Colorectal Cancer & Screening NOTE: This presentation will take 30-60 minutes if you use all the slides. This is the main message: Men and women age 50 and over should get regular screening for colorectal cancer. There are 2 brochures that can be given out for this presentation: Common Questions, and Instructions for the Fecal Immunochemical Test. May 2017

Sometimes there are things that may be hard to talk about… But not talking about them is even harder Today we’re going to talk about a type of cancer called colorectal cancer. Sometimes, it is called colon, rectal or bowel cancer. While it may be hard or embarrassing for some of you to talk about colorectal cancer, since we don’t often talk about that part of our bodies with others, not talking about it can cost lives. Many people are dying needlessly of colorectal cancer as it is often found too late for effective treatment. Yet, there are effective ways (through screening) to find colorectal cancer early before there are any symptoms and when treatment is very effective. Some of you may know friends or family members who have been diagnosed or died from this type of cancer. This presentation will help you to learn more about this common cancer and how it can be prevented or caught and treated early through screening. (Presenters may ask the group if anyone has friends or family with colorectal cancer). This presentation will explain three things: 1) The basic facts about colorectal cancer 2) The main way to reduce your risk 3) The best way to prevent or detect colorectal cancer early Please share this information. If you like, take extra brochures and information sheets for your friends and family.

What is Colorectal Cancer? Cancer that develops on the inner wall of the colon and rectum (large bowel or large intestine) As cancers of the colon and rectum are very similar, they are called “Colorectal Cancer” NOTE: In the anatomical picture, the colon and rectum are in pink color.

What are Polyps? Pre-cancerous polyps are small growths that may be found on the inner wall of the colon & rectum Polyps can develop and exist over long periods of time without any signs or symptoms before becoming cancer Colon → This picture shows what a polyp looks like.

Colorectal Cancer Facts In 2017, 2,398 new cases of colorectal cancer are expected in Alberta Colorectal cancer will develop in 1 in 13 men and 1 in 16 women throughout their lifetime In Alberta, colorectal cancer is the 2nd most commonly diagnosed cancer in men and 3rd most commonly diagnosed cancer in women Colorectal cancer will develop in 1 in 13 men and 1 in 16 women throughout their lifetime. This means that if there are 13 men in the room – it doesn't necessarily mean that 1 in 13 of them will develop colorectal cancer. It means, that if all 13 of those men live until at least 85 years old, then 1 out of 13 will develop colorectal cancer. References: Surveillance & Reporting. Cancer Measurement Outcomes Research and Evaluation, Alberta Health Services, 2017.

More Colorectal Cancer Facts In 2017, 774 colorectal cancer deaths are expected in Alberta Colorectal cancer is the 2nd leading cause of death from cancer in Alberta for both men and women combined The leading cause of cancer deaths in Alberta men is lung cancer. Next is prostate, followed by colorectal cancer. For Alberta women, the leading cause of cancer deaths is lung cancer. Next is breast, followed by colorectal cancer. So, colorectal cancer is the 2nd leading cause of cancer deaths for both men and women are combined. Reference: Surveillance & Reporting. Cancer Measurement Outcomes Research and Evaluation, Alberta Health Services, 2017.

What Causes Colorectal Cancer? There is no single cause All men and women 50 and over are at higher risk Some people are more at risk than others based on personal and family history NOTE: Encourage people to talk to their healthcare provider about their risk of colorectal cancer.

Risk Factors You Can’t Change Age Family history Ethnicity Personal cancer history Inflammatory Bowel Disease NOTES: Age – approximately 90% of cases are in adults 50 and over Family history includes – colorectal cancer, Familial Adenomatous Polyposis (FAP), Hereditary Non-Polyposis Colorectal Cancer (HNPCC). The more relatives affected, the higher the risk. Ethnicity – African Americans have been found to have a higher incidence and mortality of colorectal cancer than other racial groups in the U.S. and the reason for this is not yet understood. Jews of Eastern European descent (Ashkenazi Jews) have one of the highest risks of colorectal cancer and several gene mutations have been found to increase their risk of colorectal cancer. Personal cancer history includes – colorectal, small bowels/intestines, uterus, ovaries or breast Inflammatory Bowel Disease includes ulcerative colitis and Crohn’s disease

Risk Factors You Can Change Food choices Physical activity Body weight Smoking There are some things we can do to lower our risk of colorectal cancer. Many of these things we can do also help prevent or decrease our risk for other chronic diseases (heart disease, diabetes, osteoporosis, etc).

Ways to Decrease Your Risk Get screened regularly! Eat more fibre (whole grains, beans, lentils, peas, bran) Eat less saturated fats (red meat, whole milk dairy products) Eat lots of vegetables and fruit It is important to be screened regularly. Talk to your doctor or nurse about what type of colorectal cancer screening is best for you. There is a strong link between the food you choose to eat and colorectal cancer risk. Good sources of fibre include wholegrain products, fruit, vegetables, nuts/seeds, and legumes. Examples include: Wholegrain products: oats, rye, barley, bran, quinoa, wholemeal bread, wholewheat pasta, wholegrain breakfast cereals (porridge oats, All-Bran, Weetabix, etc) Fruit: oranges, prunes, berries, bananas, apples, pears, avocado Vegetable: broccoli, carrots, sweet potatoes, green beans Nuts/Seeds: flax seed, almond, pecans, pistacios Legumes (also called pulses): beans, lentils, and peas A diet high in red meats (beef, lamb, liver, etc) and processed meats (hot dogs, deli meats, etc) can increase your risk of colorectal cancer. Limit intake of red meat (a main source of saturated fats) to no more than 18 ounces a week (about 3 small steaks). This is a touchy subject for Albertans! Meats are an important source of protein and vitamin B12. But studies show that people who eat a lot of red meat tend to eat less plant-based food and therefore have less protection against cancer. Include 7 – 10 servings of vegetables and fruit in your daily diet. Eat at least one dark green and one orange vegetable each day. Examples include broccoli, romaine lettuce, spinach, carrots, sweet potatoes, pumpkins/squash, turnips, garlic, oranges and berries.

More Ways to Reduce Your Risk Lower alcohol intake Add exercise into your daily life Stay at a healthy body weight Stop smoking and snuff/chew and avoid second hand smoke Lower alcohol consumption to moderate or low levels. If alcohol is consumed, amount should be limited to no more than two drinks a day for men and one a day for women. Pregnant women should not consume any alcohol. Try incorporating regular physical activity into your daily life. It is recommended that you aim for 2 and a ½ hours of moderate to vigorous activity per week. Moderate exercise can mean anything from a brisk walk to playing outside with grandchildren. Stay at a healthy weight. Stop smoking and using snuff/chew. NOTE: Tobacco also comes in smokeless (spit) form that is placed inside the mouth and is also harmful: Snuff – ground-up moist tobacco usually placed between the bottom lip and gum (also known as “dipping”). Chew – shredded tobacco leaves placed between gum and cheek (also called “a wad”). Plug – shredded tobacco leaves pressed into a hard block and placed between gum and cheek.

What about Symptoms? Approximately 90% of people who get colorectal cancer are 50 and over with no symptoms Colorectal cancer in the early stages usually does not have any symptoms. When found early, 90% of cases can be prevented or treated successfully.

If symptoms do occur… Symptoms may include: Changes in bowel movements (constipation, diarrhea) Narrow or bloody stools Abdominal cramps Unexplained weight loss Constant tiredness/weakness See your doctor or nurse right away if you have symptoms! If there are symptoms present, usually the colorectal cancer is in a later stage. Important message: Do not wait for symptoms to appear before talking to your healthcare provider about colorectal cancer and screening. Everyone 50 and over should be screened regularly for colorectal cancer.

Why is Finding Colorectal Cancer Early Important? If found early through regular screening, the success rate for treatment is greater than 90% If found at a later stage when there are symptoms, only about 10% of people survive (to 5 years) Screening can also prevent colorectal cancer by removing pre-cancerous polyps Screening can help detect polyps, which are pre-cancerous cells. Polyps sometimes bleed into the colon – traces of blood may be found in the stool that you can’t see with your own eyes. The most common screening tests in Alberta are: Fecal Immunochemical Test, also called FIT – this test is done in your own home and can help find blood in the stool that you can’t see. Colonoscopy – this is done if you have an abnormal FIT or if you are at higher risk for colorectal cancer. If polyps are found during a colonoscopy, they can be removed. More details about the different screening tests will come in later slides.

How Do I Get Screened? If you are 50 and over, talk to your doctor or nurse about getting screened regularly for colorectal cancer About 40% of Albertans aged 50 to 74 have been screened for colorectal cancer – leaving 60% unscreened! To find a doctor call Health Link Alberta at 811 visit: www.informalberta.ca NOTES: Encourage people in your group to talk to their healthcare provider about colorectal cancer screening. You may want to start a discussion about colorectal cancer and screening with the following sample questions: Why do you think so few Albertans 50 to 74 get screened for colorectal cancer? Can this be changed? Do you think it’s important for Albertans 50 to 74 to be screened for colorectal cancer? Why or why not? Feel free to create your own questions to encourage discussion and interaction. 15

Colorectal Cancer Screening Tests The Alberta Colorectal Cancer Screening Program recommends the FIT, a home stool test, every year for everyone 50 to 74 Other screening tests are available – talk to your doctor or nurse about what is right for you There are a number of different colorectal cancer screening tests available in Alberta, including: Fecal Immunochemical Test (FIT), a home stool test Colonoscopy Flexible Sigmoidoscopy Double Contrast Barium Enema The first 2 tests are the most common in Alberta. The Alberta Colorectal Cancer Screening Program recommends doing a FIT every year because the evidence shows that this test is most effective for populations. Colonoscopy is a test used for people who have an abnormal FIT test result, and for people who are at higher risk for colorectal cancer.

What is a FIT? Also called Fecal Immunochemical Test (FIT) Finds blood in the stool that you can’t see Your doctor will arrange for you to do the FIT at home You don’t have to change your diet or medications NOTES: Refer to the brochure Colorectal Cancer Screening: Instructions for the Fecal Immunochemical Test (FIT) for step-by-step instructions on how to do the test.

A FIT home stool test is easy! Collect one sample of stool Place a small sample of stool in the FIT bottle Return the sample to the lab

What does an abnormal test result mean? If the FIT result is abnormal, this means blood was found in the stool sample This does not necessarily mean you have cancer More testing is needed to determine the cause of bleeding An abnormal test may also be due to pre-cancerous polyps, or other conditions such as hemorrhoids (piles)

Colonoscopy When a FIT is abnormal, colonoscopy is the recommended follow-up test A thin flexible tube is placed into the rectum and colon for the doctor to examine the areas. General colonoscopy procedure: Powerful laxatives are given ahead of time to clear the bowel of stool A long flexible tube with a small camera is inserted through the anus A special doctor examines the lining of the entire colon and rectum for polyps or cancer Biopsies and removal of polyps can be performed during the procedure If cancer is found, the doctor will speak with you about the next steps and treatment choices Discuss with your doctor the rare risks of this procedure and whether you would prefer to be awake during the procedure or given a light anesthetic If the results from a colonoscopy are normal, then no further screening tests are required for the next 10 years. If the follow-up colonoscopy is normal, no colorectal cancer screening is required for 10 years

What is the Alberta Colorectal Cancer Screening Program (ACRCSP)? An organized colorectal cancer screening program in Alberta Coordinated by the Alberta Health Services – Screening Programs In partnership with healthcare providers www.screeningforlife.ca/colorectal There is more information on the website about colorectal cancer screening and other types of cancer screening (Breast and Cervical).

1-866-727-3926, www.screeningforlife.ca/contact What does the ACRCSP Do? Encourages men and women aged 50 to 74 to get screened Sends letters to people about their FIT results 1-866-727-3926, www.screeningforlife.ca/contact

What about other cancers? There are programs for Breast, Cervical & Colorectal cancer screening in Alberta There is not enough evidence for screening whole populations for other cancers (prostate, ovarian, skin, etc) Tests for other cancers may be useful on an individual basis, but may not be useful, and/or cost-effective with large populations. However, there may be new screening tests available in the future that fit this criteria. To find out more about your needs, talk to your healthcare provider

What Can I Do Now? If you are 50 and over, talk to your doctor or nurse about getting screened for colorectal cancer Do the FIT home stool test every year Follow-up with your doctor or nurse right away if you have an abnormal test result Don’t just leave the FIT home stool test in the bathroom – it is important to finish it and take it back to the lab Follow-up with an abnormal test result with your doctor or nurse is important to get further tests if needed.

Colorectal Cancer Screening Saves Lives What Else Can I Do? Talk to your friends and family about getting screened Talk to your co-workers and neighbours about getting screened Talk to everyone 50 and over about getting screened Remember, screening is one of the best things you can do for yourself to prevent and find colorectal cancer early. When found early, 90% of cases can be prevented or treated successfully. Colorectal Cancer Screening Saves Lives 25

Questions?