Aspirin and colorectal cancer?

This paper evaluates aspirin in the reduction of colorectal cancer risk against the nine causality criteria suggested by Bradford-Hill in 1965. Although some questions remain, the evidence is suggestive of a reduction by perhaps 20-30%. Aspirin could make important contributions to public health programmes given that it reduces cardiovascular disease risk and is relatively safe. It is appropriate for bodies such as the World Health Organisation and national governments to begin to consider the future use of aspirin for the reduction of two major sources of death and disability.     

Are patients with skin cancer at lower risk of developing colorectal or breast cancer?

Ultraviolet exposure may reduce the risk of colorectal and breast cancer as the result of rising vitamin D levels. Because skin cancer is positively related to sun exposure, the authors hypothesized a lower incidence of breast and colorectal cancer after skin cancer diagnosis. They analyzed the incidence of colorectal and breast cancer diagnosed from 1972 to 2002 among 26,916 Netherlands skin cancer patients (4,089 squamous cell carcinoma (SCC), 19,319 basal cell carcinoma (BCC), and 3,508 cutaneous malignant melanoma (CMM)). Standardized incidence ratios were calculated. A markedly decreased risk of colorectal cancer was found for subgroups supposedly associated with the highest accumulated sun exposure: men (standardized incidence ratio (SIR) = 0.83, 95% confidence interval (CI): 0.71, 0.97); patients with SCC (SIR = 0.64, 95% CI: 0.43, 0.93); older patients at SCC diagnosis (SIR = 0.59, 95% CI: 0.37, 0.88); and patients with a SCC or BCC lesion on the head and neck area (SIR = 0.59, 95% CI: 0.36, 0.92 for SCC and SIR = 0.78, 95% CI: 0.63, 0.97 for BCC). Patients with CMM exhibited an increased risk of breast cancer, especially advanced breast cancer (SIR = 2.20, 95% CI: 1.10, 3.94) and older patients at CMM diagnosis (SIR = 1.87, 95% CI: 1.14, 2.89). Study results suggest a beneficial effect of continuous sun exposure against colorectal cancer. The higher risk of breast cancer among CMM patients may be related to socioeconomic class, both being more common in the affluent group.     

Does garlic reduce risk of colorectal cancer? A systematic review

Colorectal cancer (CRC) is the 3rd leading cause of cancer death in the United States and the 2nd leading cause of cancer death in Australia. Environmental factors play important roles in the multiple-stage process of CRC and nutritional intervention has been identified as playing a major role in its prevention. The aim of this study was to review systematically the scientific evidence from all studies conducted over the last decade that examined effects of garlic on CRC. Levels of evidence were ranked from level I to level V according to study designs and the quality of each study was assessed against a set of quality criteria based on those used by the National Health and Medical Research Council in Australia. One randomized controlled trial (RCT, level II) reported a statistically significant 29% reduction in both size and number of colon adenomas in CRC patients taking aged garlic extract. Five of 8 case control/cohort studies (level III) suggested a protective effect of high intake of raw/cooked garlic and 2 of 8 of these studies suggested a protective effect for distal colon. A published meta-analysis (level III) of 7 of these studies confirmed this inverse association, with a 30% reduction in relative risk. Eleven animal studies (level V) demonstrated a significant anticarcinogenic effect of garlic and/or its active constituents. On balance, there is consistent scientific evidence derived from RCT of animal studies reporting protective effects of garlic on CRC despite great heterogeneity of measures of intakes among human epidemiological studies.     

General practitioners’ preferences with regard to colorectal cancer screening organisation Colon cancer screening medico-legal aspects

Objective

French health authorities put general practitioners at the heart of the colorectal cancer screening. This position raises organisational issues and poses medico-legal problems for the professionals and institutions involved in these campaigns, related to the key concepts of medical decisions and suitability of standards. The objective of our study is to reveal the preferences of general practitioners related to colorectal cancer screening organisation with regard to the medico-legal risk

Faecal occult blood screening for colorectal cancer: is it cost-effective?

Recently published evidence from two large-scale clinical trials conducted in England and in Denmark suggests that faecal occult blood screening for colorectal cancer significantly reduces mortality. However, before screening can be advocated as part of national health policy, its cost-effectiveness must be demonstrated. The English screening trial has been the subject of a detailed economic evaluation over the past 10 years. In this paper, cost-effectiveness estimates of screening are presented, based on cost and outcome data combined in a mathematical model developed from the trial's clinical findings. The estimates of cost per quality-adjusted life-year gained from colorectal cancer screening show the procedure to be of similar cost-effectiveness to breast cancer screening in the short term. Over the longer term, however, the estimates for colorectal cancer screening appear superior. © 1998 John Wiley & Sons, Ltd.     

Are gender-associated differences in quality of life in colorectal cancer patients disease-specific?

Purpose  The purpose of this study was to investigate gender-associated differences in quality of life in colorectal cancer patients and compare such differences to the general population. Methods  Colorectal cancer patients attending three oncological centres in Austria were consecutively recruited and assessed with the EORTC QLQ-C30. For the purpose of comparison, a gender- and age-matched healthy control group was drawn from a representative sample of the Austrian general population. Results  About 206 patients (47.1% women; mean age 64.8 years) with colorectal cancer were included and compared with 206 persons from the general population. A two-way analysis of variance showed significant main effects (gender and colorectal cancer vs. healthy) for most EORTC QLQ-C30 scales, but a significant interaction effect was only found for diarrhea. This means that gender-associated differences specific for colorectal cancer patients were only found for diarrhea. Conclusion  The vast majority of studies on gender-associated differences in quality of life compare male and female oncological patients and neglect the issue of the disease-specificity of such differences. Our study revealed that women and men suffering from colorectal cancer scored differently across many aspects of quality of life, but with the exception of diarrhea, these differences were also found in the general population, i.e. they indicated no gender-specific reaction to disease.     

Participation and screening programmes for colorectal cancer: more would be better?

In clinical terms, a screening compliance rate of 100% may be deemed optimal in that the number of abnormalities detected is thereby maximized. This paper explores optimum compliance rates from the cost-effectiveness point of view by modelling the individual's decision to participate in the screening programme. Using data derived from contemporary colorectal screening trials, it assesses the compliance and cost effects of utilizing differing methods of screening invitation, and explores the incremental cost and benefits associated with compliance enhancement techniques. Given the estimated costs and benefits, attempts to attain higher levels of compliance would appear justifiable.     

Do benefits and barriers differ by stage of adoption for colorectal cancer screening?

In 2003, over 148,300 people were expected to be diagnosed and 56,000 to die from colorectal cancer (CRC). First-degree relatives (FDRs) of people with colon cancer have a two- to eight-fold increased risk for CRC. Despite evidence that screening is effective, adherence with screening recommendations in this at-risk population is low. This study's purposes were to (1) identify perceived benefits and barriers of fecal occult blood testing (FOBT), sigmoidoscopy and colonoscopy, and (2) compare demographic characteristics and perceived benefits and barriers by stage of adoption for CRC screening. Participating FDRs (n = 257) completed a 40-min structured telephone interview. Despite high rates of agreement with the benefits of screening, most FDRs were not contemplating being screened. Of those 50 and older, most were in precontemplation for FOBT, sigmoidoscopy and colonoscopy. Older age was related to stage for FOBT and sigmoidoscopy, but not colonoscopy. Lack of provider recommendation also was related to stage. Consistent with theoretical predictions, precontemplators had (1) higher rates of endorsement of specific barriers to screening and (2) lower rates of endorsement of benefits than contemplators or actors. For morbidity and mortality reduction, participation in routine, periodic screening is imperative. These findings can guide development of screening-promoting interventions.     

Meat cooking habits and risk of colorectal cancer in Córdoba, Argentina

OBJECTIVE: Colorectal cancer is the third cause of death among women and the fifth among men in Córdoba, Argentina. We previously reported colorectal cancer to be associated with a high intake of fatty meats and bovine viscera and inversely associated with dietary fiber intake. In this study, we investigated the role of method of cooking meat and preferences in browned surfaces in the risk of colorectal cancer. METHODS: A case-control retrospective study was carried out by interviewing 296 patients and 597 control subjects with a food-frequency questionnaire. Meat consumption and preferred cooking procedures (boiled, roasted, barbecued, cooked in a flat iron-pan without fat, and fried) were investigated. Odds ratios and 95% confidence intervals were obtained by unconditional logistic regression analysis. RESULTS: Barbecuing was the cooking method preferred by men, whereas iron-pan cooking was favored by women; frying was the least favored method. Fatty beef, sausages, and bovine viscera were preferentially barbecued or boiled, whereas lean beef was mainly roasted, iron-pan cooked, or fried. Chicken was barbecued or roasted. The multivariate relative risks (adjusted by age, sex, social stratum, and total energy intake) for preferring darkly browned surfaces were significantly associated with an increased risk for all cooking procedures (odds ratio, 4.57; 95% confidence interval, 3.10 to 6.73). No associations were found for red roasted or for boiled meats. CONCLUSION: Increased risk seems to be related to cooking temperature and close contact of the food to the heating source, because higher risks were observed for heavily browned surfaces when meats were barbecued or iron-pan cooked.     

Multivitamin use and colorectal cancer incidence in a US cohort: does timing matter?

Multivitamins contain several nutrients, including folic acid, that are hypothesized to reduce the risk of colorectal cancer. Previous studies suggest that multivitamin use may reduce colorectal cancer risk but only after a long latency period. The authors examined the association between regular multivitamin use (four or more times per week) and colorectal cancer incidence among 145,260 men and women in the Cancer Prevention Study II Nutrition Cohort. Current multivitamin use was reported on a questionnaire at enrollment in 1992-1993. All participants had also reported multivitamin use on a questionnaire completed for a different study approximately 10 years earlier (in 1982). The authors observed 797 incident cases of colorectal cancer during follow-up from 1992 to 1997. After multivariate adjustment, regular multivitamin use at enrollment was not associated with risk of colorectal cancer (rate ratio = 1.04, 95% confidence interval: 0.87, 1.23), whereas regular multivitamin use 10 years before enrollment was associated with reduced risk (rate ratio = 0.71, 95% confidence interval: 0.57, 0.89). Regular multivitamin users 10 years before enrollment were at similarly reduced risk whether they were still regular multivitamin users at enrollment or had stopped. These results are consistent with the hypothesis that past, but not recent, multivitamin use may be associated with modestly reduced risk of colorectal cancer.     

"Do we really need all that equipment?": factors influencing colorectal cancer screening decisions

The lifetime risk of developing colorectal cancer is 2.5 to 5% in the general population. Colorectal screening can prevent mortality, and there are a number of screening methods, ranging from noninvasive to highly invasive. Although recommendations have been widely disseminated in the media and scientific journals, screening usage is low. In this project, the authors examine the factors that influence individuals' decisions regarding colorectal screening. They conducted semistructured interviews with 30 people (13 men and 17 women) selected to provide a maximum variation sample. They categorized factors into the following themes: concern for one's personal well-being, competing demands, preparing for the procedure, the screening process, gender concerns, fear of having cancer, feeling healthy, cost, the experiences of others, and turning 50 years old.     

Rural disparities in receipt of colorectal cancer screening among adults ages 50–64 with disabilities

BackgroundColorectal cancer is the third leading cause of cancer deaths in the United States. Early detection can reduce mortality; however, only 59% of U.S. adults age 50 and over meet recommended colorectal cancer screening guidelines. Studies in the general population have observed that rural residents are less likely to have received colorectal cancer screening than residents of urban areas.ObjectiveTo determine whether urban/rural disparities in colorectal cancer screening exist among people with disabilities, similar to the disparities found in the general population.MethodsWe analyzed Medical Expenditure Panel Survey annual data files from 2002 to 2008. We conducted logistic regression analyses to examine the relationship between urban/rural residence and ever having received screening for colorectal cancer (via colonoscopy, sigmoidoscopy, or fecal occult blood test).ResultsAmong U.S. adults ages 50–64 with disabilities, those living in rural areas were significantly less likely to have ever received any type of screening for colorectal cancer. The urban/rural difference was statistically significant regardless of whether or not we controlled for demographic, socioeconomic, health, and health care access variables.ConclusionsDisparity in screening for colorectal cancer places rural residents with disabilities at greater risk for late stage diagnosis and mortality relative to people with disabilities in urban areas. Thus, there is a need for strategies to improve screening among people with disabilities in rural areas.