HLTH 634

June 3, 2017

EARLY DETECTION AND

SCREENING OF COLON CANCER
LITERATURE REVIEW
BRIANNA KELLY
LIBERTY UNIVERSITY
HLT 634 HEALTH COMMUNICATION AND ADVOCACY
LIBERTY UNIVERSITY

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Introduction
Cancer is a disease that is known worldwide. It is a disease that can affect everyone from
pediatrics to geriatrics and the rates of incidence are only increasing. Over the years there has
been a plethora of research done about different aspects of cancer. One of the most important
issues within the cancer arena is the topic of early detection and screening. Colon cancer is a
type of cancer that can be found early due to early detection and screening, but is still the
number 3 most common cancer in the United States and more and more people are
succumbing to this disease. The purpose of this health program is the educate people in
underserved populations of the importance of early detection and screening of colon cancer.
This will be done through educational sessions that work to help participants learn the signs
and symptoms of colon cancer, as well as the importance and benefits of early detection. This
literature review takes a look at current research that has been done on colon cancer, early
detection, and the screening process. In this research, key words like colon cancer,
colorectal cancer, screening, and early detection. were used and the searchers were
limited to research that had been done within the last 5-8 years. This allowed for the most
relevant and recent work to be reviewed.

Body of Evidence
The majority of data that was collected in this literature review came from online medical
journals. These journals were case studies that were conducted by researchers. The
researchers than took the data they collected and wrote articles summarizing what they
found. In all of the articles I reviewed, they talked about the importance of early detection
and proper screening to find colon cancer. This literature review focused on colon cancer not
only in the United States, but throughout the world to get a better understanding on a global
level.
Colon cancer is a disease that affects people on a global level. Colon cancer affects both
men and women and the rates are increasing. De Rosa, Costabile, and Rega focused on the
scientific aspect of colon cancer. They sought to understand the importance of characterizing
genotypic and phenotypic heterogeneity.1 They found that it was important to look at the
genes and to characterize them based on both molecular and clinical characteristics.1 This is
important because it helps doctors create a personalized plan on how to treat ones cancer
based on the characteristics of their genes.1 They found that there is an increase in survival
and a reduction of side effects when a patients treatment plan is tailored based on their gene
type.
Similarly, to De Rosa, Costabile, and Regas research, Weiss, Corley, and Quinn
discussed current colon cancer testing. Colon cancer can occur anywhere within the colon,
but must people have tumors on either the right side or the left side of their colon.2
Researchers have discussed whether colonoscopies are actually effective in decreasing colon
cancer that is found on the right side of the colon. Researchers created a nested case study
using members of Kaiser Permanente healthcare. They chose to look at participants that were
between the ages of 55 and 90 that has succumbed to colon cancer between the years of 2006
and 2012.2 They looked at the data of 1747 patients that lost their lives to colon cancer and
3460 people that didnt have cancer.2 Through their research they found that people that
received a colonoscopy had a 67% reduction in risk of death for colon cancer on the right

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side, and 75% reduction for colon cancer on the left side.2 This is important because this
research proved that screening colonoscopies are an important tool in diagnosing colon
cancer at an early stage.2
Comparably, in Korea, the National Cancer Screening program sought to gather
information on cancer screening and socioeconomic status. They reviewed the data of 10,528
patients that suffered from cancer of the breast, cervix, colorectal, and stomach.3 They put
each patient into one of four groups based on their socioeconomic status.3 Their stage of
cancer was defined as either early or late stage.3 Through their research they found that
people in the lowest socioeconomic status had a much higher risk of being diagnosed with
cancer at a later stage.3 Their results correlated with our proposed health plan. We believe
that more work needs to be done to help people in low socioeconomic status gain access to
proper screening.
More and more research is being done to create newer more effective ways to predict
incidence of colon cancer. According to a study published in the Cancer Prevention Research
journal, there is a new technique that helps detect genetic variations that can cause colon
cancer.4 They found that cancer cells are released into feces from the surface of early-stage
colorectal cancer.4 Although this is a possibility, it has been very complicated to do. Through
their research they found that utilizing a combination of locked nucleic acid based, blocking
polymerase chain reaction and melting, they were able to do so.4 About 60 percent of patients
with colon cancer have these genes. If these genes are found early on, this could help find
colon cancer before it is late stage. They have found that this new technique is almost 5,000
fold more sensitive than other noninvasive screening technqniques.4
In Alberta, Canada research was done to look further into the early detection of colorectal
cancer and delays in care.5 They sought to understand the factors that contributed to a delay
in care. 9626 patients have a part of this study. They found that 25% of patients were seen as
urgent, 32% were screen detected, and 43% per sympotomatic.5 For people that were non-
urgent their time of diagnosis was greater than 6 months.5 Patients that went to their general
physicians for 3 or more visits in regards to their symptoms had a median of 140 days until
they were diagnosed.5 This research showed just how important educating both patients and
healthcare professionals can be. If a patient present with the same symptoms more than once,
more testing should be done to dive a little deeper. Colonoscopies or noninvasive testing
should be used to rule out colon cancer.5
According to the American Cancer Society, there are guidelines that should be looked at
when deciding who should begin getting colon cancer screening. Both men and women that
are 50 years of age or older should begin regular screening.6 People that have a family history
of colon cancer and people that have had polyps removed from their colon have a higher risk
of developing colon cancer.6 People that have a history of ulcerative colitis or Crohns
disease also have a higher risk of developing colon cancer and people that have familial
adenomatous polyposis or Lynch syndrome.6 It is important to know what guidelines are in
place because this helps create guidelines for ones own research and helps figure out what
groups of people should be researched.
The American Cancer Society, The American College of Radiology, and the US Multi-
Society Task Force on Colorectal Cancer worked to find out if early detection had a great
impact on colorectal cancer.7 They looked at all the screening tests that were available to
detect colon cancer, both invasive and noninvasive.7 They discovered that most screening
tests that were available are a good option to diagnose colon cancer at an early stage.7 This

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early detection helped reduce the rate of mortality.7 This is because the patients colon cancer
was found at a stage that was curable. This further explains how important and effective early
detection is at reducing the incidence of death due to late stage colon cancer diagnosis.
The Center for Disease Control and Prevention has done research to determine what type
of education can be used to help the community gain a better understanding of the
importance of colon cancer and early detection.8 They discussed group education where
members are screened for colon cancer after the group is presented with information that
talked about the importance and benefits of screening for colon cancer.8 They also discuss
ways to overcome any barriers that might prevent one from participating in screening.8 One
on One education is another technique that they discussed. This is where a teacher, health
advisor, or volunteer works with an individual to explain and educate on colon cancer and
early detection.8 This is a good option because it helps tailor the message to an individual and
makes the education more personalized.8
Similar to other research discussed in this literature review, colon cancer incidence is on
the rise in some areas and decreasing in others. In Western countries, rates of colon cancer
are decreasing due to cancer screening programs and the early detection of colon cancer.9 In
other countries were screening isnt done as regularly, rates are steadily increasing.9 The
availability of screening programs does have an effect on peoples abilities to find their colon
cancer at an early stage.9 People from low socioeconomic status that dont have access to this
care, typically fine their colon cancer at a later stage. This leads to higher rates of mortality.9
Researchers Ay and Eryilmaz published an article that looked at focused on red cell
distribution and colon cancer.10 Researchers looked at 115 patients with polyps in their colon
and 30 that had colon cancer that were diagnosed histpathologically.10 Patients that were
anemic or had other blood diseases werent included. Red blood cells, mean corpuscular
volume, hemoglobin, and platelet numbers were recorded and how they related to colon
cancer was looked at.10 They found that patients that had colon cancer had higher numbers of
red blood cells than those that didnt. They concluded that patients with high red blood cells
can be a way to find out whether someone has colon cancer.10 They found this is a cheap and
easy way to get the ball rolling in the early detection of colon cancer, but shouldnt be the
only test done.1

Summary and Conclusions

The most important research that was discovered correlated with the purpose of our proposed
health program. The research article published in GUT medical journal that focused on
finding whether screening colonoscopies had an effect on diagnosis of colon cancer. The
study that was conducted in Korea that focused on socioeconomic status and cancer
screening was also extremely important. They found that people that were in low
socioeconomic statuses had a higher likelihood of finding their colon cancer at a later stage.
More research can be done to dive deeper into the effects of early detection. A lot of research
has been done to prove that early detection is important, but there isnt a significant amount
of research that shows the impacts early detection has on patients survival rates. This
literature review depicted the important of early detection and colon cancer. All research
proved that early detection is a way to find colon cancer at an early stage. Doing so also
reduced the rate of mortality due to late stage colon cancer.

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References:

1. De Rosa M, Rega D, Costabile V, et al. The biological complexity of colorectal

cancer: Insights into biomarkers for early detection and personalized care.
Therapeutic Advances in Gastroenterology. 2016;9(6).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5076770/. Accessed June 4, 2017.
2. Weiss NS, Corley DA, Quinn VP, et al. Effectiveness of screening colonoscopy in
reducing the risk of death from right and left colon cancer: A large community-based
study. Gut. October 2016:2016312712. doi:10.1136/gutjnl-2016-312712.
http://gut.bmj.com/content/early/2016/10/12/gutjnl-2016-312712.long. Accessed June
4, 2017.
3. Keon S-A, Kim M, Dang M-R. Difference of stage at cancer diagnosis by
socioeconomic status for four target cancers of the National Cancer Screening
Program in Korea: Results from the Gwangju and Jeonnam cancer registries. Journal
of Epidemiology.
http://www.sciencedirect.com/science/article/pii/S0917504017300230. Published
March 6, 2017. Accessed June 4, 2017.
4. Scholtka B. New Method For Early Detection Of Colon Cancer. Biocompare.
http://www.biocompare.com/Life-Science-News/144763-New-Method-For-Early-
Detection-Of-Colon-Cancer/. Published September 5, 2013. Accessed June 4, 2017.
5. Sikdar KC, Dickinson J, Winget M. Factors associated with mode of colorectal
cancer detection and time to diagnosis: a population level study. BMC Health
Services Research.
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-016-1944-y.
Published January 5, 2017. Accessed June 4, 2017.
6. American Cancer Society Recommendations for Colorectal Cancer Early Detection.
American Cancer Society. https://www.cancer.org/cancer/colon-rectal-
cancer/detection-diagnosis-staging/acs-recommendations.html. Published January 27,
2017. Accessed June 4, 2017.
7. Screening and Surveillance for the Early Detection of Colorectal Cancer and
Adenomatous Polyps, 2008: A Joint Guideline From the American Cancer Society,
the US Multi-Society Task Force on Colorectal Cancer, and the American College of
Radiology. AGA INSTITUTE. http://www.gastrojournal.org/article/S0016-
5085(08)00232-1/pdf. Published 2008. Accessed June 4, 2017.
8. Cancer Prevention and Control. Centers for Disease Control and Prevention.
https://www.cdc.gov/cancer/dcpc/research/articles/screening_int.htm. Published July
19, 2012. Accessed June 4, 2017.
9. Labianca R, Nordlinger B, Beretta GD, et al. Early colon cancer: ESMO Clinical
Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology.
https://academic.oup.com/annonc/article/24/suppl_6/vi64/161392. Published October
1, 2013. Accessed June 4, 2017.
10. Ay S, Eryilmaz2 M. Is Early Detection of Colon Cancer Possible with Red Blood
Cell Distribution Width? Distinction of Colon Cancers and Polyps with the Red Cell
Distribution Width.

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http://journal.waocp.org/article_30500_277f67743feb95b98b299df8fe5c5381.pdf.
Published 2015. Accessed June 4, 2017.

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