removal of adenomas prevent the development of colorectal cancer. Colonoscopy has emerged as the dominant method for evaluating symptomatic patients with colorectal cancer and for surveillance of patients with previous colon polyps or cancer. In the United States, fecal occult blood testing and flexible sigmoidoscopy are the most commonly used screening methods in average-risk persons, although there is an emerging trend toward the use of colonoscopy. For both screening and surveillance, the type of screening test used and the intervals at which it is performed are based on risk stratification, which also serves as the basis for selecting potential candidates for chemoprevention. Because colonoscopy, like most screening procedures, has several disadvantages, including risk of perforation and bleeding and an inherent "miss rate," alternative methods of prevention are being explored. A variety of agents with potential chemopreventive benefits have been identified, including cyclooxygenase (COX)-2-specific inhibitors (coxibs) even though these agents have not been approved for this use in the United States. COX-2 is overexpressed in colonic adenomas and cancers, and its inhibition has been shown to produce regression of polyps in familial adenomatous polyposis. Nonselective COX inhibition with nonsteroidal anti-inflammatory drugs (NSAIDs) has been consistently associated with reductions in the risk of mortality and the incidence of colorectal adenomas and cancers in case-control studies. Thus, selective COX-2 inhibition is a potential method of risk reduction in high-risk screening and surveillance groups, and large-scale trials of coxibs for the prevention of recurrence of adenomas after polypectomy are currently underway.
UI - 12019405
AU - Kunisaki C; Shimada H; Nomura M; Akiyama H; Takahashi M; Matsuda G
TI - Lack of efficacy of prophylactic continuous hyperthermic peritoneal perfusion on subsequent peritoneal recurrence and survival in patients with advanced gastric cancer.
SO - Surgery 2002 May;131(5):521-8
AD - Second Department of Surgery, Yokohama City University, School of Medicine, Yokohama, Japan.
BACKGROUND: Peritoneal recurrence is a major cause of death in advanced gastric cancer. Although many kinds of chemotherapy intended to prevent peritoneal recurrence of gastric cancer have been evaluated, few have been successful. Few studies have assessed the clinical significance of continuous hyperthermic peritoneal perfusion in peritoneal recurrence. METHODS: From 1992 to 1999, a total of 124 patients with advanced gastric cancer with tumors invading deeper than the serosa but with no peritoneal metastasis underwent potentially curative gastrectomy and were enrolled in this study. Prophylactic continuous hyperthermic peritoneal perfusion (P-CHPP) was performed in 45 patients younger than 65 years old and without comorbidity who gave informed consent. Seventy-nine patients who did not meet the inclusion criteria represented the control group. After reconstruction of the alimentary tract, P-CHPP was carried out for 40 minutes with 150 mg cisplatin, 15 mg mitomycin C, and 150 mg etoposide in 5 to 6 L physiologic saline maintained at 42 degrees C to 43 degrees C. The surgical results, recurrent pattern, and postoperative morbidity were assessed by univariate and multivariate analysis. RESULTS: When compared with patients not undergoing P-CHPP, patients treated by P-CHPP had higher incidences of respiratory failure (73% vs 19%; P <.0001) and renal failure (7% vs 0%; P <.03). Neither 5-year survival (49% vs 56%) nor the patterns of recurrence (peritoneal, hematogenous, and lymphatic) were affected by P-CHPP. CONCLUSIONS: P-CHPP by our methods had no efficacy as prophylactic treatment for peritoneal recurrence induced by gastric cancer. New therapeutic strategies, such as chemosensitivity assessment, are necessary to obtain good therapeutic results with CHPP.
UI - 11857050
AU - Negri E; La Vecchia C; Franceschi S
TI - Relations between vegetable, fruit and micronutrient intake. Implications for odds ratios in a case-control study.
SO - Eur J Clin Nutr 2002 Feb;56(2):166-70
AD - Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy. email@example.com
OBJECTIVE: To investigate whether the protection observed for some micronutrients, such as beta-carotene, in several observational studies may simply reflect vegetable and fruit intake. DESIGN: A case-control study conducted in Italy. SUBJECTS: The subjects were 1225 colon cancer patients, 728 rectal cancer patients and 4154 hospital controls. RESULTS: For the 16 micronutrients considered, the more closely a micronutrient was correlated with total vegetable and fruit intake, the more it appeared protective against colorectal cancer. CONCLUSION: When studying the effect of a nutrient on disease risk in an observational setting, its relation to other nutrients and foods must be taken into account.
UI - 12019505
AU - Immanuel A; Lamb PJ; Wayman J; Preston S; Griffin SM
TI - Prevention of the neoplastic progression of Barrett's oesophagus by argon beam plasma ablation (Br J Surg 2001;88:1357-62).
SO - Br J Surg 2002 May;89(5):626; discussion 626
The above citations and abstracts reflect those newly added to CANCERLIT for the month and topic listed in the title. The citations have been retrieved from CANCERLIT using a predefined search strategy of indexed subject terms. Although the search strategy has been refined as best as possible, citations may appear that are not directly related to the topic, and occasionally relevant references may be omitted.