Colorectal Cancer PreventionNo Ifs, Ands or Butts
Colorectal Cancer PreventionNo Ifs, Ands or Butts
Karen E. Kim, MD, MSProfessor of Medicine
Director, Office of Community Engagement and Cancer Disparities
University of Chicago
Karen E. Kim, MD, MSProfessor of Medicine
Director, Office of Community Engagement and Cancer Disparities
University of Chicago
Cancer 2015Cancer 2015
1.64 million new cancer diagnosed in 2015
577,190 cancer deaths 1500 deaths/day 1 in 4 deaths 226 billion –cost of cancer
1.64 million new cancer diagnosed in 2015
577,190 cancer deaths 1500 deaths/day 1 in 4 deaths 226 billion –cost of cancer
cancer.uchicago.edu
Survival Rates…..then and nowSurvival Rates…..then and now
In 1913, the survival rate on average for all cancers was only 10%...
In 1913, the survival rate on average for all cancers was only 10%...
cancer.uchicago.edu
The Good NewsThe Good News
The rates of cancer cases and deaths are declining.
Two out of three cancer cases and deaths can be prevented by lifestyle changes or detected early enough to control or cure them.
There are almost 10 million survivors of cancer in the U.S. today.
The rates of cancer cases and deaths are declining.
Two out of three cancer cases and deaths can be prevented by lifestyle changes or detected early enough to control or cure them.
There are almost 10 million survivors of cancer in the U.S. today.
cancer.uchicago.edu
Colorectal CancerColorectal Cancer
6% lifetime risk (1 in 18) Men=women 3rd most common cancer 3rd leading cause of cancer death 85% preventable
#1 cause of death among non smokers
6% lifetime risk (1 in 18) Men=women 3rd most common cancer 3rd leading cause of cancer death 85% preventable
#1 cause of death among non smokerscancer.uchicago.edu
CRC Risk FactorsCRC Risk Factors
Age → 90% of cases occur in people 50 and older
Race →African Americans have highest incidence
and deaths
Gender →slight male predominance, but common in both
men and women
Age → 90% of cases occur in people 50 and older
Race →African Americans have highest incidence
and deaths
Gender →slight male predominance, but common in both
men and women
cancer.uchicago.edu
Other Risk FactorsOther Risk FactorsFamily and personal history Personal history of colorectal polyps,
previously treated colorectal cancer, or inflammatory bowel disease
Having a family history of colorectal cancers, certain other cancers, and benign colon polyps
Lifestyle issues Being physically inactive Nutrition (high fat, low fruit and vegetable
consumption) Obesity Smoking, Alcohol
Family and personal history Personal history of colorectal polyps,
previously treated colorectal cancer, or inflammatory bowel disease
Having a family history of colorectal cancers, certain other cancers, and benign colon polyps
Lifestyle issues Being physically inactive Nutrition (high fat, low fruit and vegetable
consumption) Obesity Smoking, Alcohol
cancer.uchicago.edu
Risk varies by family historyRisk varies by family history
Johns LE, Am J Gastro 2001
4% 8% 9%15% 16%
80%
U.S. Adherence Rates Cancer Screening
U.S. Adherence Rates Cancer Screening
Adherence RatesBreast Cancer 72% * Cervical Cancer 86% * Prostate Cancer 75%**Colorectal Cancer 45-66%* **
* Seeff Cancer 2002;95:2211-22**Sirovich JAMA 2003;289:1414-20
Adherence RatesBreast Cancer 72% * Cervical Cancer 86% * Prostate Cancer 75%**Colorectal Cancer 45-66%* **
* Seeff Cancer 2002;95:2211-22**Sirovich JAMA 2003;289:1414-20
cancer.uchicago.edu
Colorectal Cancer Screening* (%) among Adults 50 Years and Older by State, 2006-2008
Colorectal Cancer Screening* (%) among Adults 50 Years and Older by State, 2006-2008
cancer.uchicago.edu
Colon Cancer is a Disease that Benefits from Screening
Colon Cancer is a Disease that Benefits from Screening
Colon cancer develops slowly over many years.
Colon cancer starts out as non-cancerous growths called polyps.
Colon cancer develops slowly over many years.
Colon cancer starts out as non-cancerous growths called polyps.
cancer.uchicago.edu
The Earlier You Catch It the Better You Do
The Earlier You Catch It the Better You Do
(SEER Data 1992-1999)
How Do We Screen for CRC?
Look for Blood in Stool Look for Polyps
Occult blood test
Bariumenema
Colonoscopy Virtual Colonoscopy
FIT
cancer.uchicago.edu
Tests That Primarily Detect CancerTests That Primarily Detect Cancer
Annual guaiac-based fecal occult blood test -with high test sensitivity for cancer (Hemoccult Sensa)
Annual fecal immunochemical test (FIT) Stool DNA test (sDNA)
- interval uncertain
Annual guaiac-based fecal occult blood test -with high test sensitivity for cancer (Hemoccult Sensa)
Annual fecal immunochemical test (FIT) Stool DNA test (sDNA)
- interval uncertain
Gastroenterology 2008;134: 1570-95
cancer.uchicago.edu
Tests That Detect Adenomatous Polyps and Cancer
Tests That Detect Adenomatous Polyps and Cancer
Flexible sigmoidoscopy : 5 yrs Colonoscopy : 10 yrs Double contrast barium enema : 5 yrs CT colonography (CTC) : 5 yrs
Flexible sigmoidoscopy : 5 yrs Colonoscopy : 10 yrs Double contrast barium enema : 5 yrs CT colonography (CTC) : 5 yrs
Gastroenterology 2008;134: 1570-95
cancer.uchicago.edu
2008 CRC Facts/Screening Flaws2008 CRC Facts/Screening Flaws
Every 7 secondssomeone turns 50 Every 3.5 minutessomeone is diagnosed with CRC Every 9 minutessomeone dies from CRC
Every 5 secondssomeone is not getting screened Less than 40% of Americans aged 50+ are screened
for CRC
Every 7 secondssomeone turns 50 Every 3.5 minutessomeone is diagnosed with CRC Every 9 minutessomeone dies from CRC
Every 5 secondssomeone is not getting screened Less than 40% of Americans aged 50+ are screened
for CRC
cancer.uchicago.edu
If all Americans 50 and older were screened for colon cancer,
we could cut the death rate in half –
saving approximately
30,000 lives a year!
If all Americans 50 and older were screened for colon cancer,
we could cut the death rate in half –
saving approximately
30,000 lives a year!
Impact of Screening
cancer.uchicago.edu
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