1 colorectal cancer # 2 cancer killer # 2 cancer killer screening saves lives

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Colorectal Cancer

# 2CancerKiller

# 2CancerKiller

SCREENING SAVES LIVESSCREENING SAVES LIVES

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Average risk - 1 out of 18 chance per lifetime

High risk – 1 out of 5 chance per lifetime

The Bad News: Frequency

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The Bad News: Deadly

1. Lung Cancer2. Colorectal Cancer

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The Bad News: Expensive

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Assessing your individual risk

You have a higher risk if you have any of the following risk factors:

• Personal history of colorectal cancer or polyps• Personal history of inflammatory bowel disease• Family history of colorectal cancer or polyps• Certain inherited cancer syndromes

Even without symptoms, people with these risk factors need earlier and more frequent screening

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Assessing your individual risk

Also, you have a higher risk if you have one or more of the following symptoms:– Rectal bleeding– Iron deficiency anemia– Change in bowel habits; constipation or diarrhea– Persistent abdominal pain

If you have these symptoms, you should seek evaluation immediately.

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AVERAGE RISK

If you don’t have these risk factors or symptoms, you are considered to have average risk for developing colorectal cancer.

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IMPORTANCE OF AGE 50

Colorectal Cancer Occurrencefor Average Risk Individuals

Before Age 50

6%

After Age 50

94%

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ATTENTION AVERAGE RISK IOWANS

American Cancer Society. Cancer Facts & Figures 2002. Atlanta, GA: American Cancer Society; 2002:20–27.

75Average-Risk Cases: 75%%

High-Risk Cases:25%

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Good News

10 years

A series of changes in the cells lining the colon takes 10 years to progress from normal to colon cancer.

There is time to intervene There is time to intervene

10 years

Normal Polyp Cancer

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• The most preventable form of digestive tract cancer if screening is performed

More Good News

Alive at diagnosis Alive 5 years later

1 year 2 year 3 year 4 year 5 year

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And More Good News:

FOBT Flex Sig

Colonoscopy

Double Contrast Barium Enema

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So What’s the Problem?

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025

50

75

100

Late DetectionFive year survival rates

Stage I Stage II Stage III Stage IV

96%84% 65%

8%0

25

50

75100

SEER*Stat -- Version 6.2.4

Only 60% of patientsare diagnosed early

40% of patientsare diagnosed late

100%

Stage 0

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Why aren’t Iowans screened?

• The most common reasons -

• “My doctor never told me I should be screened.” • “I’m embarrassed!” • “The screening tests cost too much!”• “I don’t think that insurance covers screening.”• “I don’t have a family history of colorectal cancer.”• “I don’t have any symptoms of colorectal cancer.”

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How do you screen for colorectal cancer?

Beginning at age 50: Fecal occult blood test (FOBT) every year or Flexible sigmoidoscopy (FS) every 5 years,

or FOBT annually + FS every 5 years or Colonoscopy every 10 yrs or Double -contrast barium enema every 5 yrs.

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Fecal Occult Blood Test (FOBT)

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Flexible Sigmoidoscopy

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Location of polyps/cancer

15%

25%20%

10%

30%

Left sideRight side

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FOBT AND FS

• FOBT detects larger, bleeding polyps, but is less accurate for smaller, non-bleeding polyps

• Flexible sigmoidoscopy detects left-sided lesions, but misses 30-40% of all polyps and cancers that are right-sided

• The combination of both tests largely corrects the limitations of performing either test alone. FS + FOBT=75%

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Colonoscopy

removes polyps

biopsies cancer

examinesentire colon

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Double Contrast Barium Enema (DCBE)

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Other New Screening Tests

• Virtual colonoscopy

• Stool DNA test

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Virtual Colonoscopy

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Stool DNA Test

PhysicianSends

Requisitionto Lab

Lab ProvidesCollection and

Shipping Materialsto Patient

Patient CollectsStool at Home

Patient ReturnsSpecimen to Lab

Physician

:

PhysicianCommunicates

Results to PatientDNA Alteration

IdentifiedPerform colonoscopy

No DNA AlterationIdentified

Continue screening

Stool DNA AnalysisIs Performed in Lab

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What Should You Consider in Choosing a Screening Test

• What does my doctor recommend?

• Which test is most accurate?

• Which test is most convenient?

• Which causes the least discomfort, fear embarrassment?

• Cost-insurance, Medicare coverage?

• What do other people say about it?

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Test cost

Screening Test Estimated ChargeFOBT $10-30FS $150-300DCBE $250-500Colonoscopy $600-1500

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Blood stool test (FOBT) annually Sigmoidoscopy every 4 years Colonoscopy every 10 years Double contrast barium enema as an alternative to either sigmoidoscopy or colonoscopy every 5 yrs

Medicare Coverage for Average Risk patients

(since July 1, 2001)

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Don’t wait until 65 to be screened!

• Insurance covers most, if not all kinds of screening. Consult your insurance plan or provider to determine which tests are covered.

• Screening should begin at age 50, not at age 65, when Medicare coverage begins.

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The Cost of NOT screening

– Individual early disability and death

– Emotional costs for patients and

family

– Treatment cost of colon cancer care

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So What?

• An average risk adult has a 1 in 18 chance of developing this cancer.

• A high risk adult has a 1 in 5 chance of developing this cancer.

Can you afford to take this chance?

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You Can Reduce Deaths Due to Colon Cancer

Screening!

Screening!

Any method of screening is preferable to not

screening!

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Have You and Your Loved Ones

Been Screened?

# 2CancerKiller

# 2CancerKiller

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This presentation was developed by the Iowa Colorectal Cancer Task Force

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Acknowledgements

• American Cancer Society• Centers for Disease Control and Prevention• Exact Sciences• Dr. John Bond, Univ. of Minnesota• Dr. Douglas Rex, Univ. of Indiana• Dr. Robert Summers, Univ. of Iowa• Dr. Nancy Thompson, Univ. of Iowa• Dr. Steven Wolfe, Univ. of Iowa

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www.cancer.org

www.ccalliance.org

www.preventcancer.org/colorectal

www.hopkinskimmelcancercenter.org

www.colorectal-cancer.net

www.cdc.gov/cancer/screenforlife/index.htm

Colorectal Cancer Web Links