Colorectal Cancer PreventionNo Ifs, Ands or Butts

Colorectal Cancer PreventionNo Ifs, Ands or Butts

Karen E. Kim, MD, MSProfessor of Medicine

Director, Office of Community Engagement and Cancer Disparities

University of Chicago

Karen E. Kim, MD, MSProfessor of Medicine

Director, Office of Community Engagement and Cancer Disparities

University of Chicago

Cancer 2015Cancer 2015

1.64 million new cancer diagnosed in 2015

577,190 cancer deaths 1500 deaths/day 1 in 4 deaths 226 billion –cost of cancer

1.64 million new cancer diagnosed in 2015

577,190 cancer deaths 1500 deaths/day 1 in 4 deaths 226 billion –cost of cancer

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MEN AND CANCERMEN AND CANCER

1 in 4 will die

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Women and cancerWomen and cancer

1 in 5 will die

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Survival Rates…..then and nowSurvival Rates…..then and now

In 1913, the survival rate on average for all cancers was only 10%...

In 1913, the survival rate on average for all cancers was only 10%...

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66%

5-Year Relative Survival Rates All Races (1950s - 2003)

50%35%

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The Good NewsThe Good News

The rates of cancer cases and deaths are declining.

Two out of three cancer cases and deaths can be prevented by lifestyle changes or detected early enough to control or cure them.

There are almost 10 million survivors of cancer in the U.S. today.

The rates of cancer cases and deaths are declining.

Two out of three cancer cases and deaths can be prevented by lifestyle changes or detected early enough to control or cure them.

There are almost 10 million survivors of cancer in the U.S. today.

cancer.uchicago.edu

cancer.uchicago.edu

Colorectal CancerColorectal Cancer

6% lifetime risk (1 in 18) Men=women 3rd most common cancer 3rd leading cause of cancer death 85% preventable

#1 cause of death among non smokers

6% lifetime risk (1 in 18) Men=women 3rd most common cancer 3rd leading cause of cancer death 85% preventable

#1 cause of death among non smokerscancer.uchicago.edu

CRC Risk FactorsCRC Risk Factors

Age → 90% of cases occur in people 50 and older

Race →African Americans have highest incidence

and deaths

Gender →slight male predominance, but common in both

men and women

Age → 90% of cases occur in people 50 and older

Race →African Americans have highest incidence

and deaths

Gender →slight male predominance, but common in both

men and women

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Cancer and AgingCancer and Aging

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Other Risk FactorsOther Risk FactorsFamily and personal history Personal history of colorectal polyps,

previously treated colorectal cancer, or inflammatory bowel disease

Having a family history of colorectal cancers, certain other cancers, and benign colon polyps

Lifestyle issues Being physically inactive Nutrition (high fat, low fruit and vegetable

consumption) Obesity Smoking, Alcohol

Family and personal history Personal history of colorectal polyps,

previously treated colorectal cancer, or inflammatory bowel disease

Having a family history of colorectal cancers, certain other cancers, and benign colon polyps

Lifestyle issues Being physically inactive Nutrition (high fat, low fruit and vegetable

consumption) Obesity Smoking, Alcohol

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Risk varies by family historyRisk varies by family history

Johns LE, Am J Gastro 2001

4% 8% 9%15% 16%

80%

U.S. Adherence Rates Cancer Screening

U.S. Adherence Rates Cancer Screening

Adherence RatesBreast Cancer 72% * Cervical Cancer 86% * Prostate Cancer 75%**Colorectal Cancer 45-66%* **

* Seeff Cancer 2002;95:2211-22**Sirovich JAMA 2003;289:1414-20

Adherence RatesBreast Cancer 72% * Cervical Cancer 86% * Prostate Cancer 75%**Colorectal Cancer 45-66%* **

* Seeff Cancer 2002;95:2211-22**Sirovich JAMA 2003;289:1414-20

cancer.uchicago.edu

cancer.uchicago.edu

Colorectal Cancer Screening* (%) among Adults 50 Years and Older by State, 2006-2008

Colorectal Cancer Screening* (%) among Adults 50 Years and Older by State, 2006-2008

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Colon Cancer is a Disease that Benefits from Screening

Colon Cancer is a Disease that Benefits from Screening

Colon cancer develops slowly over many years.

Colon cancer starts out as non-cancerous growths called polyps.

Colon cancer develops slowly over many years.

Colon cancer starts out as non-cancerous growths called polyps.

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The Earlier You Catch It the Better You Do

The Earlier You Catch It the Better You Do

(SEER Data 1992-1999)

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How Do We Screen for CRC?

Look for Blood in Stool Look for Polyps

Occult blood test

Bariumenema

Colonoscopy Virtual Colonoscopy

FIT

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Tests That Primarily Detect CancerTests That Primarily Detect Cancer

Annual guaiac-based fecal occult blood test -with high test sensitivity for cancer (Hemoccult Sensa)

Annual fecal immunochemical test (FIT) Stool DNA test (sDNA)

- interval uncertain

Annual guaiac-based fecal occult blood test -with high test sensitivity for cancer (Hemoccult Sensa)

Annual fecal immunochemical test (FIT) Stool DNA test (sDNA)

- interval uncertain

Gastroenterology 2008;134: 1570-95

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Tests That Detect Adenomatous Polyps and Cancer

Tests That Detect Adenomatous Polyps and Cancer

Flexible sigmoidoscopy : 5 yrs Colonoscopy : 10 yrs Double contrast barium enema : 5 yrs CT colonography (CTC) : 5 yrs

Flexible sigmoidoscopy : 5 yrs Colonoscopy : 10 yrs Double contrast barium enema : 5 yrs CT colonography (CTC) : 5 yrs

Gastroenterology 2008;134: 1570-95

cancer.uchicago.edu

cancer.uchicago.edu

Get Screened!!Get Screened!!

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2008 CRC Facts/Screening Flaws2008 CRC Facts/Screening Flaws

Every 7 secondssomeone turns 50 Every 3.5 minutessomeone is diagnosed with CRC Every 9 minutessomeone dies from CRC

Every 5 secondssomeone is not getting screened Less than 40% of Americans aged 50+ are screened

for CRC

Every 7 secondssomeone turns 50 Every 3.5 minutessomeone is diagnosed with CRC Every 9 minutessomeone dies from CRC

Every 5 secondssomeone is not getting screened Less than 40% of Americans aged 50+ are screened

for CRC

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If all Americans 50 and older were screened for colon cancer,

we could cut the death rate in half –

saving approximately

30,000 lives a year!

If all Americans 50 and older were screened for colon cancer,

we could cut the death rate in half –

saving approximately

30,000 lives a year!

Impact of Screening

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