1. 1 Colorectal Cancer # 2 Cancer Killer # 2 Cancer Killer SCREENING SAVES LIVES

2. 2 Average risk - 1 out of 18 chance per lifetime High risk – 1 out of 5 chance per lifetime The Bad News: Frequency

3. 3 The Bad News: Deadly 1.Lung Cancer 2.Colorectal Cancer

4. 4 The Bad News: Expensive

5. 5 Assessing your individual risk You have a higher risk if you have any of the following risk factors: Personal history of colorectal cancer or polyps Personal history of inflammatory bowel disease Family history of colorectal cancer or polyps Certain inherited cancer syndromes Even without symptoms, people with these risk factors need earlier and more frequent screening

6. 6 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.

7. 7 AVERAGE RISK If you don’t have these risk factors or symptoms, you are considered to have average risk for developing colorectal cancer.

8. 8 IMPORTANCE OF AGE 50

9. 9 ATTENTION AVERAGE RISK IOWANS American Cancer Society. Cancer Facts & Figures 2002. Atlanta, GA: American Cancer Society; 2002:20–27. 75Average-Risk Cases: 75% High-Risk Cases: 25%

10. 10 Good News 10 years A series of changes in the cells lining the colon takes 10 years to progress from normal to colon cancer. There is time to intervene 10 years NormalPolypCancer

11. 11 The most preventable form of digestive tract cancer if screening is performed More Good News Alive at diagnosis Alive 5 years later 1 year2 year3 year4 year5 year

12. 12 And More Good News: FOBTFlex Sig Colonoscopy Double Contrast Barium Enema

13. 13 So What’s the Problem?

14. 14 0 25 50 75 100 Late Detection Five year survival rates Stage IStage II Stage IIIStage IV 96% 84% 65% 8% 0 25 50 75 100 SEER*Stat -- Version 6.2.4 Only 60% of patients are diagnosed early 40% of patients are diagnosed late 100% Stage 0

15. 15 Why aren’t Iowans screened? The most common reasons - “My doctor never told me I should be screened.” “I’m embarrassed!” “The screening tests cost too much!” “I don’t think that insurance covers screening.” “I don’t have a family history of colorectal cancer.” “I don’t have any symptoms of colorectal cancer.”

16. 16 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.

17. 17 Fecal Occult Blood Test (FOBT)

18. 18 Flexible Sigmoidoscopy

19. 19 Location of polyps/cancer 15% 25% 20% 10% 30% Left side Right side

20. 20 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%

21. 21 Colonoscopy removes polyps biopsies cancer examines entire colon

22. 22 Double Contrast Barium Enema (DCBE)

23. 23 Other New Screening Tests Virtual colonoscopy Stool DNA test

24. 24 Virtual Colonoscopy

25. 25 Stool DNA Test Physician Sends Requisition to Lab Lab Provides Collection and Shipping Materials to Patient Patient Collects Stool at Home Patient Returns Specimen to Lab Physician : Communicates Results to Patient DNA Alteration Identified Perform colonoscopy No DNA Alteration Identified Continue screening Stool DNA Analysis Is Performed in Lab

26. 26 What Should You Consider in Choosing a Screening Test What does my doctor recommend? Which test is most accurate? Which test is most convenient? Which causes the least discomfort, fear embarrassment? Cost-insurance, Medicare coverage? What do other people say about it?

27. 27 Test cost Screening Test Estimated Charge FOBT$10-30 FS$150-300 DCBE$250-500 Colonoscopy$600-1500

28. 28  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 Medicare Coverage for Average Risk patients (since July 1, 2001)

29. 29 Don’t wait until 65 to be screened! Insurance covers most, if not all kinds of screening. Consult your insurance plan or provider to determine which tests are covered. Screening should begin at age 50, not at age 65, when Medicare coverage begins.

30. 30 The Cost of NOT screening –Individual early disability and death –Emotional costs for patients and family –Treatment cost of colon cancer care

31. 31 So What? An average risk adult has a 1 in 18 chance of developing this cancer. A high risk adult has a 1 in 5 chance of developing this cancer. Can you afford to take this chance?

32. 32 You Can Reduce Deaths Due to Colon Cancer Screening! Any method of screening is preferable to not screening!

33. 33 Have You and Your Loved Ones Been Screened? # 2 Cancer Killer # 2 Cancer Killer

34. 34 This presentation was developed by the Iowa Colorectal Cancer Task Force

35. 35 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

36. 36 www.cancer.org www.ccalliance.org www.preventcancer.org/colorectal www.hopkinskimmelcancercenter.org www.colorectal-cancer.net www.cdc.gov/cancer/screenforlife/index.htm Colorectal Cancer Web Links