SLIDE 1 A Family Affair: Understanding Colorectal Cancer Risk Factors and Screening Options
Sioux Falls, South Dakota
October 3, 2017
Durado Brooks, MD, MPH
Vice-President, Cancer Control Intervention
SLIDE 2 What is Cancer?
Cells are the basic building blocks of the
body.
Cancer is the general name for a group of
more than 100 diseases.
Cancer cells occur when cells grow in an out
Cell Mutates Cells Grow Cancer Cells
SLIDE 3 Colon and Rectum
The colon (large bowel
is a muscular tube
about 5 feet long
absorbs water and
salt from food
stores waste
matter The rectum is the last 6 inches of the digestive system.
SLIDE 4 What is Colorectal Cancer?
Colorectal cancer occurs when cells in the colon
- r rectum start to grow in an uncontrolled way
Often called simply “colon cancer” or “CRC”
SLIDE 5 How Common is CRC?
135,430 new cases expected in US in 2017
2nd most common cancer when men and women
are combined
50,260 US deaths
2nd leading cause of cancer deaths; only lung cancer
kills more Americans
1.2 million Americans living with CRC Incidence and death rates have fallen steadily past 30 years
Cancer Facts and Figures 2017
SLIDE 6
Overall CRC death rate decline in the US
SLIDE 7
Who Can Get Colorectal Cancer?
Anyone.
Men and women of all ages and all races get CRC
– however risk is higher in African Americans and American Indian/Alaska Natives than other US populations
SLIDE 8
What Increases the Risk of Getting CRC?
Family History
Cancer or polyps Especially if diagnosed before age 60
Age
90% of colorectal cancers are found in men
and women age 50 and older
SLIDE 9 What Increases the Risk of Getting CRC?
Modifiable risk factors
Lack of physical activity
Less active raises risk
Overweight
Obesity raises risk of having
and of dying from CRC Smoking raises risk Alcohol use raises risk Red and processed meat raises risk
SLIDE 10
Polyps and CRC
Polyps are not cancer – but if left in place can grow and transform into cancer 9 out of 10 cases start with a polyp Many cases of CRC can be prevented by finding and removing polyps.
SLIDE 11
Cancer Screening
Screening tests are done for people who don’t have symptoms (“asymptomatic”). They are part of routine health care – like checking your blood pressure. They should be done at regular intervals. CRC Screening Tests look for early cancer or pre-cancers (polyps) of the colon and/or rectum.
SLIDE 12
Why is Screening Important?
People can’t feel abnormal growths (polyps or early cancer) growing inside of them. The only way to find them is by getting screened.
SLIDE 13 Why is Screening Important?
Screening finding cancer early improved survival Survival Rates by Disease Stage*
100 90 80 70
5-yr
60 50
Survival
40 30 20 10
90.3% 70.4% 12.5%
Local Regional Distant
Stage of Detection
SLIDE 14 Why is Screening Important?
There are 2 goals for CRC screening:
- 2. Early Detection
- 1. Prevention
Find cancer in the early stages, Find and remove polyps when best chance for a cure to prevent cancer
SLIDE 15 CRC Screening Tests
Options for Average risk adults age 50 and older: Direct Visualization Tests
Colonoscopy every 10 years, or Flexible sigmoidoscopy (FSIG) every 5 years, or Double contrast barium enema (DCBE) every 5 years, or CT colonography (CTC) every 5 years
Stool Based Tests
Guaiac-based fecal occult blood test (gFOBT) with high test sensitivity for cancer, or Fecal immunochemical test (FIT) with high test sensitivity for cancer, or Stool DNA test (sDNA), with high sensitivity for cancer
SLIDE 16
Most Commonly Used Screening Tests
Colonoscopy Stool Testing
SLIDE 17 Colonoscopy
with camera
- Views entire inside
- f colon
- If normal, no other
testing needed for 10 yrs
Medicare and most insurance – often with no co-pay
SLIDE 18
Colonoscopy
If polyps are found during a colonoscopy they can be removed with tools used through the narrow scope. Removing polyps before they turn into cancer is how tests like this can prevent cancer.
SLIDE 19 Other Things to Know About Colonoscopy
Colonoscopy misses some polyps and
cancers
Very safe overall, but complications can
- ccur (bleeding, perforation, stroke, heart
attack,…)
Doctors have different skill levels at finding
and removing polyps
Many patients don’t like the colon cleansing
required before the test (the “prep”)
Can be expensive if not covered by insurance
SLIDE 20 Types of Stool Tests*
A) Tests that look for hidden blood
Fecal Immunochemical Test (“FIT”)
B) Tests that look for hidden blood AND for abnormal DNA
One test (Cologuard) available in U.S.
*Stool tests are only appropriate for average risk patients
SLIDE 21 Fecal Immunochemical Tests (FIT)
Looks for microscopic amounts
Patient gets a kit with
instructions from their doctor's
Complete the kit at home Return the kit to the doctor's
- ffice or medical lab for testing
If test is abnormal – MUST have
colonoscopy
SLIDE 22
Fecal Immunochemical Test (FIT)
Finds approximately 7 of 10 cancers. Recommended for CRC screening in
guidelines from major organizations.
If test results are normal it should be
repeated every year.
Patients with abnormal FIT results MUST
have a colonoscopy.
If FIT is chosen as the initial screening test,
and results are abnormal, the patient may have a co-pay for the needed colonoscopy.
SLIDE 23 Stool Test for Abnormal DNA
Cancer and polyps bleed
will only find them sometimes. Colon cells are shed into the stool continuously. Polyps and cancer cells contain genetic material (DNA). Stool DNA tests look for abnormal DNA from cells that are passed in the stool.
SLIDE 24 Cologuard (FIT + DNA)
One test (Cologuard)
currently available.
Combines stool test for
blood plus stool test for abnormal DNA.
In one large study
Cologuard detected more than 9 of 10 cancers.
Recommended for CRC
screening in guidelines from major
SLIDE 25
Cologuard (FIT + DNA)
If test results are normal Cologuard should be
repeated once every 3 years.
Patient with abnormal Cologuard result MUST
have colonoscopy
Covered by Medicare and some private
insurers
If Cologuard is chosen as the initial screening
test, and results are abnormal, the patient may have a co-pay for the needed colonoscopy.
SLIDE 26 How Can You Lower Your Risk?
Get screened for colorectal cancer
Early cancer has no symptoms – so don’t wait!
Discuss your personal and family history with your doctor Maintain a healthy weight throughout life Eat a healthy diet
Emphasis on fruits, vegetables and whole grains Limit processed and red meats
SLIDE 27 How Can You Lower Your Risk?
Be more physically active (walking, biking, gardening,…) Limit alcohol consumption Notify your doctor if you have signs and symptoms
Blood in stool Change in bowel habits Abdominal pain Weight loss
SLIDE 28 Patient Education
This image canno t currently be display ed.
Get Tested For Colon Cancer: Here's How." An 7-minute video reviewing
- ptions for colorectal cancer
screening tests, including test preparation. Available as DVD, or you can refer patients to the URL to view from their personal computer.
https://www.cancer.org/cancer/colon-rectal-cancer/colon-cancer-videos.html
