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 Yale-New Haven Hospital, New Haven, Connecticut, USA HealthLINK: Cancer

October 29, 1999

News this month
Screen for life for colorectal cancer

Despite the availability of effective screening tests and new screening guidelines, too few people are getting screened for colorectal cancer, according to recent reports from the U.S. Centers for Disease Control and Prevention (CDC). Colorectal cancer will be diagnosed in about 130,000 people this year and will cause about 56,000 deaths in men and women equally.

Many deaths from colorectal cancer could be prevented with regular screening and appropriate treatment.

Although many deaths from colorectal cancer could be prevented with regular screening and appropriate treatment, current U.S. screening rates are low, according to a recent report in the CDC’s Morbidity and Mortality Weekly Report.

In 1997, all 50 states, the District of Columbia and Puerto Rico participated in the Behavioral Risk Factor Surveillance System (BRFSS), a population-based, random telephone survey of Americans 18 years or older. In all, 52,754 people at least 50 years old were asked if they had ever had a blood stool test (fecal occult blood test or FOBT) using a home kit and whether they had ever had a sigmoidoscopy or proctoscopy, and when the last tests had been performed. Overall, only 41 percent of these adults reported having had one of the two commonly recommended screening tests, which are recommended annually for all people age 50 and older.

Who’s getting tested?

  • For both types of tests, people at higher levels of education and income were more likely to have the test done, as were people with health care coverage.
  • Women (35.1%) were more likely than men (26.7%) to have exam done.
  • There were differences from state to state. People in Mississippi were the least likely (9.2%) to have the FOBT while people in Maine were the most likely (28.4%). The proportion of respondents who reported having had sigmoidoscopy/ proctoscopy during the preceding five years ranged from 15.5 percent in Oklahoma to 41.5 percent in the District of Columbia. In Connecticut, 24.2 percent had FOBT while 35.1 percent had the exam.

Despite new research that clearly shows the benefits of screening, these results are only slightly improved from 1995 CDC state-based findings.

The greatest risk factor for colorectal cancer is age.

The low numbers prompted the U.S. Surgeon General to launch "Screen for Life—The National Colorectal Cancer Action Campaign." The campaign is a collaboration between the CDC, the Health Care Financing Administration and the National Cancer Institute. The national education campaign aims to educate Americans age 50 years and older about the importance of screening for colorectal cancer. The campaign also encourages people at increased risk for colorectal cancer to talk to their doctors about screening.

Who is at risk for colorectal cancer?
While some risk factors for colorectal cancer, such as family history and age, cannot be changed, other risk factors can be controlled. According to the CDC, the greatest risk factor for colorectal cancer is age. Ninety percent of people with colorectal cancer are age 50 and older. Other risk factors may include physical activity, excessive alcohol consumption and a high-fat or low fiber diet. People with irritable bowel syndrome are also considered at elevated risk.

Estrogen replacement therapy or nonsteroidal anti-inflammatory drugs may decrease the risk of colorectal cancer.



Physician Referral Online

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of Yale-New Haven Hospital.

Physician Referral Online
Using your own criteria, you can request information from a database of 900 area physicians who have registered to participate.

Request an appointment
We would be happy to assist you in scheduling an appointment with a member of the hospital's medical staff. Use the link above or call:

203-688-2000
or toll free
1-888-700-6543
to talk with a referral coordinator.
Barbara Burtness, M.D.

Where we stand with colorectal cancer

There’s been great interest lately in how to best prevent colorectal cancer. Does a high fiber diet work? Do nonsteroidal, anti- inflammatory medications protect against this type of cancer? In both of these areas, the protective effect of the interventions is not yet well established. In fact, we are currently participating in a major clinical trial to determine whether aspirin has a protective effect against colorectal cancer.

"We cannot emphasize too highly the importance of getting screened annually for colorectal cancer after the age of 50.…screening is the most powerful intervention in stopping colorectal cancer."

But whatever the results of these trials may be, we cannot emphasize too highly the importance of getting screened annually for colorectal cancer after the age of 50. Since 1993 we have known screening is the most powerful intervention in stopping colorectal cancer. There is no debate about the tremendous value of a sigmoidoscopy exam every three to five years in detecting colorectal cancer in its earliest stages.

Family history of colorectal cancer
In certain families, genetics certainly play a part in the acquisition of colorectal cancer. In 1996, Dr. Stanley Winawer found that "siblings and parents of patients with adenomatous polyps are at increased risk for colorectal cancer, particularly when the cancer is diagnosed before the age of 60 or, in the case of siblings, when a parent has had colorectal cancer. "Certainly anyone who has a family history of the disease should start getting screened about 10 years younger than their youngest relative was when they got it. Anyone who has chronic inflammatory bowel disease like ulcerative colitis should be screened early as well.

"Anyone who has a family history of the disease should start getting screened about 10 years younger than their youngest relative was when they got it."

How colorectal cancer forms
In most cases, colorectal cancer develops slowly over a period of years from small growths on the inside wall of the colon called polyps. During a flexible sigmoidoscopy, a hollow, lighted tube is used to visually inspect the inside walls of the rectum and the left side of the colon (which is the sigmoid colon). The physician is looking for any polyps or other abnormalities. For reasons we do still not fully understand, some or all of these growths may gradually become cancerous over time. So during an exam, if any polyps are seen, the physician removes them, ending the risk that they will become cancerous. So you have detection and treatment all in one step in many cases.

Any removed tissue is examined in a lab to determine whether the polyps were benign, pre-cancerous or cancerous. Sometimes, a more complete exam is required and the physician performs a colonoscopy, which is an examination of the entire colon.

The importance of polyp removal in the prevention of colorectal cancer has been emphasized for several years. One of the first studies to document its value was done by Winawer and published in the New England Journal of Medicine in 1993. The National Polyp Study examined the incidence of colorectal cancer in 1,418 patients who underwent colonoscopy during which one or more polyps were removed. The patients were then followed for nearly six years on average. During follow-up, only five early-stage cancers were found and removed, and no symptomatic cancers were found.

Rectal bleeding is a major indicator of the presence of colorectal cancer.

A test you can do at home
In addition to the tests done in your doctor’s office, fecal occult blood tests are a very important part of screening for colorectal cancer. A fecal occult blood test checks for any blood that is present in a small sample of stool. These tests can even be done at home now, and then the sample is mailed into a lab. Bleeding is a major indicator of the presence of colorectal cancer, which is why it’s important that anyone with rectal bleeding should seek further evaluation.

Current screening guidelines
With that said, how often should you be screened? Several scientific organizations have put forth the following screening guidelines for people over age 50:

  • Annual FOBT
  • Flexible sigmoidoscopy every five years
  • Total colon examination by colonoscopy every 10 years or by double contrast barium enema every five to 10 years

Dr. Barbara Burtness is a principal investigator of a number of colorectal cancer trials at the Yale Cancer Center and is a medical oncologist affiliated with Yale-New Haven Hospital.

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