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NCI CANCERLIT^® Search: Screening and Prevention of Digestive Cancers - September 2001

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Last Modified: November 1, 2001

• Faecal occult blood testing in the secondary prevention of colorectal cancer.

• Endoscopic screening in the prevention of colorectal cancer.

• Is pancreatic cancer a preventable disease?

• Advantages and disadvantages of population screening for cancer and surveillance of at-risk groups.

• Gastrointestinal lymphoma: prevention and treatment of early lesions.

• Calcium and fibre supplementation in prevention of colorectal adenoma recurrence: a randomised intervention trial. European Cancer Prevention Organisation Study Group.

• Fibre supplementation.

• Long-term interferon therapy for 1 year or longer reduces the hepatocellular carcinogenesis rate in patients with liver cirrhosis caused by hepatitis C virus: a pilot study.

• Medicare expands preventive screening benefits.

• Health beliefs and endoscopic screening for colorectal cancer: potential for cancer prevention.

• Barrett's-related esophageal adenocarcinoma: is chemoprevention a potential option?

• Investigating the role of immunomodulation for colon cancer prevention: results of an in vivo dose escalation trial of levamisole with immunologic endpoints.

• Toward prevention of hepatocellular carcinoma developing in chronic hepatitis C.

• Colorectal cancer screening. Recommendation statement from the Canadian Task Force on Preventive Health Care.

• Salicylic acid: a link between aspirin, diet and the prevention of colorectal cancer.

• Physical activity and cancer prevention -- is 'no pain, no gain' passe?

• Oral contraceptives, cancer and vascular disease.

• APACC, a French prospective study on aspirin efficacy in reducing colorectal adenoma recurrence: design and baseline findings.

• Implementation of a 4-y, high-fiber, high-fruit-and-vegetable, low-fat dietary intervention: results of dietary changes in the Polyp Prevention Trial.

CancerMail from the National Cancer Institute

1
UI - 21227886
AU - Kronborg O
TI - Faecal occult blood testing in the secondary prevention of colorectal cancer.
SO - Eur J Cancer Prev 2001 Apr;10(2):167-8
AD - Department of Surgical Gastroenterology A, Odense University Hospital, Denmark. ole.kronborg@ouh.fyns-amt.dk

2
UI - 21227887
AU - Armbrecht U
TI - Endoscopic screening in the prevention of colorectal cancer.
SO - Eur J Cancer Prev 2001 Apr;10(2):169-72
AD - Chefarzt Marbachtal KIinik, Bad Kissingen, Germany. marbachtalklinik@t-online.de

3
UI - 21400913
AU - Gapstur SM; Gann P
TI - Is pancreatic cancer a preventable disease?
SO - JAMA 2001 Aug 22-29;286(8):967-8

4
UI - 21255256
AU - Craanen ME; Kuipers EJ
TI - Advantages and disadvantages of population screening for cancer and surveillance of at-risk groups.
SO - Best Pract Res Clin Gastroenterol 2001 Apr;15(2):211-26
AD - Department of Gastroenterology, Academic Hospital, Amsterdam, The Netherlands.
Despite improvements in diagnostic and therapeutic modalities, the prognosis of patients with gastrointestinal malignancies has remained poor. In essence, this poor outcome is related to the majority of patients presenting at an already advanced stage of disease at the time of diagnosis. Unfortunately, however, mass screening and surveillance programmes aimed at early detection and treatment in the population at large are in most countries considered to be cost-ineffective. Moreover, even with regard to established risk groups, there is considerable debate over whether current surveillance strategies are beneficial to these patients in terms of a reduction in cancer-related mortality. This chapter addresses various aspects of screening and surveillance. In the first part, general issues are discussed, whereas the second part focuses particularly on disease entities frequently encountered in gastrointestinal practice. Copyright 2001 Harcourt Publishers Ltd.

5
UI - 21255263
AU - Ruskone-Fourmestraux A; Rambaud JC
TI - Gastrointestinal lymphoma: prevention and treatment of early lesions.
SO - Best Pract Res Clin Gastroenterol 2001 Apr;15(2):337-54
AD - Service de Gastroenterologie, Hotel Dieu, 1, Place Parvis Notre Dame, Paris, cedex 04, 75181, France.
Gastrointestinal lymphomas comprise a group of distinct clinicopathological entities. Differences in lifestyle and environmental factors between countries could account for the variety in the distribution of the main subtypes: low-grade B-cell lymphomas of the mucosa-associated lymphoid tissue type, alpha-chain disease and enteropathy (coeliac disease)-associated T-cell lymphoma (EATL). The possibility of preventing these lymphomas implies a knowledge of their natural history together with an identification of potential predisposing factors. The development of the lymphoid hyperplasia and subsequently low-grade lymphoma with the possibility of high-grade transformation is a multifactorial process involving both antigenic and host-related factors. The pathogenic role of Helicobacter pylori and gluten has been demonstrated in gastric lymphoma and enteropathy-associated T-cell lymphoma respectively, while environmental factors, especially non-specific bacterial ones, may play a major role in the pathogenesis of alpha-chain disease. The most difficult task in preventing these lymphomas is the recognition of early lesions likely to regress after the removal of the exogenous stimulus. Copyright 2001 Harcourt Publishers Ltd.

6
UI - 20523169
AU - Bonithon-Kopp C; Kronborg O; Giacosa A; Rath U; Faivre J
TI - Calcium and fibre supplementation in prevention of colorectal adenoma recurrence: a randomised intervention trial. European Cancer Prevention Organisation Study Group.
SO - Lancet 2000 Oct 14;356(9238):1300-6
AD - Registre Bourguignon des Tumeurs Digestives, Faculte de Medecine de Dijon, France.
BACKGROUND: Some epidemiological studies have suggested that high dietary intake of calcium and fibre reduces colorectal carcinogenesis. Available data are not sufficient to serve as a basis for firm dietary advice. We undertook a multicentre randomised trial to test the effect of diet supplementation with calcium and fibre on adenoma recurrence. METHODS: We randomly assigned 665 patients with a history of colorectal adenomas to three treatment groups, in a parallel design: calcium gluconolactate and carbonate (2 g elemental calcium daily), fibre (3.5 g ispaghula husk), or placebo. Participants had colonoscopy after 3 years of follow-up. The primary endpoint was adenoma recurrence. Analyses were by intention to treat. FINDINGS: 23 patients died, 15 were lost to follow-up, 45 refused repeat colonoscopy, and five developed severe contraindications to colonoscopy. Among the 552 participants who completed the follow-up examination, 94 stopped treatment early. At least one adenoma developed in 28 (15.9%) of 176 patients in the calcium group, 58 (29.3%) of 198 in the fibre group, and 36 (20.2%) of 178 in the placebo group. The adjusted odds ratio for recurrence was 0.66 (95% CI 0.38-1.17; p=0.16) for calcium treatment and 1.67 (1.01-2.76, p=0.042) for the fibre treatment. The odds ratio associated with the fibre treatment was significantly higher in participants with baseline dietary calcium intake above the median than in those with intake below the median (interaction test, p=0.028) INTERPRETATION: Supplementation with fibre as ispaghula husk may have adverse effects on colorectal adenoma recurrence, especially in patients with high dietary calcium intake. Calcium supplementation was associated with a modest but not significant reduction in the risk of adenoma recurrence.

7
UI - 21078384
AU - Simone CB; Simone NL; Simone CB 2nd
TI - Fibre supplementation.
SO - Lancet 2001 Feb 3;357(9253):393-4

8
UI - 21253470
AU - Ikeda K; Saitoh S; Kobayashi M; Suzuki Y; Suzuki F; Tsubota A; Arase Y; Murashima N; Chayama K; Kumada H
TI - Long-term interferon therapy for 1 year or longer reduces the hepatocellular carcinogenesis rate in patients with liver cirrhosis caused by hepatitis C virus: a pilot study.
SO - J Gastroenterol Hepatol 2001 Apr;16(4):406-15
AD - Department of Gastroenterology, Toranomon Hospital and Okinaka Memorial Institute for Medical Research, Tokyo, Japan. ikedakenji@tora.email.ne.jp
BACKGROUND AND METHODS: In order to elucidate the influence of a long-term administration of interferon on the appearance rates of hepatocellular carcinoma (HCC) in hepatitis C virus (HCV)-related cirrhosis, we retrospectively analyzed 694 patients with cirrhosis. A total of 113 patients underwent interferon therapy, including 25 patients with a long-term administration of interferon for 1 year or more, and the other 581 patients received no antiviral drugs. RESULTS: Crude cumulative appearance rates of HCC in the interferon and the untreated groups were 14.1, and 28.4% at the end of the 5th year, and 36.7 and 52.5% at the end of the 10th year, respectively (P = 0.0028). As there was a waiting time between diagnosis and treatment (median 2.0 months, average 21.3 months) in the treated group, Cox proportional hazard analysis using a time-dependent covariate was introduced to evaluate the anticarcinogenic effect of interferon. Although male sex, higher alpha-fetoprotein, older age, lower albumin concentration, and lower platelet count significantly increased the carcinogenesis rate, interferon was not a significant contributing factor to the carcinogenesis rate as a whole (hazard ratio = 0.83, P= 0.32). When the patients with interferon were divided into two groups according to therapy duration, long-term interferon therapy significantly decreased the hepatocellular carcinogenesis rate after an adjustment by significant covariates (hazard ratio = 0.28, P= 0.0048). CONCLUSION: When interferon is administered for 12 months or longer, effective cancer prevention will be achieved, even in patients with HCV-related cirrhosis.

9
UI - 21430216
AU - Moore KJ
TI - Medicare expands preventive screening benefits.
SO - Fam Pract Manag 2001 Jun;8(6):16

10
UI - 21385794
AU - Codori AM; Petersen GM; Miglioretti DL; Boyd P
TI - Health beliefs and endoscopic screening for colorectal cancer: potential for cancer prevention.
SO - Prev Med 2001 Aug;33(2 Pt 1):128-36
AD - Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD 21287, USA. acodori@mail.jhmi.edu
BACKGROUND: Colorectal cancer can be prevented through endoscopic removal of adenomatous polyps. Because screening endoscopy rates are low, it is critical to identify correlates of screening behavior that are amenable to interventions to improve screening rates. Our purpose was to identify the correlates of endoscopic screening among persons at risk for colorectal cancer. METHODS: We surveyed 1,160 healthy, adult, first-degree relatives of colorectal cancer patients in 583 kindreds, for a 43% response rate. Using multiple logistic regression analysis, we tested the association between screening behavior and perceived risk for colorectal cancer, the belief that colorectal cancer can be prevented, demographic factors, strength of family history, and practical barriers to screening. RESULTS: Persons screened at least once were older, were male, had stronger family histories, had a regular doctor, and had health insurance. After these fixed factors were accounted for, the belief that colorectal cancer can be prevented and higher perceived risk were associated with significantly greater odds of screening. CONCLUSIONS: This study establishes the need for trials evaluating the cancer prevention potential of the link between screening behavior and health beliefs. Physicians must be aware of their patients' family colorectal cancer history and recommend appropriate endoscopic screening for those at increased risk, particularly women. Patients should be educated about their cancer risk and about preventing colorectal cancer. Copyright 2001 American Health Foundation and Academic Press.

11
UI - 21404071
AU - Fennerty MB; Triadafilopoulos G
TI - Barrett's-related esophageal adenocarcinoma: is chemoprevention a potential option?
SO - Am J Gastroenterol 2001 Aug;96(8):2302-5
AD - Division of Gastroenterology, Oregon Health Sciences University, Portland 97201-3098, USA.
OBJECTIVE: Review the rationale behind secondary prevention of Barrett's related esophageal adenocarcinoma and critically appraise the emerging literature regarding prevention of neoplasia in Barrett's esophagus with antisecretory and/or cyclo-oxygenase inhibition therapy. METHODS: The existing English language literature regarding secondary cancer prevention in patients with Barrett's esophagus is reviewed and its potential clinical implications discussed. RESULTS: There is biologic plausibility to pursue "chemoprevention" trials with antisecretory and/or cyclo-oxygenase inhibition therapy in patients with Barrett's esophagus. CONCLUSION: Chemoprevention trials using potent antisecretory therapy coupled with cyclo-oxygenase 2 inhibition are warranted and may provide a means of decreasing the occurrence of cancer and cancer-related mortality in this disease.

12
UI - 21238968
AU - Holcombe RF; Milovanovic T; Stewart RM; Brodhag TM
TI - Investigating the role of immunomodulation for colon cancer prevention: results of an in vivo dose escalation trial of levamisole with immunologic endpoints.
SO - Cancer Detect Prev 2001;25(2):183-91
AD - Division of Hematology-Oncology and Chao Family Comprehensive Cancer Center, University of California, Irvine,USA.
The potential role of immunomodulatory agents for colon cancer prevention has not been studied systematically. Levamisole (LMS), which is immunostimulatory, is synergistic with 5-fluorouracil in the adjuvant therapy of patients with stage III colon cancer. This pilot study was initiated to explore the potential utility of LMS as a colon cancer prevention agent and to define the minimum dose at which it retains potentially beneficial effects on the immune system. Normal volunteers were treated over 3 days with LMS at four different dose levels and were monitored for toxicity and immunologic changes. Immunologic endpoints included lymphocyte antigen expression, serum cytokine levels, and two new ex vivo assays that defined LMS's activity in modulating T-helper-1 (Th1) cytokine production. In addition, in vitro dose-response analyses of LMS's effects on cellular immune function were performed. LMS was tolerated without toxicity at low dosages only. Significant increases (P < .0001) in the proportion of peripheral blood mononuclear cells expressing the natural killer antigen CD16 were noted at all dose levels. LMS did not alter serum cytokine levels and only minimally affected Th1 cellular immune function. In vitro analysis demonstrated that LMS is synergistic with interleukin 12 in the induction of a Th1 cytokine response at very low concentrations (1microM). This study suggests that short-term LMS is only minimally immunomodulatory but that immune activity is equivalent at low dosages where the medication is better tolerated. Additional, longer-term, studies of low-dose LMS as a potential colon cancer chemopreventive agent should be considered.

13
UI - 21340483
AU - Miyakawa Y; Iino S
TI - Toward prevention of hepatocellular carcinoma developing in chronic hepatitis C.
SO - J Gastroenterol Hepatol 2001 Jul;16(7):711-4

14
UI - 21393475
AU - Canadian Task Force on Preventive Health Care
TI - Colorectal cancer screening. Recommendation statement from the Canadian Task Force on Preventive Health Care.
SO - CMAJ 2001 Jul 24;165(2):206-8

15
UI - 21385815
AU - Paterson JR; Lawrence JR
TI - Salicylic acid: a link between aspirin, diet and the prevention of colorectal cancer.
SO - QJM 2001 Aug;94(8):445-8
AD - Department of Biochemistry, Dumfries and Galloway Royal Infirmary, Dumfries, UK. J.Paterson@dgri.scot.nhs.uk
Aspirin was introduced into clinical practice more than 100 years ago. This unique drug belongs to a family of compounds called the salicylates, the simplest of which is salicylic acid, the principal metabolite of aspirin. Salicylic acid is responsible for the anti-inflammatory action of aspirin, and may cause the reduced risk of colorectal cancer observed in those who take aspirin. Yet salicylic acid and other salicylates occur naturally in fruits and plants, while diets rich in these are believed to reduce the risk of colorectal cancer. Serum salicylic acid concentrations are greater in vegetarians than non-vegetarians, and there is overlap between concentrations in vegetarians and those taking low-dose aspirin. We propose that the cancer-preventive action of aspirin is due to its principal metabolite, salicylic acid, and that dietary salicylates can have the same effect. It is also possible that natural salicylates contribute to the other recognized benefits of a healthy diet.

16
UI - 21426769
AU - Vainio H; Bianchini F
TI - Physical activity and cancer prevention -- is 'no pain, no gain' passe?
SO - Eur J Cancer Prev 2001 Aug;10(4):301-2

17
UI - 21426770
AU - La Vecchia C
TI - Oral contraceptives, cancer and vascular disease.
SO - Eur J Cancer Prev 2001 Aug;10(4):303-5

18
UI - 21426774
AU - Benamouzig R; Yoon H; Little J; Martin A; Couturier D; Deyra J; Coste T; Chaussade S; APACC Study Group. Association pour la Prevention par Aspirine du Cancer Colorectal
TI - APACC, a French prospective study on aspirin efficacy in reducing colorectal adenoma recurrence: design and baseline findings.
SO - Eur J Cancer Prev 2001 Aug;10(4):327-35
AD - Service de gastro-enterologie, Hopital Avicenne, 125 rue de Stalingrad, 93009 Bobigny Cedex, France. robert.benamouzig@avc.ap-hop-paris.fr
Colorectal cancer is the second most frequent cause of death from cancer in western countries. Many lines of evidence suggest that non-steroidal anti-inflammatory drugs (NSAIDs) may offer chemoprevention against colorectal cancer. A multicentre, double-blind, randomized, controlled trial is underway to determine the efficacy of regular aspirin intake (160 or 300 mg/day) in reducing colorectal adenoma recurrence. We now report the baseline characteristics of subjects enrolled into the trial. Results: A total of 618 polyps were excised from 274 patients at the baseline colonoscopy. Men had on average (+/-SD) 2.5 +/- 1.8 polyps per subject and women had 1.7 +/- 1.2. Ninety-one (33.7%) had three or more adenomas and 183 (67.8%) had more than one adenoma measuring 10 mm or more in diameter. The mean (+/-SD) age of the subjects was 57.7 (+/- 9.4) years. Sixty-seven (24.9%) reported that they had previously had adenoma(s), 95 (35.2%) reported a family history of colorectal cancer and 41 (15.2%) a family history of colorectal adenomas. Perspective: All subjects will undergo a one-year clearance colonoscopy by February 2001. Clinical, molecular biological and dietary data will enable us to investigate other factors influencing the recurrence of adenomas in this group of high-risk subjects.

19
UI - 21413415
AU - Lanza E; Schatzkin A; Daston C; Corle D; Freedman L; Ballard-Barbash R; Caan B; Lance P; Marshall J; Iber F; Shike M; Weissfeld J; Slattery M; Paskett E; Mateski D; Albert P; PPT Study Group
TI - Implementation of a 4-y, high-fiber, high-fruit-and-vegetable, low-fat dietary intervention: results of dietary changes in the Polyp Prevention Trial.
SO - Am J Clin Nutr 2001 Sep;74(3):387-401
AD - National Cancer Institute, Bethesda, MD, USA. el33t@nih.gov
BACKGROUND: The Polyp Prevention Trial (PPT) was a multicenter randomized clinical trial designed to determine the effects of a high-fiber (4.30 g/MJ), high-fruit-and-vegetable (0.84 servings/MJ), low-fat (20% of energy from fat) diet on the recurrence of adenomatous polyps in the large bowel. OBJECTIVE: Our goal was to determine whether the PPT intervention plan could effect change in 3 dietary goals and to examine the intervention's effect on the intake of other food groups and nutrients. DESIGN: Participants with large-bowel adenomatous polyps diagnosed in the past 6 mo were randomly assigned to either the intervention (n = 1037) or the control (n = 1042) group and remained in the trial for 4 y. Three dietary assessment instruments were used to measure dietary change: food-frequency questionnaires (in 100% of the sample), 4-d food records (in a 20% random cohort), and 24-h dietary recalls (in a 10% random sample). RESULTS: Intervention participants made and sustained significant changes in all PPT goals as measured by the dietary assessment instruments; the control participants' intakes remained essentially the same throughout the trial. The absolute differences between the intervention and control groups over the 4-y period were 9.7% of energy from fat (95% CI: 9.0%, 10.3%), 1.65 g dietary fiber/MJ (95% CI: 1.53, 1.74), and 0.27 servings of fruit and vegetables/MJ (95% CI: 0.25, 0.29). Intervention participants also reported significant changes in the intake of other nutrients and food groups. The intervention group also had significantly higher serum carotenoid concentrations and lower body weights than did the control group. CONCLUSION: Motivated, free-living individuals, given appropriate support, can make and sustain major dietary changes over a 4-y period.