Colorectal cancer screening

The role of religion/spirituality for cancer patients and their caregivers

Research has shown that religiosity and spirituality significantly contribute to psychosocial adjustment to cancer and its treatments. Religion offers hope to those suffering from cancer, and it has been found to have a positive effect on the quality of life of cancer patients. Numerous studies have found that religion and spirituality also provide effective coping mechanisms for patients as well as family caregivers. Research indicates that cancer patients who rely on spiritual and religious beliefs to cope with their illness are more likely to use an active coping style in which they accept their illness and try to deal with it in a positive and purposeful way. Faith-based communities also offer an essential source of social support to patients, and religious organizations can play a direct and vital role in cancer prevention by providing screening, counseling, and educational programs, especially in minority communities.

Colorectal cancer screening

Colorectal cancer is the second most lethal cancer in the United States. The lifetime risk of developing colorectal cancer in the United States is 5%. Early detection decreases mortality, and involves stratifying individuals by risk factors. Clinicians can use several methods for detection and surveillance of colorectal cancer including the digital rectal exam (DRE), fecal occult-blood test (FOBT), flexible sigmoidoscopy, colonoscopy, and double contrast barium enema. Several groups offer guidelines recommending specific screening techniques and intervals. In general, a combination of an annual FOBT and a flexible sigmoidoscopy every 5 years is recommended for average-risk individuals. Colonoscopy is the gold standard for visualizing the entire colon, and is reserved for abnormal findings on FOBT or flexible sigmoidoscopy or for individuals of greater-than-average risk for colorectal cancer.

Screening for colorectal cancer: present, past and future

Colorectal cancer results in 18,000 deaths annually in England and Wales, with 24,000 new cases diagnosed each year. Despite a better understanding of the genetics, and advancement in surgical and anaesthetic techniques, there has been little reduction in mortality and morbidity from this disease over the past 25 years. Colorectal cancer fits recognized criteria for a disease that should be screened in asymptomatic individuals. The putative duration of the adenoma to carcinoma sequence gives an ample window of opportunity to detect and treat colorectal cancer. In this article we have reviewed the strategies involved in screening for colorectal cancer in an asymptomatic population. We have presented trials and arguments for and against the different screening methods and discussed cost effectiveness of screening. In the USA and Canada, major professional organizations and societies now endorse screening; in the UK it is still far from being accepted. We feel that the available evidence shows that colorectal cancer screening has the potential to reduce the morbidity and mortality from this disease and that funding for a mass screening and public education programme should be sought.

Utility of preoperative fiberoptic flexible sigmoidoscopy in the evaluation of patients with suspected gynecologic malignancy

BACKGROUND

Fiberoptic flexible sigmoidoscopy (FFS) is routinely requested preoperatively as part of evaluation of pelvic masses to exclude colonic involvement by the tumor or concurrent colonic neoplasm. The aim of our study was to evaluate the utility of preoperative FFS in patients with suspected gynecologic malignancy.

METHODS

FFS, performed using a 60 cm sigmoidoscope, evaluated (1) presence of bowel involvement by the tumor, (2) extrinsic compression by the tumor, and (3) presence of colonic neoplasms. FFS findings were correlated with surgical findings.

RESULTS

A total of 107 women underwent preoperative FFS and subsequent surgery. Eleven patients (11%) had lower gastrointestinal symptoms. At surgery, 63% of pelvic tumors were malignant and 37% were benign. The most common abnormality at FFS was colonic polyps in 23 patients (21%). Colonic adenomas were found in 11 patients (10%). Extrinsic compression by the tumor without mucosal abnormalities was seen in 15 patients (14%). The most common intraoperative finding was tumor adhering to the bowel in 18 patients requiring dissection, but only 1 patient required bowel resection. Eight of these 18 patients had preoperative lower gastrointestinal symptoms. All 15 patients with extrinsic compression at FFS had tumor adhering to the bowel.

CONCLUSIONS

Pelvic masses cause extrinsic compression at FFS in 14% of patients. This is suggestive of tumor adherent to the bowel at surgery. However, bowel resection is rarely required because of tumor involvement. Most patients with bowel adherence by tumor have lower gastrointestinal symptoms. Colonic adenomas are found in one tenth of patients, mostly in patients older than 50 years of age. Preoperative FFS does not change the surgical management of pelvic tumors. Screening FFS is indicated in all patients with pelvic tumors over age 50, as in persons with average risk, but is otherwise unnecessary in evaluation of pelvic masses.

Epidemiologic panorama of colorectal cancer in Mexico, 1980-1993

INTRODUCTION

Colorectal cancer is the third cause of cancer-related death in the world, with 468,000 estimated deaths in 1993. In some countries mortality rates have started to decline, and survival rates have increased. In this study performed in Mexico, information is presented on the increase in mortality from this form of cancer, especially in more economically developed areas.

METHODS

The mortality trend for colorectal cancer was evaluated and standardized by five-year age groups in the period 1980 to 1993. Also, the standardized mortality ratio was calculated for Mexico's 32 states, as was the possible association between mortality and indicators of rurality level and fertility rates in the different regions of Mexico.

RESULTS

In the period studied, 18,962 deaths were officially reported. The average age of death was 66 years. The mortality rate among women (1.8) was significantly higher than among men (1.55 per 100,000 inhabitants). Mortality from colorectal cancer grew by 100 percent in both genders (beta = 0.089; P < 0.001), especially in the age group 34 and younger, in the 45 to 49 age group, and in the older than 75 age group (P < 0.05). The standardized mortality ratio was greater in the states in the north of Mexico. Finally, an inverse correlation was observed throughout Mexico between the rurality index (r = -0.60; P < 0.001) and the fertility rates (r = -0.43; P < 0.05) and mortality from colorectal cancer.

CONCLUSIONS

In this study, there is evidence that mortality from this cancer is higher in geographic areas with greater socioeconomic development, similar to regional patterns observed in other countries. In Mexico, the coming years will see a serious epidemic in mortality from this disease; therefore, immediate attention must be given to identifying the profile of high-risk subjects and implementing early cancer detection measures.

Mutations of the p53 gene in the stool of patients with resectable colorectal cancer

BACKGROUND

This study was undertaken to evaluate whether genetic analysis in the stool can be useful for detecting malignant tumors in the colon and rectum. We searched for the possible presence of mutations in the p53 gene in the stool of patients with resectable colorectal cancer. Alterations in the p53 gene are the most frequent among mutant genes related to colorectal cancer.

METHODS

Surgically resected tumor specimens and stool samples from 25 patients with colorectal cancer were examined for mutations of exons 5-8 of the p53 gene by polymerase chain reaction single-strand conformation polymorphism (PCR-SSCP). Results were compared with those achieved by fecal occult blood testing.

RESULTS

Mutations of the p53 gene were found in the tumor tissues in 11 of 25 patients (44%). Of these 11 patients, 7 (64%) had evidence of alterations in the p53 gene within the stool. Of five patients who were negative for fecal occult blood testing, p53 mutations in the stool were evident in three patients.

CONCLUSIONS

This method of stool DNA analysis for tumor-specific mutations is expected to have a wide application in clinical screening for colorectal cancer.

Genetic testing for colon cancer susceptibility: Anticipated reactions of patients and challenges to providers

The commercial availability of genetic tests for colon cancer susceptibility is creating new opportunities and challenges for both patients and providers. To provide information useful in the education and counseling of individuals considering genetic testing, we conducted structured interviews with 45 male and female first-degree relatives of colorectal cancer patients. Fifty-one percent of respondents indicated that they definitely would want to obtain a genetic test for colon cancer susceptibility when it is available and 31% said that they probably would want to be tested. Interest in genetic testing was significantly higher among persons with less formal education and those with a Catholic religious preference. Motivations for genetic testing included the following: to know if more screening tests are needed, to learn if one's children are at risk and to be reassured. Barriers to testing included concerns about insurance, test accuracy and how one's family would react emotionally. Most participants anticipated that they would become depressed and anxious if they tested positive for a mutation, while many would feel guilty and still worry if they tested negative. Of note, about one-half of respondents expected that they would decrease their use of screening tests and make fewer attempts to reduce dietary fat if they tested negative. These preliminary results underscore the importance of educating patients about the potential risks, benefits and limitations of genetic testing, with particular emphasis on the possibility of adverse psychological effects and implications for health insurance. The potential for false reassurance following a negative test result should be addressed by emphasizing the residual risks of cancer among non-carriers of predisposing mutations.

Prevention and early detection of cancer in women

Cancer remains a significant problem for women. When detected early, cancer is more easily treated and the possibility of long-term cure is greatest. Nurses play an important role in the prevention and early detection of cancer in women. Nurses can serve as role models to women by incorporating cancer prevention and detection practices into their personal health behaviors. Nurses also have many opportunities to incorporate primary, secondary, and tertiary prevention methods into their practice, regardless of the setting. The impact on quality of life and decreased mortality as a result of implementation of prevention and early detection practices is significant.

Behavioral science in translational research and cancer control

Behavioral science plays an integral, essential role in cancer control. This review examines that role in two broad areas: (1) in the development and implementation of cancer control technologies, and (2) in the emerging focus on the process of translating cancer research into clinical practice. In developing and implementing cancer control technologies, what we know of human processes as a result of behavioral science is identified as the common link in all stages of the cancer process (prevention, detection, treatment, rehabilitation, terminal care). The value of behavioral science is shown in conservative projections (incorporating likely rates of patient noncooperation) of the health benefits obtainable by the year 2000 if effective behavioral strategies in three key areas were broadly implemented. Smoking prevention and cessation programs could lead to 7.2 million fewer smokers; application of cancer screening programs might result in 45,000 additional 5-year cancer survivors each year; and behavioral programs could lead to improved quality of life in 150,000 patients per year who experience treatment side effects despite the use of antiemetics. Behavioral science also is shown to contribute to translational science by providing a pragmatic conceptual model for clinical practice and facilitating collaborative research between basic scientists and clinical researchers. As an example of behavioral science's contribution to translational research, behavioral issues in genetic screening for cancer risk are outlined based on the experience of several families with the BRCA1 genetic marker and patients with Huntington's disease.

Behavioral and psychosocial cancer research in the underserved. An agenda for the future

BACKGROUND

This research was undertaken to review the status of behavioral and psychosocial cancer research in the underserved.

METHODS

The author extensively reviewed the literature related to behavioral and psychosocial cancer research in the underserved for this article. The author's experience as the Principal Investigator for the only National Institutes of Health smoking cessation study targeting Asian-Americans also was used in analyzing the literature and developing an agenda for the future.

RESULTS

Two questions and accompanying agenda items were addressed. The underserved were defined, and the effect of being underserved was illustrated through their disproportionate and earlier (younger) presence in morbidity and mortality statistics. Initiating behavioral and psychosocial cancer research in the underserved begins with a proper attitude and making accommodations to culture. The agenda for research should be practical and assessed on the basis of prevalence and preventability of cancer related behaviors. Examples from underserved Asian-American populations were cited.

CONCLUSIONS

Behavioral and psychosocial cancer research needs to be done.