CRC Prevention and Screening

Departments of Nursing/Health, Nutrition and Exercise Sciences

Objectives

Review guidelines to prevent colorectal cancer (CRC) with “healthy living”

Review screening recommendations for CRC

Encourage discussion of CRC screening at physician appointments

Cancer DeathsNorth Dakota

Cancer (all types) second-leading cause of death

Colorectal cancer ranks second Lung Cancer 1st Colorectal Cancer 2nd Breast Cancer 3rd Prostate Cancer 4th

www.cdc.gov/cancer/CancerBurden/nd.htm

Preventable and treatable Colorectal cancer

On average, 13 years of life lost 93% of cases in people over 50 75% of cases in people of

average risk

“The disease no one has to die from.”

What is the “prescription” for healthy living?

Don’t smoke Eat a healthy diet Maintain a healthy weight Exercise regularly Limit alcoholic beverages

Helps prevent cancer, heart disease and diabetes

Eyre H et al. Cancer J Clin. 2004;54:190-207. Byers T et al., CA Cancer J Clin 2002;52:92-119.

Smoking Increases CRC risk

1. Stop smoking!

Tobacco use Single largest preventable cause of

disease and premature death in the U.S.

Smoking Shown to cause CRC and 13 other

cancers

The New American PlateAmerican Institute of Cancer Research

Meal patterns for a healthful life!

Vegetables1½ cups

Milk8 fl. oz.

Meat, Beans, Seeds2-3 oz. equivalents

Fruits½ cup

Whole Grains2 oz. equivalents

www.aicr.org

Healthy Oils2 tsp. equivalents

Emphasize Plant SourcesReduces risk of CRC

Include fruits and vegetables

Dietary Guidelines 1½-2 cups fruits 2½-3 cups vegetables

Include whole grains, beans, seeds and nuts

Meat Variety and ModerationReduces risk of CRC

Follow Dietary Guidelines Include a variety of lean

meat/protein sources Use smaller portions for a

total of 5-6½ oz./day

Limit high-fat, processed meats

Limit cooking at high temperatures Suggest braising, steaming, poaching,

stewing, microwaving meats

Calcium and Vitamin D Reduces risk of CRC

Vitamin D -“sunshine vitamin” Produced in the skin in sunlight

Calcium sources Dairy products (milk, yogurt, cheese) Fortified grains and orange juice Calcium supplements

Fortified fluid milkMost reliable daily source for both

Folic Acid Reduces risk of CRC

Include food sources

Fortified breakfast cereals Enriched grain products Orange juice and other fruits Green, leafy vegetables Beans, nuts and seeds

SeleniumReduces risk of CRC

Include food sources

Protein-rich foods (meats, fish, beans, seeds, breads and cereals, milk)

Content of food varies depending on the selenium content of soil

Alcohol Moderation reduces risk of CRC

Limit alcohol intake Women - One drink or less per day Men - Two drinks or less per day

CRC risk increases substantially More than two drinks per day

Maintain a Healthy Weight Reduces risk of CRC

Overweight and Obesity

Associated with up to 2/3 of all cancers

Associated with a greater risk for colon cancer

North Dakota statistics More than 60% of adults either overweight or obese

Physical Activity (PA)Reduces risk of CRC

Recommend 30 minutes or more 5 or more days each week

Best reduction of risk 45 minutes or more of moderate

to vigorous PA 5 or more days each week

ScreeningReduces risk of CRC

Early detection and removal of polyps provides a greater than 90% cure rate!

CRC Screening Methods - Age 50+

Annual - Fecal Occult Blood Test -OR

Every 5 years - Flexible Sigmoidoscopy-OR

Combination of tests Annual - Fecal Occult Blood Test Every 5 years - Flexible Sigmoidoscopy

-OR

Every 10 years - Colonoscopy-OR

Every 5 years - Double Contrast Barium Enema

Fecal Occult Blood Test (FOBT)CRC screening procedure

FOBT detects blood in stool Polyps and CRC can bleed slowly Blood “hidden” in the stool

Convenient - done at home

Costs $3.50 Medicare pays Most health insurances cover cost

Ouyang DL et al., Am J Gastroenterol. 2005;100:1393-1403.

Endoscope ProceduresVisualization of the colon

Flexible sigmoidoscopy

Examines lower third

Colonoscopy Examines entire length

Double Contrast Barium EnemaCRC screening procedure

Barium added to the enema solution

X-rays taken of colon Barium outlines lining of the colon

to detect polyps or abnormalities Suggested once every 5 years

What are polyps?

Start small and grow larger over time

May bleed into the colon

Use FOBT to check

May become cancerous

David M. Martin, M.D. and Atlanta South Gastroenterology, P.C. - www.endoatlas.com

Removal of polypsOutpatient endoscope procedure

Visualize May appear like a

mushroom on a “stalk”

Remove with a wire loop Painless Takes only minutes

Analyze To determine if cancerous

Benign polyp (noncancerous)


Early cancerous polyps Cured by wire loop


Screening statisticsNorth Dakota (Age 50+)

FOBT in past two years — 21%

Ever had a sigmoidoscopy or colonoscopy — 54%

Screening needed for early detection!

http://apps.nccd.cdc.gov/brfss (2004)

People at high risk for CRCStart screening before age 50

Personal or family history

Polyps or colorectal cancer

Ulcerative colitis or Crohn’s disease

Ask your doctor!Arrange to be screened for CRC

Now that I’m 50, what tests for cancer should I have?

I’ve read that there’s more than one test for colon cancer. Which one do you think is right for me?

www.cancer.org

Symptoms of late CRCSee your doctor for a diagnostic workup!!!

A change in bowel habits

Diarrhea or constipation

Feeling the bowel does not completely empty

Vomiting

Abdominal discomfort (gas, bloating, cramps)

Weight loss for no known reason

Unexplained anemia

Any blood in the stool - merits a follow-up!

(Do not assume blood is from hemorrhoids)

Symptoms persisting for more than two weeks

Late CRCOnly an 8% survival rate


Screening saves lives!

More than 90% of CRC deaths are preventable

With healthy lifestyles

With removal of benign or precancerous polyps

With early detection of cancer and treatment

Thank you! Developed by

Beverly Greenwald, PhD, RN

Assisted by Jane U. Edwards, PhD, LRD

Health & Medicine

CRC Prevention and Screening