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COLORECTAL CANCER

Population

  • –Adults

Recommendations

AAFP 2018

  • Risk Factor CRC

    • Diet:

      • Cholesterol and fat intake: 2-fold increased risk of CRC with increased cholesterol intake, and 25% increased risk of serrated polyps with increased fat intake.

      • Dairy intake: 15% reduced risk of CRC with more than 8 oz of cow’s milk per day.

      • Fiber: Increased fiber intake does not reduce the risk of CRC or recurrent adenomatous polyps.

      • Red meat intake: 22% increased risk of CRC with increasing red meat and processed meat intake.

    • Lifestyle:

      • Alcohol intake: 8% increased risk of CRC and 24% increased risk of serrated polyps.

      • Cigarette smoking: 114% increased risk of high-risk adenomatous polyps and CRC in current smokers.

      • Obesity: Bariatric surgery associated with 27% reduced risk of CRC.

      • Physical activity: 26% decreased risk of colon cancer for occupational physical activity, and 20% decreased risk of colon cancer with recreational physical activity; 12% decreased risk of rectal cancer for occupational physical activity, and 13% decreased risk of rectal cancer with recreational physical activity.

  • Preventive Strategy

    • Increased consumption of fruits and reduction in red meat and processed meat consumption may lower the risk of CRC. (JAMA. 2005;293:172) (Cancer Res. 2010;70:2401)

    • B6 (pyridoxal-5ʹ-phosphate) levels are inversely associated with risk of colon CA. B6 found in cereals, meat, fish, vegetables, bananas, and avocado. (JAMA. 2010;303:1077)

    • If family history of CRC (no genetic abnormality), increase frequency of surveillance. (Gastroenterology. 2015;149:1438)

Source

  • Am Fam Physician. 2018;97(10):658-665.

Therapeutic Approaches

  • –NSAIDS: 63% decreased risk of CRC; although not recommended secondary to increased risk of GI and cardiovascular events; meta-analysis of 15 RCTs.a

  • –Aspirin: Although aspirin use decreases CRC incidence by 40%, a 2016 USPSTF guideline including three RCTs recommended against aspirin use in the average-risk population due to increased risk of gastrointestinal bleeding and hemorrhagic stroke. Individuals 50–59 y of age with a 10-y cardiovascular event risk of at least 10% who are willing to take aspirin for at least 10 y (ie, the time it takes to accrue the cancer prevention benefit) may benefit from aspirin use for CRC risk reduction. A 2017 systematic review with meta-analysis found that the effect of aspirin was similar to FOBT and flexible sigmoidoscopy for reducing CRC incidence and mortality, and aspirin was more effective for cancers in the proximal colon.

  • –USPSTF approves use of low-dose aspirin for prevention of colorectal cancer in adults 50- to 59-y-old. Benefits statistically shown after 10 y of daily aspirin use. In 60- to 69-y old patients, decision to take low-dose aspirin is individualized based on risk factors. Aspirin is not recommended in patients <50 or older than 70. (Ann Intern Med. 2016;164;836) (Ann Intern Med. 2016;164:777)

  • –Statins: Statin use is associated with 17% decreased risk of advanced adenomatous polyps and 50% decreased risk of CRC; effect observed in ...

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