National Cancer Institute®
Last Modified: April 1, 2002
UI - 11913913
AU - Yusoff IF; Hoffman NE; Ee HC
TI - Colonoscopic surveillance for family history of colorectal cancer: are NHMRC guidelines being followed?
SO - Med J Aust 2002 Feb 18;176(4):151-4
AD - Department of Gastroenterology, Sir Charles Gairdner Hospital, Nedlands, WA.
OBJECTIVES: To assess whether referrals for surveillance colonoscopy and subsequent follow-up recommendations for patients with a family history of colorectal cancer concurred with the published National Health and Medical Research Council (NHMRC) guidelines. DESIGN: A prospective audit of patients with a family history of colorectal cancer referred for surveillance colonoscopy. Follow-up recommendations were assessed retrospectively. SETTING AND SUBJECTS: All patients referred to a major teaching hospital for surveillance colonoscopy on the basis of a family OUTCOME MEASURES: Concurrence of referrals and recommendations with NHMRC guidelines. RESULTS: Of 340 patients referred because of a family history of colorectal cancer, 202 (83 men, 119 women) were asymptomatic. Their mean age was 50 years (95% CI, 48.3-51.6 years). The family history of 95 (47%) of these patients satisfied the NHMRC criteria for colonoscopic surveillance. Another 20 patients (17%) satisfied the criteria, but were referred before the recommended age to commence surveillance. Analysis by referral source showed that the proportion of referrals meeting NHMRC guidelines was higher from specialists than from general practitioners (75% v 45%), and this difference was significant. Follow-up recommendations, when made, concurred with NHMRC guidelines in 81% of cases. CONCLUSIONS: Further education of the medical community is required to increase understanding of colorectal screening strategies and ensure appropriate resource allocation.
UI - 11913914
AU - Bampton PA; Sandford JJ; Young GP
TI - Applying evidence-based guidelines improves use of colonoscopy resources in patients with a moderate risk of colorectal neoplasia.
SO - Med J Aust 2002 Feb 18;176(4):155-7
AD - Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, SA. firstname.lastname@example.org
OBJECTIVES: To determine whether applying National Health and Medical Research Council (NHMRC) guidelines for colorectal cancer prevention would reduce the number of follow-up colonoscopies. DESIGN: A prospective audit of colonoscopic surveillance decisions before and after the intervention. SETTING: The endoscopy suite at a metropolitan INTERVENTION: Dissemination of NHMRC guidelines, and supervision of application of the guidelines by a nurse coordinator. SUBJECTS: We compared colonoscopic surveillance decisions before and after the intervention in two groups of 100 consecutive patients after polypectomy and in two groups of 50 consecutive patients with a family history of colorectal cancer after a normal colonoscopy. MAIN OUTCOME MEASURES: Change in concordance of decisions with NHMRC guidelines; and effect on number of follow-up colonoscopies. RESULTS: After the intervention, the proportion of postpolypectomy surveillance decisions matching the guidelines increased from 37% to 96% (P < 0.05). The mean time to repeat colonoscopy after polypectomy increased from 2.7 to 3.5 years (P < 0.005) (ie, a 23% reduction in the number of postpolypectomy surveillance colonoscopies performed per year). Likewise, the proportion of family-history surveillance decisions matching the guidelines increased from 63% to 96%. Adhering to the guidelines resulted in a 17% reduction in colonoscopies performed on the basis of a family history of colorectal cancer. CONCLUSIONS: Supervised application of evidence-based guidelines to a colorectal cancer surveillance program significantly reduces the number of surveillance colonoscopies performed.
UI - 11904306
AU - Gupta RA; DuBois RN
TI - Cyclooxygenase-2 inhibitor therapy for the prevention of esophageal adenocarcinoma in Barrett's esophagus.
SO - J Natl Cancer Inst 2002 Mar 20;94(6):406-7
UI - 11904316
AU - Wu K; Willett WC; Fuchs CS; Colditz GA; Giovannucci EL
TI - Calcium intake and risk of colon cancer in women and men.
SO - J Natl Cancer Inst 2002 Mar 20;94(6):437-46
AD - Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave., Building 2, Boston, MA 02115, USA.
BACKGROUND: Calcium has been hypothesized to reduce the risk of colon cancer, and in a recent randomized trial, calcium supplementation was associated with reduction in the risk of recurrent colorectal adenomas. We examined the association between calcium intake and colon cancer risk in two prospective cohorts, the Nurses' Health Study (NHS) and the Health Professionals Follow-up Study (HPFS). METHODS: Our study population included 87 998 women in NHS and 47 344 men in HPFS who, at baseline (1980 for NHS and 1986 for HPFS), completed a food frequency questionnaire and provided information on medical history and lifestyle factors. Dietary information was updated at least every 4 years. During the follow-up period (1980 to May 31, 1996 for the NHS cohort; 1986 to January 31, 1996 for the HPFS cohort), 626 and 399 colon cancer cases were identified in women and men, respectively. Pooled logistic regression was used to estimate relative risks (RRs), and all statistical tests were two-sided. RESULTS: In women and men considered together, we found an inverse association between higher total calcium intake (>1250 mg/day versus < or =500 mg/day) and distal colon cancer (women: multivariate RR = 0.73, 95% confidence interval [CI] = 0.41 to 1.27; men: RR = 0.58, 95% CI = 0.32 to 1.05; pooled RR = 0.65, 95% CI = 0.43 to 0.98). No such association was found for proximal colon cancer (women: RR = 1.28, 95% CI = 0.75 to 2.16; men: RR = 0.92, 95% CI = 0.45 to 1.87; pooled RR = 1.14, 95% CI = 0.72 to 1.81). The incremental benefit of additional calcium intake beyond approximately 700 mg/day appeared to be minimal. CONCLUSIONS: Higher calcium intake is associated with a reduced risk of distal colon cancer. The observed risk pattern was consistent with a threshold effect, suggesting that calcium intake beyond moderate levels may not be associated with a further risk reduction. Future investigations on this association should concentrate on specific cancer subsites and on the dose-response relationship.
UI - 11905419
AU - Lambert R
TI - Early diagnosis and prevention of colorectal cancer. The Third European Endoscopy Forum: conclusions of a symposium held in Faro, Portugal, June 8-10, 2001, with the help of an educational grant from Olympus.
SO - Endoscopy 2002 Mar;34(3):244-6
UI - 11902587
AU - Schoen RE
TI - The case for population-based screening for colorectal cancer.
SO - Nature Rev Cancer 2002 Jan;2(1):65-70
AD - Division of Gastroenterology, Pennsylvania University Hospital, Pittsburgh 15213-2582, USA. email@example.com
Screening for colorectal cancer is commanding increasing attention. Other cancer screening programmes have been a part of public consciousness for some time, but, until recently, colorectal cancer screening has remained in the background. Fuelled by new research, market opportunities and increased recognition of individual risk, screening for colorectal cancer is becoming a recommended procedure, but controversy about how best to implement widespread screening remains.
UI - 11932472
AU - Giardiello FM; Yang VW; Hylind LM; Krush AJ; Petersen GM; Trimbath JD;
TI - Piantadosi S; Garrett E; Geiman DE; Hubbard W; Offerhaus GJ; Hamilton SR Primary chemoprevention of familial adenomatous polyposis with sulindac.
SO - N Engl J Med 2002 Apr 4;346(14):1054-9
AD - Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
BACKGROUND: Familial adenomatous polyposis is caused by a germ-line mutation in the adenomatous polyposis coli gene and is characterized by the development of hundreds of colorectal adenomas and, eventually, colorectal cancer. Nonsteroidal antiinflammatory drugs can cause regression of adenomas, but whether they can prevent adenomas is unknown. METHODS: We conducted a randomized, double-blind, placebo-controlled study of 41 young subjects (age range, 8 to 25 years) who were genotypically affected with familial adenomatous polyposis but phenotypically unaffected. The subjects received either 75 or 150 mg of sulindac orally twice a day or identical-appearing placebo tablets for 48 months. The number and size of new adenomas and side effects of therapy were evaluated every four months for four years, and the levels of five major prostaglandins were serially measured in biopsy specimens of normal-appearing colorectal mucosa. RESULTS: After four years of treatment, the average rate of compliance exceeded 76 percent in the sulindac group, and mucosal prostaglandin levels were lower in this group than in the placebo group. During the course of the study, adenomas developed in 9 of 21 subjects (43 percent) in the sulindac group and 11 of 20 subjects in the placebo group (55 percent) (P=0.54). There were no significant differences in the mean number (P=0.69) or size (P=0.17) of polyps between the groups. Sulindac did not slow the development of adenomas, according to an evaluation involving linear longitudinal methods. CONCLUSIONS: Standard doses of sulindac did not prevent the development of adenomas in subjects with familial adenomatous polyposis.
UI - 11910370
AU - Fennerty MB
TI - Barrett's-related esophageal cancer: has the final hurdle been cleared, now paving the way for human chemoprevention trials?
SO - Gastroenterology 2002 Apr;122(4):1172-5
UI - 11819768
AU - Miehlke S; Kirsch C; Dragosics B; Gschwantler M; Oberhuber G; Antos D;
TI - Dite P; Lauter J; Labenz J; Leodolter A; Malfertheiner P; Neubauer A; Ehninger G; Stolte M; Bayerdorffer E Helicobacter pylori and gastric cancer:current status of the Austrain Czech German gastric cancer prevention trial (PRISMA Study).
SO - World J Gastroenterol 2001 Apr;7(2):243-7
AD - Medical Department I, Technical University Hospital Carl Gustav Carus, Fetscherstrabetae 74, D 01307 Dresden, Germany.
AIM: To test the hypothesis that Helicobacter pylori eradication alone can reduce the incidence of gastric cancer in a subgroup of individuals with an increased risk for this fatal disease. METHODS: It is a prospective, randomized, double blind, placebo controlled multinational multicenter trial. Men between 55 and 65 years of age with a gastric cancer phenotype of Helicobacter pylori gastritis are randomized to receive a 7 day course of omeprazole 2 X 20mg, clarithromycin 2 X 500mg, and amoxicillin 2 X 1g for 7 days, or omeprazole 2 X 20mg plus placebo. Follow-up endoscopy is scheduled 3 months after therapy, and thereafter in one-year intervals. Predefined study endpoints are gastric cancer, precancerous lesions (dysplasia, adenoma), other cancers, and death. patients (18.3%) had a corpus dominant type of H. pylori gastritis, and 167 of those were randomized (58.8%). In the active treatment group (r = 86), H. pylori infection infection was cured in 88.9% of patients. Currently, the cumulative follow-up time is 3046 months (253.38 patient years, median follow up 16 months). So far, none of the patients developed gastric cancer or any precancerous lesion. Three (1.8%) patients reached study endpoints other than gastric cancer. CONCLUSION: Among men between 55 and 65 years of age, the gastric cancer phenotype of H. pylori gastritis appears to be more common than expected. Further follow up and continuing recruitment are necessary to fulfil the main aim of the study.
UI - 9062331
AU - Burke W; Petersen G; Lynch P; Botkin J; Daly M; Garber J; Kahn MJ;
TI - McTiernan A; Offit K; Thomson E; Varricchio C Recommendations for follow-up care of individuals with an inherited predisposition to cancer. I. Hereditary nonpolyposis colon cancer. Cancer Genetics Studies Consortium.
SO - JAMA 1997 Mar 19;277(11):915-9
AD - Department of Medicine, University of Washington, Seattle 98105-6920, USA.
OBJECTIVE: To provide recommendations for cancer surveillance and risk reduction for individuals carrying mutations associated with hereditary nonpolyposis colon cancer (HNPCC). PARTICIPANTS: A task force with expertise in medical genetics, oncology, primary care, gastroenterology, and epidemiology convened by the Cancer Genetics Studies Consortium (CGSC), organized by the National Human Genome Research Institute (previously the National Center for Human Genome Research). EVIDENCE: Studies evaluating cancer risk, surveillance, and risk reduction in individuals genetically susceptible to colon cancer were identified using MEDLINE and bibliographies of articles thus identified. Indexing terms used were "genetics" in combination with "colon cancer," and "screening" in combination with "cancer family" and "HNPCC." For studies evaluating specific interventions, quality of evidence was assessed using criteria of the US Preventive Services Task Force. CONSENSUS PROCESS: The task force developed recommendations through discussions over a 14-month period. CONCLUSIONS: Efficacy of cancer surveillance or other measures to reduce risk in individuals who carry cancer-predisposing mutations is unknown. Based on observational studies, colonoscopy every 1 to 3 years starting at age 25 years is recommended for individuals known to have HNPCC-associated mutations. Endometrial cancer screening is also recommended, based on expert opinion concerning presumptive benefit. No recommendation is made for or against prophylactic surgery (ie, colectomy, hysterectomy); these surgeries are an option for mutation carriers, but evidence of benefit is lacking. It is recommended that individuals considering genetic testing be counseled regarding the unknown efficacy of measures to reduce risk and that care for individuals with cancer-predisposing mutations be provided whenever possible within the context of research protocols designed to evaluate clinical outcomes.
UI - 10736622
AU - Russo GL; Della Pietra V; Mercurio C; Palumbo R; Iacomino G; Russo M;
TI - Tosto M; Zappia V Protective effects of butyric acid in colon cancer.
SO - Adv Exp Med Biol 1999;472():131-47
AD - Institute of Food Science and Technology, National Research Council, Avellino, Italy.
UI - 11922582
AU - Hamajima N; Matuo K; Watanabe Y; Suzuki T; Nakamura T; Matsuura A; Yamao
TI - K; Ohashi K; Tominaga S A pilot study to evaluate stomach cancer risk reduction by Helicobacter pylori eradication.
SO - Am J Gastroenterol 2002 Mar;97(3):764-5
UI - 11959871
AU - Dong Z; Tang P; Li L; Wang G
TI - The strategy for esophageal cancer control in high-risk areas of China.
SO - Jpn J Clin Oncol 2002 Mar;32 Suppl():S10-2
AD - Department of Epidemiology, Cancer Institute and Hospital (CI/H), Chinese Academy of Medical Sciences (CAMS), Beijing, China.
Even though the mortality from esophageal cancer has decreased during the last two decades nationwide in China, the mortality from esophageal cancer in high-risk areas is still at a high level. Moreover, the 5-year survival rate of patients with resectable esophageal cancer after treatment ranges between 20 and 30%, as majority of patients with esophageal cancer were diagnosed in late stages. Therefore, esophageal cancer control in high-risk areas in China remains a critical task. A strategy is proposed that the high-risk population would be screened by endoscopy with mucosal iodine staining and biopsy of all unstained lesions and diagnosis of severe dysplasia carcinoma in situ, and intra-mucosal carcinoma could be cured by radical mucosectomy. A pilot study showed that the strategy is feasible and cost-effective for the high prevalence of premalignant lesions and carcinomas in early stages. It would be expected that the mortality from esophageal cancer could be decreased in high-risk areas if the proposed strategy is carried out on a large scale.
UI - 11965269
AU - Ransohoff DF
TI - Lessons from the UK sigmoidoscopy screening trial.
SO - Lancet 2002 Apr 13;359(9314):1266-7
AD - Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. firstname.lastname@example.org
UI - 11965274
AU - UK Flexible Sigmoidoscopy Screening Trial Investigators
TI - Single flexible sigmoidoscopy screening to prevent colorectal cancer: baseline findings of a UK multicentre randomised trial.
SO - Lancet 2002 Apr 13;359(9314):1291-300
BACKGROUND: This randomised controlled trial is examining the hypothesis that a single flexible sigmoidoscopy screening offered at around age 60 years can lower the incidence and mortality of colorectal cancer. We report here on acceptability, safety, feasibility, and yield. METHODS: Men and women aged 55-64 years, in 14 UK centres, who responded to a mailed questionnaire that they would attend for flexible sigmoidoscopy screening if invited, were randomly assigned screening or control (ratio one to two). The control group was not contacted. Small polyps were removed during screening, and colonoscopy was undertaken if high-risk polyps (three or more adenomas, size 1 cm or greater, villous, severely dysplastic, or malignant) were found. FINDINGS: Of 354,262 people asked about their interest in having flexible sigmoidoscopy screening, 194,726 (55%) responded positively, and 170,432 eligible individuals were randomised. Attendance among those assigned screening was 71% (40,674 of 57,254). 2131 (5%) were classified as high-risk and referred for colonoscopy; 38,525 with no polyps or only low-risk polyps detected were discharged. Distal adenomas were detected in 4931 (12.1%) and distal cancer in 131 (0.3%). Proximal adenomas were detected in 386 (18.8% of those undergoing colonoscopy) and proximal cancer in nine cases (0.4%). 62% of cancers were Dukes' stage A or locally excised. There was one perforation after flexible sigmoidoscopy and four after colonoscopy. An average of 48 people were screened, and two or three colonoscopy referrals generated, per centre each week.Interpretation Our flexible sigmoidoscopy screening regimen is acceptable, feasible, and safe. The prevalence of neoplasia is high, and colonoscopy referral rates of 5% are acceptable.
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