Introduction

Moshe Shike, MD, Sidney J. Winawer, MD

Colorectal cancer is the second leading cause ofdeath from cancer in this country. Although con-siderable progress has been made in understand-

ing primary and secondary prevention of this disease, ef-fective prevention opportunities are not well appreciatedby the general public.

This supplement to The American Journal of Medicinepresents the proceedings of an interdisciplinary sympo-sium addressing recent advances and critical issues incolorectal cancer prevention. The symposium coveredcurrent knowledge of both primary and secondary pre-vention but focused mainly on new developments in pri-mary prevention.

Sidney Winawer, MD, presents an overview of thenatural history of colorectal cancer that highlights op-portunities for intervention; Moshe Shike, MD, pro-vides an overview of the role of diet and lifestyle in theprevention of colorectal cancer, and John Bond, MD,presents an update of screening guidelines. Nutritionalregulation of gene expression is a new area of research,and Robert Cousins, PhD, explains how new tech-niques may help to elucidate protective mechanisms atthe genetic level.

The role of dietary fiber in colon cancer is discussed byBandaru Reddy, DVM, PhD, and Joanne Lupton, PhD,considers the potential mechanisms of action of wheatbran fiber in reducing the risk of colorectal cancer. Afterpreclinical data on the role of wheat bran fiber in colorec-

tal cancer are presented by David Kritchevsky, PhD,David Earnest, MD, reviews data from marker trials inanimals and humans and offers a progress report on theArizona phase III clinical study of the effect of wheat branon the recurrence of adenomatous colon polyps. FinlayMacrae, MD, reports data from several randomized, con-trolled trials of polyp prevention, especially that of theAustralian Polyp Prevention Project. Joanne Slavin, PhD,RD, concludes by discussing the implementation of di-etary modifications.

The observation of the Nurses’ Health Study1 regard-ing the relationship between consumption of dietary fi-bers and colorectal cancer and adenoma was publishedjust prior to the release of this supplement. The studyconcluded that there was no correlation between theamount of dietary fiber consumed and the risk of devel-oping colorectal neoplasia. The nurses’ study observationadds significantly to our knowledge regarding the role offiber and further underscores the inconsistencies in thedata, as pointed out in a number of articles in this sup-plement. The effect of fiber consumption on health ingeneral and on the risk of colorectal cancer in particularrequires more definitive data from prospective interven-tion trials. However, an approach utilizing both primaryand secondary prevention remains the best strategy forsubstantially reducing the risk of adenoma and cancer inthe colon.

REFERENCE1. Fuchs CS, Giovannucci EL, Colditz GA, Hunter DJ, Stampfer

MJ, Rosner B, Speizer FE, Willett WC. Dietary fiber and therisk of colorectal cancer and adenoma in women. N Engl JMed. 1999;340:169–176.

From the Department of Medicine, GI-Nutrition Service, MemorialSloan-Kettering Cancer Center, New York, New York.

Requests for reprints should be addressed to Moshe Shike, MD, Can-cer Prevention and Wellness Program, Memorial Sloan-Kettering Can-cer Center, 1275 York Avenue S-524, New York, New York 10021.

2S © 1999 by Excerpta Medica, Inc. 0002-9343/99/$19.00All rights reserved. PII S0002-9343(99)00337-4