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#2
Cancer
Killer
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The Bad News: Deadly
2. Lung Cancer
3. 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:
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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 Occurrence
for Average Risk Individuals
Before
Age 50
6%
After
Age 50
94%
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ATTENTION AVERAGE RISK
IOWANS
High-Risk Cases:
25%
American Cancer Society. Cancer Facts & Figures 2002. Atlanta, GA: American Cancer 9
Society; 2002:20–27.
Good News
10
years
Double
Contrast
Colonoscopy Barium
Enema
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So What’s the Problem?
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Late Detection
Five year survival rates
100% 96%
100 84% 100 65%
75 75
50 50
25 25 8%
0 0
Stage 0 Stage I Stage II Stage III Stage IV
Only 60% of patients 40% of patients
are diagnosed early are diagnosed late
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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
10% 15%
30% 25%
20%
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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
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Other New Screening Tests
• Virtual colonoscopy
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Virtual Colonoscopy
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Stool DNA Test
Physician Patient Collects
Sends Stool DNA Analysis
Requisition Stool at Home Is Performed in Lab
to Lab Physician
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Medicare Coverage for
Average Risk patients
• 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
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The Cost of NOT screening
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So What?
• An average risk adult has a 1 in 18
chance of developing this cancer.
#2
Cancer
Killer
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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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Colorectal Cancer Web Links
www.cancer.org
www.ccalliance.org
www.preventcancer.org/colorectal
www.hopkinskimmelcancercenter.org
www.colorectal-cancer.net
www.cdc.gov/cancer/screenforlife/index.htm
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