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Colorectal Cancer

#2
Cancer
Killer

SCREENING SAVES LIVES


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The Bad News: Frequency
Average risk - 1 out of 18 chance per lifetime

High risk – 1 out of 5 chance per lifetime

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The Bad News: Deadly

2. Lung Cancer
3. Colorectal Cancer

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The Bad News: Expensive

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Assessing your individual risk
You have a higher risk if you have any of the
following risk factors:

• Personal history of colorectal cancer or polyps


• Personal history of inflammatory bowel disease
• Family history of colorectal cancer or polyps
• Certain inherited cancer syndromes

Even without symptoms, people with these risk


factors need earlier and more frequent screening

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Assessing your individual risk
Also, you have a higher risk if you have
one or more of the following symptoms:
– Rectal bleeding
– Iron deficiency anemia
– Change in bowel habits; constipation or diarrhea
– Persistent abdominal pain
If you have these symptoms, you should
seek evaluation immediately.

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AVERAGE RISK
If you don’t have these risk factors or
symptoms, you are considered to have
average risk for developing colorectal
cancer.

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IMPORTANCE OF AGE 50
Colorectal Cancer Occurrence
for Average Risk Individuals
Before
Age 50
6%
After
Age 50
94%

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ATTENTION AVERAGE RISK
IOWANS

High-Risk Cases:
25%

75Average-Risk Cases: 75%%

American Cancer Society. Cancer Facts & Figures 2002. Atlanta, GA: American Cancer 9
Society; 2002:20–27.
Good News

A series of changes in the cells lining the colon takes


10 years to progress from normal to colon cancer.

10
years

Normal Polyp Cancer


There is time to intervene 10
More Good News

Alive at diagnosis Alive 5 years later

1 year 2 year 3 year 4 year 5 year

• The most preventable form of digestive


tract cancer if screening is performed 11
And More Good News:

FOBT Flex Sig

Double
Contrast
Colonoscopy Barium
Enema
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So What’s the Problem?

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Late Detection
Five year survival rates
100% 96%
100 84% 100 65%
75 75
50 50
25 25 8%
0 0
Stage 0 Stage I Stage II Stage III Stage IV
Only 60% of patients 40% of patients
are diagnosed early are diagnosed late

SEER*Stat -- Version 6.2.4 14


Why aren’t Iowans screened?
• The most common reasons -
• “My doctor never told me I should be screened.”
• “I’m embarrassed!”
• “The screening tests cost too much!”
• “I don’t think that insurance covers screening.”
• “I don’t have a family history of colorectal cancer.”
• “I don’t have any symptoms of colorectal cancer.”

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How do you screen
for colorectal cancer?
Beginning at age 50:
• Fecal occult blood test (FOBT) every year or
• Flexible sigmoidoscopy (FS) every 5 years,
or
• FOBT annually + FS every 5 years or
• Colonoscopy every 10 yrs or
• Double -contrast barium enema every 5 yrs.

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Fecal Occult Blood Test (FOBT)

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Flexible Sigmoidoscopy

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Location of polyps/cancer

Right side Left side

10% 15%
30% 25%
20%

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FOBT AND FS
• FOBT detects larger, bleeding polyps, but is
less accurate for smaller, non-bleeding
polyps
• Flexible sigmoidoscopy detects left-sided
lesions, but misses 30-40% of all polyps and
cancers that are right-sided
• The combination of both tests largely corrects
the limitations of performing either test alone.
FS + FOBT=75%
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Colonoscopy

examines removes biopsies


entire colon polyps cancer
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Double Contrast Barium Enema
(DCBE)

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Other New Screening Tests

• Virtual colonoscopy

• Stool DNA test

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Virtual Colonoscopy

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Stool DNA Test
Physician Patient Collects
Sends Stool DNA Analysis
Requisition Stool at Home Is Performed in Lab
to Lab Physician

Lab Provides Patient Returns Physician


Collection and Specimen to Lab Communicates
Shipping Materials Results to Patient
to Patient DNA Alteration
Identified:
Perform colonoscopy
No DNA Alteration
Identified
Continue screening
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What Should You Consider in
Choosing a Screening Test
• What does my doctor recommend?
• Which test is most accurate?
• Which test is most convenient?
• Which causes the least discomfort, fear
embarrassment?
• Cost-insurance, Medicare coverage?
• What do other people say about it?
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Test cost

Screening Test Estimated


Charge
FOBT $10-30
FS $150-300
DCBE $250-500
Colonoscopy $600-1500

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Medicare Coverage for
Average Risk patients
• Blood stool test (FOBT) annually
• Sigmoidoscopy every 4 years
• Colonoscopy every 10 years
• Double contrast barium enema as an
alternative to either sigmoidoscopy or
colonoscopy every 5 yrs

(since July 1, 2001)


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Don’t wait until 65 to be screened!
• Insurance covers most, if not all kinds of
screening. Consult your insurance plan
or provider to determine which tests are
covered.
• Screening should begin at age 50, not
at age 65, when Medicare coverage
begins.

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The Cost of NOT screening

– Individual early disability and death


– Emotional costs for patients and
family
– Treatment cost of colon cancer care

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So What?
• An average risk adult has a 1 in 18
chance of developing this cancer.

• A high risk adult has a 1 in 5 chance of


developing this cancer.

Can you afford to take this chance?


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You Can Reduce Deaths Due
to Colon Cancer
Screening!
Screening!
Any method of screening
is preferable to not
screening!
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Have You and Your Loved Ones
Been Screened?

#2
Cancer
Killer

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This presentation was developed by the
Iowa Colorectal Cancer Task Force

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Acknowledgements
• American Cancer Society
• Centers for Disease Control and Prevention
• Exact Sciences
• Dr. John Bond, Univ. of Minnesota
• Dr. Douglas Rex, Univ. of Indiana
• Dr. Robert Summers, Univ. of Iowa
• Dr. Nancy Thompson, Univ. of Iowa
• Dr. Steven Wolfe, Univ. of Iowa
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Colorectal Cancer Web Links
www.cancer.org
www.ccalliance.org
www.preventcancer.org/colorectal
www.hopkinskimmelcancercenter.org
www.colorectal-cancer.net
www.cdc.gov/cancer/screenforlife/index.htm
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