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Colorectal Cancer Awareness Month
Editorial Edward Chu, MD Professor of Medicine and Pharmacology Chief, Section of Medical Oncology Deputy Director, Yale Cancer Center Yale University School of Medicine New Haven, CT
Clinical Colorectal Cancer, Vol. 8, No, 2, 71, 2009 DOI: 10.3816/CCC.2009.n.011
Colorectal Cancer Awareness Month Colorectal cancer (CRC) continues to be a major health issue in the United States and throughout the world. In 2009, it is estimated that this disease will be diagnosed in nearly 150,000 new patients and will account for almost 50,000 deaths. As we consider these statistics, it is important to remember that March was Colorectal Cancer Awareness Month. While most of us associated with this journal are focused on developing new treatments for this disease, this is an especially timely moment for all healthcare providers involved with colon cancer to increase awareness that this is a truly preventable and curable disease through regular screenings and early detection. Screening and early detection are absolutely critical in our fight to prevent and cure colon cancer. There are presently several screening methods that have been approved by the American Cancer Society and the Centers for Disease Control, and they include fecal occult blood test, sigmoidoscopy, colonoscopy, and barium enema. Virtual colonoscopy is being increasingly used as a screening method, and there is great interest in incorporating stool DNA testing into our screening armamentarium. Without question, colonoscopy remains the gold-standard screening method as it can directly visualize the presence of polyps, remove polyps when detected, and, in so doing, facilitate the removal of the main risk factor for cancerous growth and potentially identify the presence of early-stage colon cancers, When diagnosed in its earliest stages, nearly 90% of patients with colon cancer can be cured. However, once the disease presents in a more advanced stage with metastatic spread, the overall prognosis remains poor, with the vast majority of patients incurable. While we are now observing median overall survival in the 24-30–month range with the integration of cytotoxic chemotherapy and biologic agents, the overall 5-year survival remains at less than 10%. Why the big push for colon cancer screening? Surprisingly, even in 2009, at most only 30%-40% of all individuals in the United
States over the age of 50 years undergo any type of screening, let alone the gold standard of colonoscopy. Perhaps even more striking is the fact that women undergo screening at nearly half the rate of men. There is a misperception that women are at reduced risk for developing CRC than their male counterparts, despite the fact that colon cancer incidence is the same for males and females. Moreover, primary care physicians and healthcare professionals who take care of women do not appreciate that colon cancer represents as significant a concern as breast and cervical cancer, where effective screening methods are also available. Minority and underserved populations also seek colon cancer screening at a much lower rate than the general population. As a result, we must develop creative outreach and awareness programs that can lead to increased screening efforts. As one example, we here at the Yale Cancer Center are working closely with the State of Connecticut and with community leaders to establish colon cancer screening programs for minority and underserved groups. For patients who are survivors of colon cancer, this is certainly a time to celebrate. For individuals who are 50 years and older, this is an appropriate reminder to undergo screening, as screening saves lives. In fact, yours truly, who just hit the magic age of 50 last December, had his screening colonoscopy recently. Certainly, for those individuals at increased risk because of family history, screening should occur at an earlier age and perhaps at more frequent intervals than what is generally recommended for average-risk individuals. Finally, for all healthcare professionals, we must continue to emphasize the importance of colon cancer screening and strive toward developing innovative outreach screening and education programs that serve our respective local communities.
Edward Chu, MD Editor-in-Chief
This summary may include the discussion of investigational and/or unlabeled uses of drugs and/or devices that may not be approved by the FDA. Electronic forwarding or copying is a violation of US and International Copyright Laws. Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by CIG Media Group, LP, ISSN #1533-0028, provided the appropriate fee is paid directly to Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923 USA. www.copyright.com 978-750-8400.
Clinical Colorectal Cancer April 2009
| 71
Clinical Colorectal Cancer, Vol. 8, No, 2, 71, 2009 DOI: 10.3816/CCC.2009.n.011
Colorectal Cancer Awareness Month Colorectal cancer (CRC) continues to be a major health issue in the United States and throughout the world. In 2009, it is estimated that this disease will be diagnosed in nearly 150,000 new patients and will account for almost 50,000 deaths. As we consider these statistics, it is important to remember that March was Colorectal Cancer Awareness Month. While most of us associated with this journal are focused on developing new treatments for this disease, this is an especially timely moment for all healthcare providers involved with colon cancer to increase awareness that this is a truly preventable and curable disease through regular screenings and early detection. Screening and early detection are absolutely critical in our fight to prevent and cure colon cancer. There are presently several screening methods that have been approved by the American Cancer Society and the Centers for Disease Control, and they include fecal occult blood test, sigmoidoscopy, colonoscopy, and barium enema. Virtual colonoscopy is being increasingly used as a screening method, and there is great interest in incorporating stool DNA testing into our screening armamentarium. Without question, colonoscopy remains the gold-standard screening method as it can directly visualize the presence of polyps, remove polyps when detected, and, in so doing, facilitate the removal of the main risk factor for cancerous growth and potentially identify the presence of early-stage colon cancers, When diagnosed in its earliest stages, nearly 90% of patients with colon cancer can be cured. However, once the disease presents in a more advanced stage with metastatic spread, the overall prognosis remains poor, with the vast majority of patients incurable. While we are now observing median overall survival in the 24-30–month range with the integration of cytotoxic chemotherapy and biologic agents, the overall 5-year survival remains at less than 10%. Why the big push for colon cancer screening? Surprisingly, even in 2009, at most only 30%-40% of all individuals in the United
States over the age of 50 years undergo any type of screening, let alone the gold standard of colonoscopy. Perhaps even more striking is the fact that women undergo screening at nearly half the rate of men. There is a misperception that women are at reduced risk for developing CRC than their male counterparts, despite the fact that colon cancer incidence is the same for males and females. Moreover, primary care physicians and healthcare professionals who take care of women do not appreciate that colon cancer represents as significant a concern as breast and cervical cancer, where effective screening methods are also available. Minority and underserved populations also seek colon cancer screening at a much lower rate than the general population. As a result, we must develop creative outreach and awareness programs that can lead to increased screening efforts. As one example, we here at the Yale Cancer Center are working closely with the State of Connecticut and with community leaders to establish colon cancer screening programs for minority and underserved groups. For patients who are survivors of colon cancer, this is certainly a time to celebrate. For individuals who are 50 years and older, this is an appropriate reminder to undergo screening, as screening saves lives. In fact, yours truly, who just hit the magic age of 50 last December, had his screening colonoscopy recently. Certainly, for those individuals at increased risk because of family history, screening should occur at an earlier age and perhaps at more frequent intervals than what is generally recommended for average-risk individuals. Finally, for all healthcare professionals, we must continue to emphasize the importance of colon cancer screening and strive toward developing innovative outreach screening and education programs that serve our respective local communities.
Edward Chu, MD Editor-in-Chief
This summary may include the discussion of investigational and/or unlabeled uses of drugs and/or devices that may not be approved by the FDA. Electronic forwarding or copying is a violation of US and International Copyright Laws. Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by CIG Media Group, LP, ISSN #1533-0028, provided the appropriate fee is paid directly to Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923 USA. www.copyright.com 978-750-8400.
Clinical Colorectal Cancer April 2009
| 71