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Abramson Cancer CenterNCI CANCERLIT® Search: Screening and Prevention of Digestive Cancers - January 2002
National Cancer Institute®
Last Modified: January 1, 2002
Table of Contents
1
UI - 10749896
AU - Atkin WS; Whynes DK
TI -
Improving the cost-effectiveness of colorectal cancer screening.
SO - J Natl Cancer Inst 2000 Apr 5;92(7):513-4
2
UI - 11035892
AU - Frazier AL; Colditz GA; Fuchs CS; Kuntz KM
TI -
Cost-effectiveness of screening for colorectal cancer in the general
population.
SO - JAMA 2000 Oct 18;284(15):1954-61
AD - Channing Laboratory, 181 Longwood Ave, Boston, MA 02115, USA.
lindsay.frazier@channing.harvard.edu
CONTEXT: A recent expert panel recommended that persons at average risk
of colorectal cancer (CRC) begin screening for CRC at age 50 years using
1 of several strategies. However, many aspects of different CRC
screening strategies remain uncertain. OBJECTIVE: To assess the
consequences, costs, and cost-effectiveness of CRC screening in
average-risk individuals. DESIGN: Cost-effectiveness analysis from a
societal perspective using a Markov model. SUBJECTS: Hypothetical
subjects representative of the 50-year-old US population at average risk
for CRC. SETTING: Simulated clinical practice in the United States. MAIN
OUTCOME MEASURES: Discounted lifetime costs, life expectancy, and
incremental cost-effectiveness (CE) ratio, compared used 22 different
CRC screening strategies, including those recommended by the expert
panel. RESULTS: In 1 base-case analysis, compliance was assumed to be
60% with the initial screen and 80% with follow-up or surveillance
colonoscopy. The most effective strategy for white men was annual
rehydrated fecal occult blood testing (FOBT) plus sigmoidoscopy
(followed by colonoscopy if either a low- or high-risk polyp was found)
every 5 years from age 50 to 85 years, which resulted in a 60% reduction
in cancer incidence and an 80% reduction in CRC mortality compared with
no screening, and an incremental CE ratio of $92,900 per year of life
gained compared with annual unrehydrated FOBT plus sigmoidoscopy every 5
years. In a base-case analysis in which compliance with screening and
follow-up is assumed to be 100%, screening more often than every 10
years was prohibitively expensive; annual rehydrated FOBT plus
sigmoidoscopy every 5 years had an incremental CE ratio of $489,900 per
life-year gained compared with the same strategy every 10 years. Other
strategies recommended by the expert panel were either less effective or
cost more per year of life gained than the alternatives. Colonoscopy
every 10 years was less effective than the combination of annual FOBT
plus sigmoidoscopy every 5 years. However, a single colonoscopy at age
55 years achieves nearly half of the reduction in CRC mortality
obtainable with colonoscopy every 10 years. Because of increased life
expectancy among white women and increased cancer mortality among
blacks, CRC screening was even more cost-effective in these groups than
in white men. CONCLUSIONS: Screening for CRC, even in the setting of
imperfect compliance, significantly reduces CRC mortality at costs
comparable to other cancer screening procedures. However, compliance
rates significantly affect the incremental CE ratios. In this model of
CRC, 60% compliance with an every 5-year schedule of screening was
roughly equivalent to 100% compliance with an every 10-year schedule.
Mathematical modeling used to inform clinical guidelines needs to take
into account expected compliance rates. JAMA. 2000;284:1954-1961.
3
UI - 11138826
AU - Garcia-Rodriguez LA; Huerta-Alvarez C
TI -
Reduced risk of colorectal cancer among long-term users of aspirin and
nonaspirin nonsteroidal antiinflammatory drugs.
SO - Epidemiology 2001 Jan;12(1):88-93
AD - Centro Espanol de Investigacion Farmacoepidemiologica, Madrid, Spain.
Use of nonsteroidal antiinflammatory drugs (NSAIDs) has been associated
with a reduced risk of colorectal cancer, but limited information is
available on the effect of individual nonaspirin NSAIDs. In addition,
the dose-response relation of aspirin in reducing the risk of colorectal
cancer has not been described. We carried out a population-based cohort
study with secondary case-control analysis to determine the association
between the risk of colorectal cancer and use of aspirin and individual
NSAIDs, including the role of dose and duration. The General Practice
Research Database in the U.K. was the source population. We traced
943,903 persons 40-79 years of age and free of cancer and colorectal
incident cases of colorectal cancer were ascertained. The incidence rate
of colorectal cancer per 10,000 person-years was 7.3. The risk of
colorectal cancer was reduced in users of nonaspirin NSAIDs and became
evident after 6 months of continuous treatment. The adjusted relative
risk was 0.5 (95% confidence interval = 0.4-0.7). The reduction in risk
disappeared completely 1 year after stopping NSAID treatment. The risk
of developing colorectal cancer was reduced in long-term users of
aspirin at doses of 300 mg daily (relative risk = 0.6; 95% confidence
interval = 0.4-0.9). Daily doses of 75 and 150 mg aspirin were not
associated with a reduced risk of colorectal cancer. Our data support
the existence of an important protective effect of nonaspirin NSAID
continuous intake against colorectal cancer and point to a similar
reduction in risk for aspirin at doses of at least 300 mg daily.
One-year treatment with NSAIDs would prevent one case of colorectal
cancer in a population of 1,000 persons 70-79 years of age.
4
UI - 11078753
AU - Newman L
TI -
Cost-effectiveness studies fan colonoscopy debate.
SO - J Natl Cancer Inst 2000 Nov 15;92(22):1796-8
5
UI - 11242413
AU - Glick SN
TI -
Cost-effectiveness of colorectal cancer screening.
SO - JAMA 2001 Jan 24-31;285(4):407-8
6
UI - 11242411
AU - Budenholzer B; Welch HG
TI -
Cost-effectiveness of colorectal cancer screening.
SO - JAMA 2001 Jan 24-31;285(4):407; discussion 408
7
UI - 11242412
AU - Donohoe M
TI -
Cost-effectiveness of colorectal cancer screening.
SO - JAMA 2001 Jan 24-31;285(4):407; discussion 408
8
UI - 11259474
AU - Muney AM
TI -
More about: improving the cost-effectiveness of colorectal cancer
screening.
SO - J Natl Cancer Inst 2001 Mar 21;93(6):480
9
UI - 11259475
AU - Spratt JS
TI -
Re: Cost-effectiveness studies fan colonoscopy debate.
SO - J Natl Cancer Inst 2001 Mar 21;93(6):480
10
UI - 11328256
AU - Arguedas MR; Heudebert GR; Wilcox CM
TI -
Surveillance colonoscopy or chemoprevention with COX-2 inhibitors in
average-risk post-polypectomy patients: a decision analysis.
SO - Aliment Pharmacol Ther 2001 May;15(5):631-8
AD - Department of Medicine, Division of Gastroenterology & Hepatology,
University of Alabama at Birmingham, Birmingham, AL 35294-0007, USA.
OBJECTIVES: Clinical trials are currently underway evaluating the
efficacy of COX-2 inhibitors in decreasing the incidence of adenomas and
colorectal carcinoma in 'average' risk individuals. AIM: To use decision
analysis to compare the cost-effectiveness of celecoxib to surveillance
colonoscopy in 'average' risk patients who had undergone prior adenoma
resection. METHODS: A model of the natural history of adenomas after
endoscopic polypectomy was constructed using probabilities from the
literature. Cost estimates were obtained from available Medicare
reimbursement rates and supplemented by the literature. Three strategies
were evaluated: (i) no surveillance; (ii) colonoscopic surveillance; and
(iii) celecoxib chemoprevention. We compared total costs and performed
cost-effectiveness analysis between these strategies. The outcome
measures were years of life saved and 'high-grade' adenoma prevented.
Sensitivity analyses were performed on selected variables. RESULTS: Our
base-case analysis assumed a 50% risk reduction in the incidence of
adenomas among patients using celecoxib. No surveillance was associated
with a cost of $1014 per patient, and colonoscopic surveillance with a
cost of $1572 per patient, whereas celecoxib use was associated with a
total cost of $11,503. Ten years after the index colonoscopy, 15% of
patients in the no surveillance strategy developed 'high-grade' lesions
compared to 13% of patients in the colonoscopic surveillance group and
6% in the celecoxib group. There was a small gain in years of life saved
(0.006) favouring celecoxib over colonoscopic surveillance. The
incremental cost-effectiveness ratio of celecoxib vs. colonoscopy was
$141 871 per 'high-grade' adenoma prevented and $1,715,199 per year of
life saved. The most important variables in determining the
cost-effectiveness of celecoxib were its cost and its efficacy.
CONCLUSION: Chemoprevention with COX-2 inhibitors in 'average-risk'
postpolypectomy patients is a more expensive strategy compared to
colonoscopic surveillance.
11
UI - 11416786
AU - Chambers S; Evans L; Krishnan A
TI -
Colorectal cancer among users of aspirin and non-steroidal
antiinflammatory drugs.
SO - Epidemiology 2001 Jul;12(4):471-2
12
UI - 11494547
AU - Ichida T; Ohkoshi S; Takimoto M; Ishikawa T
TI -
[Interferon therapy to chronic hepatitis type C for the prevention of
hepatocarcinogenesis]
SO - Nippon Rinsho 2001 Jul;59(7):1331-7
AD - Third Department of Internal Medicine, Niigata University School of
Medicine.
Interferon(IFN) therapy for chronic hepatitis(CH) related by hepatitis C
virus is useful for the prevention of the appearance of hepatocellular
carcinoma(HCC) by both prospective and retrospective study. IFN could be
reduced an activity of necro-inflammatory reaction leading toward the
reduction of fibrogenesis. Therefore, IFN treated group had a low
potential carcinogenesis of the liver indicating the prevention of HCC
from CH type C, even if virological complete remmision(CR) could not be
obtained after IFN treatment. Biochemical response(BR) group as well as
CR group could be inhibited hepatocarcinogenesis compare with non-IFN
treated group. Recently, IFN applied for liver cirrhosis as same concept
for the prevention of HCC.
13
UI - 11564951
AU - Wallace HM; Caslake R
TI -
Polyamines and colon cancer.
SO - Eur J Gastroenterol Hepatol 2001 Sep;13(9):1033-9
AD - Department of Medicine and Therapeutics, University of Aberdeen,
Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.
h.m.wallace@abdn.ac.uk
Colorectal cancer is a major health problem in the western world and is
associated with significant morbidity and mortality. Diet makes a
significant contribution to the disease, with high fat, low fibre diets
correlating positively with a high incidence of colorectal cancer.
Intracellular polyamine concentrations and ornithine decarboxylase
activity are both increased in colorectal cancer tissue and in
premalignant polyps. Measurement of the polyamine content of serum and
urine of individuals has been proposed as a diagnostic marker of
malignancy but a number of false positives make this idea untenable.
There may, however, still be a role for the measurement of urinary
polyamine content as a means of monitoring the efficacy of therapy.
Inhibition of polyamine metabolism by polyamine analogues or by
non-steroidal anti-inflammatory drugs may be useful in the chemotherapy
and/or chemoprevention of colorectal cancer. Preliminary results suggest
that a low polyamine diet might be helpful as part of a health care plan
for cancer patients.
14
UI - 11577008
AU - Rosignoli P; Fabiani R; De Bartolomeo A; Spinozzi F; Agea E; Pelli MA;
TI -
Morozzi G
Protective activity of butyrate on hydrogen peroxide-induced DNA damage
in isolated human colonocytes and HT29 tumour cells.
SO - Carcinogenesis 2001 Oct;22(10):1675-80
AD - Dipartimento di Scienze Biochimiche e Biotecnologie Molecolari, Sezione
di Scienze Igienistiche e Ambientali, Universita di Perugia, Via del
Giochetto, 06126 Perugia, Italy.
Epidemiological studies support the involvement of short-chain fatty
acids (SCFA) in colon physiology and the protective role of butyrate on
colon carcinogenesis. Among the possible mechanisms by which butyrate
may exert its anti-carcinogenicity an antioxidant activity has been
recently suggested. We investigated the effects of butyrate and mixtures
of SCFA (butyrate, propionate and acetate) on DNA damage induced by
H(2)O(2) in isolated human colonocytes and in two human colon tumour
cell lines (HT29 and HT29 19A). Human colonocytes were isolated from
endoscopically obtained samples and the DNA damage was assessed by the
comet assay. H(2)O(2) induced DNA damage in normal colonocytes in a
dose-dependent manner which was statistically significant at
concentrations over 10 microM. At 15 microM H(2)O(2) DNA damage in HT29
and HT29 19A cells was significantly lower than that observed in normal
colonocytes (P < 0.01). Pre-incubation of the cells with physiological
concentrations of butyrate (6.25 and 12.5 mM) reduced H(2)O(2) (15
microM) induced damage by 33 and 51% in human colonocytes, 45 and 75% in
HT29 and 30 and 80% in HT29 19A, respectively. Treatment of cells with a
mixture of 25 mM acetate + 10.4 mM propionate + 6.25 mM butyrate did not
induce DNA damage, while a mixture of 50 mM acetate + 20.8 mM propionate
+ 12.5 mM butyrate was weakly genotoxic only towards normal colonocytes.
However, both mixtures were able to reduce the H(2)O(2)-induced DNA
damage by about 50% in all cell types. The reported protective effect of
butyrate might be important in pathogenetic mechanisms mediated by
reactive oxygen species, and aids understanding of the apparent
protection toward colorectal cancer exerted by dietary fibres, which
enhance the butyrate bioavailability in the colonic mucosa.
15
UI - 11577013
AU - Glaab WE; Hill RB; Skopek TR
TI -
Suppression of spontaneous and hydrogen peroxide-induced mutagenesis by
the antioxidant ascorbate in mismatch repair-deficient human colon
cancer cells.
SO - Carcinogenesis 2001 Oct;22(10):1709-13
AD - Department of Genetic and Cellular Toxicology, Merck Research
Laboratories, WP45-320, West Point, PA 19486, USA.
warren_glaab@merck.com
Genomic instability associated with deficiencies in mismatch repair
(MMR) plays a critical role in tumorigenesis. Here we have investigated
the contribution of oxidative damage to this instability in
MMR-defective cells. Treatment with H(2)O(2) produced less cytotoxicity
in MMR-deficient cells than in those proficient in MMR, supporting a
role for MMR in the recognition and/or processing of oxidative damage.
Additionally, growth of MMR-defective cells in the presence of the
antioxidant ascorbate (500 microM) reduced the spontaneous mutation rate
at the hypoxanthine-guanine phosphoribosyl transferase (HPRT) locus by
up to 50% and reduced microsatellite instability by 30%. Induction of
HPRT mutants by exogenously added H(2)O(2) was also significantly
suppressed by ascorbate. Collectively, these results suggest that (i)
oxidative damage contributes significantly to the spontaneous mutator
phenotype in MMR-defective cells, (ii) this damage may select for
MMR-deficient cells due to their increased resistance to cell killing
and (iii) dietary antioxidants may help to suppress the mutator
phenotype and resulting carcinogenesis in individuals with compromised
MMR.
16
UI - 11603094
AU - Bigard MA
TI -
[Helicobacter pylori eradication. Therapeutic evolution, value of
complementary studies]
SO - Presse Med 2001 Sep 22;30(26):1305-12
AD - Service d'Hepatogastroenterologie, CHU de Nancy-Brabois, F54500
Vandoeuvre-les-Nancy. bigard.LettreHGE@wanadoo.fr
INDICATIONS: Eradication of Helicobacter pylori is needed for patients
with a gastroduodenal ulcer associated with H. pylori gastritis.
Eradication modifies the natural history of the disease and greatly
reduces the risk of recurrence. Eradication is also indicated for
patients with MALT lymphoma with a low degree of malignancy. Systematic
eradication of H. pylori would not be necessary for patients with
dyspepsia associated with H. pylori gastritis since a beneficial effect
is achieved in only 5% of the treated patients. Systematic eradication
in order to reduce the incidence of gastric adenocarcinoma is not
recommended. DIAGNOSIS: Direct tests (urease, pathology) provide the
diagnosis of H. pylori gastritis. Indirect tests (13C-labeled urea
respiratory test) can be most useful to determine the efficacy of
eradication treatments. THERAPY: A tri-therapy regimen given for 7 days
combining a double-dosed proton pump inhibitor, amoxicillin (2 g/d), and
clarithromycin (0.5 g b.i.d) is used to eradicate H. pylori. With this
regimen, the mean rate of eradication achieved in France is 67%. The
principal causes of failure are poor compliance and bacterial resistance
to clarithromycin. Metronidazole (1 g/d) can be used for patients
allergic to penicillin. A second cycle can be prescribed in case of
failure, substituting metronidazole for clarithromycin. FOLLOW-UP:
Eradication treatment is prescribed for patients with an ulcer after
confirmation of infection by one or two direct tests. Treatment efficacy
can be assessed by the respiratory test for patients with a duodenal
ulcer but is not systematically needed. Biopsy of a gastric ulcer can
also provide an assessment of treatment efficacy. For patients with a
non-complicated duodenal ulcer, antisecretion treatment is not required
in addition to eradication treatment.
17
UI - 11665692
AU - Fishman V; Friedel D
TI -
Inverse association between intake of cereal fiber and risk of gastric
cardia cancer.
SO - Gastroenterology 2001 Oct;121(4):1024-5
18
UI - 11597389
AU - Levi F; Pasche C; Lucchini F; La Vecchia C
TI -
Dietary fibre and the risk of colorectal cancer.
SO - Eur J Cancer 2001 Nov;37(16):2091-6
AD - Unite d'epidemiologie du cancer, Institut universitaire de medecine
sociale et preventive, Bugnon 17, 1005, Lausanne, Switzerland.
fabio.levi@inst.hospvd.ch
The relationship between various types of fibre and colorectal cancer
risk was investigated using data from a case-control study conducted in
study included 286 cases of incident, histologically-confirmed
colorectal cancers (149 colon and 137 rectal cancers) admitted to the
University Hospital of Lausanne, and 550 controls whose admission
diagnosis was of acute, non-neoplastic diseases. Dietary habits were
investigated using a validated food frequency questionnaire (FFQ). Odds
ratios (ORs) were computed after allowance for age, sex, education,
physical activity and energy intake. Fibre was analysed both as a
continuous variable and in tertiles. There was a significant inverse
relationship of total fibre intake (determined by the Englyst method as
non-starch polysaccharides) and of its components with the risk of
colorectal cancer. ORs for a difference in intake of one standard
deviation from the mean fibre intake of the control distribution was
0.57 for total fibres, 0.55 for soluble non-cellulose polysaccharides
(NCPs), 0.58 for total insoluble fibres, 0.57 for cellulose, 0.62 for
insoluble NCP and 0.62 for lignin. When fibre was classified according
to its source, the OR was 0.60 for vegetables, 0.78 for fruit and 0.74
for grain fibre. The ORs were similar for colon and rectal cancer and
consistent across the strata of the major covariates and of several
types of fibres.
19
UI - 11677471
AU - Knopf KB; Warren JL; Feuer EJ; Brown ML
TI -
Bowel surveillance patterns after a diagnosis of colorectal cancer in
Medicare beneficiaries.
SO - Gastrointest Endosc 2001 Nov;54(5):563-71
AD - Health Services and Economics Branch, Applied Research Program, Division
of Cancer Control and Population Sciences, National Cancer Institute,
National Institutes of Health, Bethesda, Maryland 20892-7344, USA.
BACKGROUND: Postoperative colon surveillance has been recommended for
patients with a diagnosis of local/regional colorectal cancer. The
extent to which these recommendations are followed in practice is poorly
characterized. Patterns of surveillance after surgery for colorectal
cancer were determined by using a large population-based database.
METHODS: This is a retrospective cohort study with cancer registry data
linked to Medicare claims. Identified were 52,283 patients treated for
local/regional colorectal cancer between 1986 and 1996, and surveillance
patterns through 1998 were determined. Surveillance patterns were
analyzed by using survival analysis and by computing the proportion of
surviving patients who underwent procedures during 4 time periods after
treatment: 2 to 14 months, 15 to 50 months, 51 to 86 months and more
than 87 months. RESULTS: Median times to first through fifth
surveillance events were 20, 14, 15, 15, and 15 months, respectively.
For 17% of the cohort there was no surveillance event. Younger patients
were more likely to undergo surveillance. Surveillance patterns were not
affected by stage. The proportions of the cohort that underwent no
surveillance during the 4 respective time periods were 54%, 52%, 60%,
and 69%. The percentages of patients who underwent surveillance annually
or more frequently in the latter 3 time periods, respectively, were 19%,
10%, and 5%, or 11% overall, treating the data for the 3 events as a
whole. Over the period from 1986 to 1998, the proportion of patients who
had no surveillance procedures gradually decreased, whereas the
proportion of those who underwent procedures annually or more frequently
remained relatively constant. CONCLUSIONS: During the period from 1986
to 1998 there was low utilization of postdiagnosis colon surveillance in
a substantial proportion of elderly patients with a diagnosis of
local/regional colorectal cancer. Over time there was a trend toward
increasing receipt of any surveillance procedures. The percentages of
patients undergoing surveillance annually or more frequently did not
change between earlier and later periods.
20
UI - 11677497
AU - Rex DK; Lieberman DA
TI -
Feasibility of colonoscopy screening: discussion of issues and
recommendations regarding implementation.
SO - Gastrointest Endosc 2001 Nov;54(5):662-7
21
UI - 11685737
AU - Monto A; Wright TL
TI -
The epidemiology and prevention of hepatocellular carcinoma.
SO - Semin Oncol 2001 Oct;28(5):441-9
AD - GI Research, San Francisco Veterans Affairs Medical Center, San
Francisco, CA 94121, USA.
Hepatocellular carcinoma (HCC) is a common cancer. Its incidence is
higher in countries where hepatitis B is endemic. HCC is substantially a
complication of liver cirrhosis. Hepatitis B virus (HBV) and hepatitis C
virus (HCV) are the predominant causes of cirrhosis, and as such, HCC.
The link between HCC and alcoholic cirrhosis is less strong. Other less
common forms of chronic liver disease can also lead to HCC. HBV is the
HCC-determining disease worldwide. In endemic regions, it tends to be
acquired early in life. The largest strides in prevention of HCC have
been made with the HBV vaccine. HCV has a lower global prevalence than
HBV, but HCV causes the most HCC in economically developed regions. In
these areas, where the incidence of HCC is low, HCV now accounts for
more than 50% of HCCs. There is no vaccine for HCV, so prevention of
HCV-associated HCC will focus on prevention of initial infection and
elimination of infection through antiviral therapies. HBV-HCV
coinfection, and the combination of either with alcohol abuse or
aflatoxin exposure seems to raise the risk of HCC development further.
Liver transplantation and other adjuvant therapies may offer better
options for secondary prevention of HCC than resection alone. Copyright
2001 by W.B. Saunders Company.
22
UI - 11685738
AU - Sherman M
TI -
Surveillance for hepatocellular carcinoma.
SO - Semin Oncol 2001 Oct;28(5):450-9
AD - University of Toronto and University Health Network, Toronto, Ontario,
Canada.
Surveillance for hepatocellular carcinoma (HCC) in patients with
recognized risk factors remains controversial. The populations for whom
surveillance may be appropriate include all patients with established
cirrhosis, and hepatitis B (HBV) carriers, even in the absence of
cirrhosis. However, even these risk groups can be stratified into
patients with higher or lower risk. The most appropriate surveillance
test is periodic ultrasound examination, although the optimum screening
interval has not been defined. Alphafetoprotein (AFP) is a poor
surveillance test, lacking in sensitivity and specificity. There are no
randomized controlled trials confirming that surveillance for HCC
reduces disease-specific mortality. Modeling studies, however, have
suggested that screening is cost-effective and reduces group mortality
by a small amount. The criteria by which cancer surveillance programs in
general can be judged have been described. Surveillance for HCC meets
some of these criteria, but not all. In particular, more effective
treatments have to be developed to improve the outcome of surveillance.
Although there is no firm evidence to support the practice of
surveillance for HCC, this has become common practice, forever
preventing the definitive study from being performed. Nonetheless,
surveillance is recommended in order to identify patients with small
HCCs, who can be entered into trials of therapy of these tumors.
Copyright 2001 by W.B. Saunders Company.
23
UI - 11679038
AU - Ellerbeck EF; Engelman KK; Gladden J; Mosier MC; Raju GS; Ahluwalia JS
TI -
Direct observation of counseling on colorectal cancer in rural primary
care practices.
SO - J Gen Intern Med 2001 Oct;16(10):697-700
AD - Department of Preventive Medicine, University of Kansas School of
Medicine, Kansas City, KS, USA. eellerbe@kumc.edu
To better understand colorectal cancer (CRC) screening practices in
primary care, medical students directly observed physician-patient
encounters in 38 physician offices. CRC was discussed with 14% of
patients >or=50 years of age; 87% of discussions were initiated by the
physician. The rate of discussions varied among the practices from 0% to
41% of office visits. Discussions were more common for new patient
visits, with younger patients, and in the 24% of offices that utilized
flow sheets. The frequency of CRC discussions in physician offices
varies widely. More widespread implementation of simple office systems,
such as flow sheets, is needed to improve CRC screening rates.
24
UI - 11695099
AU - Nagengast FM; Kaandorp CJ; CBO-werkgroep
TI -
[Revised CBO guideline 'Follow-up after polypectomy']
SO - Ned Tijdschr Geneeskd 2001 Oct 20;145(42):2022-5
AD - Universitair Medisch Centrum St Radboud, afd. Gastro-enterologie,
Nijmegen.
The purpose of follow-up after polypectomy of one or more colorectal
adenomatous polyps, is the timely removal of new adenomas and thereby
the prevention of colorectal cancer. The first check-up following
index-polypectomy can be carried out after six years if one or two
adenomas were encountered during the index polypectomy, and after three
years if three or more adenomas were encountered. The same check-up
interval of six and three years respectively applies if none to two or
more than three adenomas are encountered when a check-up colonoscopy is
carried out. A check-up one year after the polypectomy and check-ups
more frequently than respectively six and three years after polypectomy
are not considered to be useful, while each check-up is accompanied by
risks and costs. Check-ups can be suspended for patients in whom
cumulatively one adenomatous polyp has been removed: from the age of 65
years, for patients in whom cumulatively two adenomas have been removed:
from the age of 75 years, and for patients in whom cumulatively three
adenomas have been removed check-ups must be continued for as long as
the patient's vitality justifies this. Also if no adenomas are
encountered during three consecutive check-ups, a suspension of the
check-ups can be considered. Separate guidelines apply to patients with
genetically determined adenomas.
25
UI - 11697447
AU - Prinz-Langenohl R; Fohr I; Pietrzik K
TI -
Beneficial role for folate in the prevention of colorectal and breast
cancer.
SO - Eur J Nutr 2001 Jun;40(3):98-105
AD - Institute of Nutritional Science, Dept of Pathophysiology of Human
Nutrition, University of Bonn, Germany. r.prinz@uni-bonn.de
Folate is involved in the synthesis of nucleotides and amino acid
metabolism such as methylation of homocysteine to methionine. Methionine
is activated by adenosine triphosphate (ATP) to produce
S-adenosylmethionine (SAM), the primary intracellular methyl donor.
Thus, folate is essential for the synthesis, methylation, and repair of
DNA. With regard to its biochemical function it has been hypothesized
that a diminished folate status may contribute to carcinogenesis by
alteration of gene expression and increased DNA damage. Animal and human
studies support this hypothesis, particularly with respect to colorectal
cancer. Epidemiological evidence for the association between folate
status and cancer was first observed among ulcerative colitis patients.
Several case-control studies demonstrated reduction in colorectal cancer
risk with better folate status. Two large, prospective cohort studies
support the concept that high folate intake is protective against colon
cancer. In contrast to colorectal cancer, the potential association of
folate status and risk has been less investigated in breast cancer.
Recently, convincing epidemiological data establishing a positive effect
of folate status on breast cancer risk were published. This review
summarizes the epidemiological evidence for the association between
folate status and colorectal and breast cancer risk. In addition, a
short overview is given on the discussed mechanism(s) by which folate
might be involved in carcinogenesis.
26
UI - 11693339
AU - Zack DL; DiBaise JK; Quigley EM; Roy HK
TI -
Colorectal cancer screening compliance by medicine residents: perceived
and actual.
SO - Am J Gastroenterol 2001 Oct;96(10):3004-8
AD - University of Nebraska Medical Center, Omaha 68198-2000, USA.
OBJECTIVE: Implementation of colorectal cancer (CRC) screening with
widely available techniques can result in a significant reduction in
CRC-related mortality. Clinical practice paradigms are often ingrained
in physicians during residency. We, therefore, investigated both
compliance and perceived obstacles to CRC screening in the practices of
physicians-in-training. METHODS: We conducted a retrospective analysis
of medical records of patients who were receiving their primary care in
the internal medicine resident clinics at the University of Nebraska
Medical Center and were at average risk for CRC. In addition to
demographics, data on the use of screening mammography, Pap smear,
cholesterol, fecal occult blood testing (FOBT), and flexible
sigmoidoscopy (FS) were collected. A questionnaire was also distributed
to all internal medicine residents to assess their CRC screening
knowledge and perceived screening compliance. RESULTS: One hundred eight
patient charts were reviewed. The percentage of patients appropriately
screened for each test was as follows: mammography 66%, Pap smear 65%,
cholesterol 53%, FOBT 13%, and FS 16%. Residents dramatically
overestimated their perceived FS and FOBT screening rates, 78% and 88%,
respectively. Most residents identified barriers to FS screening.
Although rudimentary CRC screening knowledge appeared adequate, a number
of knowledge-based deficiencies were identified. CONCLUSIONS: Internal
medicine residents at our institution demonstrate poor CRC screening
compliance especially when compared with other health care maintenance
interventions. This cannot be entirely accounted for by inadequate
knowledge; discrepancy between the perceived and actual implementation
of CRC screening may be important. Efforts to improve screening
compliance should include a focus on physicians-in-training.
27
UI - 11693340
AU - Edwards JT; Wood CJ; Mendelson RM; Forbes GM
TI -
Extracolonic findings at virtual colonoscopy: implications for screening
programs.
SO - Am J Gastroenterol 2001 Oct;96(10):3009-12
AD - Department of Gastroenterology, Royal Perth Hospital, WA, Australia.
OBJECTIVE: Virtual colonoscopy (VC) is an evolving technology proposed
as a possible screening tool for colorectal cancer. In contrast to
conventional colonoscopy, VC may detect extracolonic abdominal
pathology. This may lead to unnecessary investigation of benign lesions,
or may benefit the patient by identifying serious pathology at an early
stage. The aim of this study was to assess the prevalence and
characteristics of extracolonic pathology found in patients undergoing
VC. METHODS: A total of 100 patients aged > or = 55 yr, referred for
colonoscopy for bowel symptoms or family history of bowel cancer,
underwent VC. Axial views of the abdomen were reviewed prospectively by
a single radiologist for extracolonic pathology. Patients with
extracolonic abnormalities were referred to their local doctor or to a
specialist clinic when appropriate. Case records were reviewed and
treating doctors contacted to document subsequent investigations and
procedures generated. RESULTS: Fifteen patients (15%) had extracolonic
abnormalities detected. In four patients, the pathology had been
diagnosed previously (umbilical hernia, gallbladder and renal calculi,
3.5-cm aortic aneurysm, ovarian cyst). Eleven patients had new
abnormalities detected: ovarian cysts (three), liver cysts (two),
uterine fibroids (two), gallstones (one), splenic calcifications (one),
aortic aneurysm (one), and renal tumor (one). Two patients with ovarian
cysts underwent surgery, and histology showed benign cysts. CONCLUSIONS:
Extracolonic abnormalities are common at VC. Most are benign, but may
lead to investigative and procedural costs. These data should be
carefully evaluated in feasibility and cost-effectiveness studies on
colorectal cancer screening using VC.
28
UI - 11700264
AU - Rennert G; Rennert HS; Miron E; Peterburg Y
TI -
Population colorectal cancer screening with fecal occult blood test.
SO - Cancer Epidemiol Biomarkers Prev 2001 Nov;10(11):1165-8
AD - Department of Community Medicine, Carmel Medical Center and Technion
Faculty of Medicine, Haifa 34362, Israel. rennert@tx.technion.ac.il
Screening for early detection of colorectal cancer using fecal occult
blood testing has been shown to be effective in reducing mortality from
this disease. The largest Health Maintenance Organization in Israel
initiated the use of Hemoccult Sensa in 1992 to evaluate the field
performance of this test. All primary care physicians were invited to
order home-based tests for their asymptomatic patients 50-74 years of
age. This report summarizes the results of 45,166 tests performed,
22,193 in the prevalence round. Seventy-eight cancers, 60 patients with
adenomas, and 163 patients with polyps were detected, yielding a cancer
detection rate of 2.61/1,000 screened in the prevalence round. Of these,
21.6% were in the right colon. Of screen-detected cancers, 44.5% and
58.9% were detected in Dukes' A and in situ stages in the prevalence and
incidence rounds, correspondingly. The overall estimated sensitivity of
the test (median follow-up, 35 months) was 85.3% for the prevalence
round with a specificity of 95.5%. The sensitivity for left-side tumors
(87.9%) was higher than for right-side or rectal tumors (78.6%). The
positive predictive value for cancer increased with increasing number of
positive fields. Four or more positive fields had a positive predictive
value for cancer of 16-26% and a positive predictive value of 46-71% for
all tumors combined. Population screening with a sensitive fecal occult
blood test performs well outside a trial setting, detecting a high
proportion of expected tumors with favorable stage distribution. Given
its proven power to significantly reduce mortality, use of this test is
strongly advised to both medical organizations and the healthy
population at average risk.
29
UI - 11694645
AU - Emenaker NJ; Calaf GM; Cox D; Basson MD; Qureshi N
TI -
Short-chain fatty acids inhibit invasive human colon cancer by
modulating uPA, TIMP-1, TIMP-2, mutant p53, Bcl-2, Bax, p21 and PCNA
protein expression in an in vitro cell culture model.
SO - J Nutr 2001 Nov;131(11 Suppl):3041S-6S
AD - Department of Physiology and Cellular Biophysics, Columbia University
College of Physicians and Surgeons, New York, NY, USA. nje7@columbia.edu
High intakes of dietary fiber or resistant starches have been associated
with a lower incidence of colon cancers. Because short-chain fatty acids
(SCFA) such as butyrate are produced in the colonic lumen by the
bacterial fermentation of dietary fibers and resistant starches, we
hypothesized that SCFA may inhibit the development of invasive human
colon cancers. To test this hypothesis, primary human invasive
colonocytes were isolated from fresh surgical specimens and treated with
0.01 mol/L acetate, propionate or butyrate; cell invasion, cell
adhesion, F-actin polymerization, urokinase plasminogen activator (uPA),
tissue inhibitor matrix metalloproteinase (TIMP)-1, TIMP-2 and mutant
p53, Bcl-2, Bax, p21 and proliferating cell nuclear antigen (PCNA)
protein expression levels were examined. Although each of the SCFA
tested significantly reduced primary cell invasion, butyrate was the
most potent, inhibiting primary invasive human colon cancer invasion by
54% (P < 0.0001). The effects of SCFA on primary cell invasion appeared
to be independent of cell adhesion and F-actin polymerization but
dependent on the inhibition of uPA (P < 0.05) and the stimulation of
TIMP-1 and TIMP-2 activities (P < 0.05). Protein expression levels of
mutant p53, p21, Bax, Bcl-2 and PCNA were significantly altered by each
of the SCFA tested (P < 0.05). These data indicate that SCFA inhibit
invasive human colon cancer by modulating proteolytic uPA and
antiproteolytic TIMP-1 and TIMP-2 activities, but their mechanisms of
action on tumor suppression, apoptosis and growth arrest may differ.
30
UI - 11715499
AU - Yang B; Zhang B; Tang Z
TI -
[Randomized controlled prospective study of secondary prevention for
primary liver cancer]
SO - Zhonghua Yi Xue Za Zhi 1999 Dec;79(12):887-9
AD - Liver Cancer Institute, Shanghai Medical University, Shanghai 200032.
OBJECTIVE: To evaluated the effectiveness of secondary prevention for
primary liver cancer (PLC). METHODS: This is a randomized controlled
study. 18,816 Shanghai urban residents, aged 35-55, with serum evidence
of HBV infection or chronic hepatitis were randomly assigned into the
screening group (9,373) or the control group (9,443). In the screening
group, participants were tested with serum AFP and real time ultrasound
every 6 months, while in the control group, participants were not
informed about the study and received no screening. Participants with
positive results underwent a diagnostic evaluation, and all patients
diagnosed as PLC were treated appropriately and followed up. RESULTS:
After 5 years of study, there were 22,631.5 person-years screened. 86
patients with PLC were detected. 51 patients were detected in the
control group within 32,944 person-years. In the screened group, 60.5%
(52/86) of patients were in stage I, and 45.3% (40/86) with small liver
cancer. However, there were no patients in stage I or with small liver
cancer in the control group. The resection rates were 46.5% in the
screened group, and 7.8% in the control group. The 1 to 5 years survival
rates of PLC patients in the screening group were 65.0%, 65.0%, 52.7%,
52.7% and 52.7%, respectively, and in the control group were 30.0%,
6.5%, 0%, 0% and 0%, respectively. CONCLUSION: Screening can detect PLC
in the early stage, and improve the prognosis of PLC, indicating that
secondary prevention can decrease the mortality of PLC.
31
UI - 11713930
AU - Lynch HT; Thorson AG; McComb RD; Franklin BA; Tinley ST; Lynch JF
TI -
Familial adenomatous polyposis and extracolonic cancer.
SO - Dig Dis Sci 2001 Nov;46(11):2325-32
AD - Department of Preventive Medicine, Creighton University School of
Medicine Omaha, Nebraska 68178, USA.
Our purpose is to focus attention on the cancer family history, coupled
with an understanding of the natural history and extracolonic tumor
spectrum of familial adenomatous polyposis (FAP), through a family
study. This family report provides an example of how colorectal cancer
(CRC) can be prevented by knowledgeable gastroenterologists and
colorectal surgeons who educate and compassionately counsel members of
high-risk families so that their compliance with diagnostic screening
and, ultimately, with protection through prophylactic colectomy, is
achieved. A working pedigree of this extended family was constructed
through interviews with the proband, followed by questionnaires sent to
all primary and secondary relatives. Appropriately signed permission
forms enabled us to secure pertinent medical and pathology records in
order to ensure accuracy of historical information. Integral
extracolonic tumors included medulloblastoma, papillary thyroid
carcinoma, hepatoblastoma, and desmoid tumors. We conclude that, due in
part to improved longevity as a result of being spared CRC, several
family members have developed certain FAP integral extracolonic cancers.
32
UI - 11720343
AU - Roth J; Mobarhan S
TI -
Preventive role of dietary fiber in gastric cardia cancers.
SO - Nutr Rev 2001 Nov;59(11):372-4
AD - Department of Medicine at the Loyola University Medical Center, Maywood,
IL 60153, USA.
The incidence of adenocarcinoma of the esophagus and gastric cardia is
increasing. Many factors are presumed to be associated: symptoms of
gastroesophageal reflux disease, tobacco use, alcohol consumption,
dietary factors, and obesity. A recent large population-based
case-control study evaluated the association between dietary fiber
intake and cancers of the gastric cardia and esophagus. This interesting
study indicated that high intake of cereal fiber may significantly
decrease the risk of gastric cardia cancer. More research is needed on
this topic in the hope that dietary intake may decrease the incidence of
these cancers.
33
UI - 11712783
AU - Cheng AL; Hsu CH; Lin JK; Hsu MM; Ho YF; Shen TS; Ko JY; Lin JT; Lin BR;
TI -
Ming-Shiang W; Yu HS; Jee SH; Chen GS; Chen TM; Chen CA; Lai MK; Pu YS;
Pan MH; Wang YJ; Tsai CC; Hsieh CY
Phase I clinical trial of curcumin, a chemopreventive agent, in patients
with high-risk or pre-malignant lesions.
SO - Anticancer Res 2001 Jul-Aug;21(4B):2895-900
AD - Department of Internal Medicine, National Taiwan University College of
Medicine, Taipei. andrew@ha.mc.ntu.edu.tw
Curcumin (diferuloylmethane), a yellow substance from the root of the
plant Curcuma longa Linn., has been demonstrated to inhibit
carcinogenesis of murine skin, stomach, intestine and liver. However,
the toxicology, pharmacokinetics and biologically effective dose of
curcumin in humans have not been reported. This prospective phase-I
study evaluated these issues of curcumin in patients with one of the
following five high-risk conditions: 1) recently resected urinary
bladder cancer; 2) arsenic Bowen's disease of the skin; 3) uterine
cervical intraepithelial neoplasm (CIN); 4) oral leucoplakia; and 5)
intestinal metaplasia of the stomach. Curcumin was taken orally for 3
months. Biopsy of the lesion sites was done immediately before and 3
months after starting curcumin treament. The starting dose was 500
mg/day. If no toxicity > or = grade II was noted in at least 3
successive patients, the dose was then escalated to another level in the
order of 1,000, 2,000, 4,000, 8,000, and 12,000 mg/day. The
concentration of curcumin in serum and urine was determined by high
pressure liquid chromatography (HPLC). A total of 25 patients were
enrolled in this study. There was no treatment-related toxicity up to
8,000 mg/day. Beyond 8,000 mg/day, the bulky volume of the drug was
unacceptable to the patients. The serum concentration of curcumin
usually peaked at 1 to 2 hours after oral intake of crucumin and
gradually declined within 12 hours. The average peak serum
concentrations after taking 4,000 mg, 6,000 mg and 8,000 mg of curcumin
were 0.51 +/- 0.11 microM, 0.63 +/- 0.06 microM and 1.77 +/- 1.87
microM, respectively. Urinary excretion of curcumin was undetectable.
One of 4 patients with CIN and 1 of 7 patients with oral leucoplakia
proceeded to develop frank malignancies in spite of curcumin treatment.
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