1. Colorectal Cancer and Screening
Cancer Screening Programs
May 2017
NOTE:
This presentation will take 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 Home Stool Test Instructions

2. How much do you know about colorectal cancer?
How common is colorectal cancer in Alberta? (i.e. 1 in X men and 1 in X women)?
How many cases of colorectal cancer can be treated successfully if found early (i.e. X out of 10)?
Does a diet rich in fruits and vegetables help reduce risk of colorectal cancer?
What is a FIT home stool test checking for? Is it a reliable way to detect signs of colorectal cancer?
1 in 13 men and 1 in 16 women will be diagnosed with colorectal cancer in their lifetime. It is the second most commonly diagnosed cancer in men and the third most commonly diagnosed cancer in women.
9 out of 10 cases of colorectal cancer can be treated successfully if found early. Early detection improves your chances of beating colorectal cancer significantly.
A diet rich in fruits and vegetables can help reduce risk of colorectal cancer. Eating a healthy diet is a good way to reduce your risk.
A FIT home stool test checks for the presence of hidden blood in the stool that may be a sign of colorectal cancer. Yes- it is a reliable way to detect signs of colorectal cancer and is the recommended test for anyone who has no personal family history of the disease or inflammatory bowel disease.

3. 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 referred to as “Colorectal Cancer”

4. 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
This image shows what a polyp looks like compared to a normal intestinal fold.

5. 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 in 1 in 16 women throughout their lifetime. So 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.
Reference:
Surveillance & Reporting. Cancer Measurement Outcomes Research and Evaluation, Alberta Health Services, 2017.

6. 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 when data from both men and women are combined.
Reference:
Surveillance & Reporting. Cancer Measurement Outcomes Research and Evaluation, Alberta Health Services, 2017.

7. 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

8. 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).

9. 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 your food choices 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, pistachios
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.

10. More Ways to Reduce Your Risk
Lower alcohol intake
Add exercise into your daily life
Stay at a healthy body weight
Consider quitting smoking and snuff/chew and avoiding 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.
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.

11. What about Symptoms?
Approximately 90% of people who get colorectal cancer are 50 and over with no symptoms
If symptoms do occur see your doctor or nurse right away!
Symptoms may include:
Changes in bowel movements (constipation, diarrhea)
Narrow or bloody stools
Abdominal cramps
Unexplained weight loss
Constant tiredness/weakness
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 there are symptoms present, usually the colorectal cancer is in a later stage.
It is very important that you 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.

12. 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, but are invisible to the naked eye.
The most common screening tests in Alberta are:
FIT (Fecal Immunochemical Test) home stool test – this can help detect blood in the stool that you can’t see.
Colonoscopy – this is the follow-up test for an abnormal FIT result. It is also used for people who are at a higher risk of 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.

13. 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 get screened for colorectal cancer – leaving 60% unscreened!
To find a doctor
call Health Link Alberta at 811
visit:
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. 13

14. Colorectal Cancer Screening Tests
The Alberta Colorectal Cancer Screening Program recommends a FIT 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:
FIT (also known as a Fecal Immunochemical 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 a Home Stool Test every year because the evidence shows that this test is most effective for populations.

16. What is a FIT Home Stool Test?
FIT is also called a Fecal Immunochemical Test
It finds blood in the stool that is not visible to the eye
You can pick up the FIT from a lab (with a form from your healthcare provider)
You do not have to change your diet or medications for the test
NOTE:
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.

17. A FIT Home Stool Test is Easy to do
Collect a sample of stool
Place a small sample of stool in the FIT bottle
Return the sample to the lab

18. What does an abnormal FIT 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
Additional testing is needed to determine the source and cause of bleeding
An abnormal test may also be due to pre-cancerous polyps, or other conditions such as hemorrhoids (piles)

19. Colonoscopy
When a FIT result 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

20. Alberta Colorectal Cancer Screening Program (ACRCSP)
An organized provincial colorectal cancer screening program
Coordinated by the Alberta Health Services – Screening Programs
Encourages men and women aged 50 to 74 to get screened
Sends letters to clients about their FIT result
In partnership with healthcare providers
Visit the website for more information.
The website also contains information on other cancer screening programs (breast and cervical cancer screening)

21. Thank you!
Questions?