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Colorectal Cancer PreventionAka: Colon Cancer Risk Factor

See Also
1. Colorectal Cancer Screening
Risk Factors: Colorectal Cancer
1. Age >50 years (accounts for 90% of Colon Cancer)
2. Past Medical History
  1. Inflammatory Bowel Disease (Ulcerative Colitis)
  2. Adenomatous polyps >5mm (Confers RR of 2-3 times)
  3. Hamartomatous polyposis syndromes
  4. Cholecystectomy
  5. Pelvic irradiation
3. Family History
  1. First degree relative with Colon Cancer (RR=2-3x)
  2. Familial adenomatous polyposis
  3. Hereditary non-polyposis Colon Cancer
4. Lifestyle related risks
  1. Tobacco abuse
  2. Obesity
5. Dietary Risk Factors
  1. High Dietary Fat
    1. Saturated fat
    2. Polyunsaturated fat
  2. Red Meat
    1. Salt-cured
    2. Pickled
    3. Smoked
    4. Barbeque
Prevention: Colorectal Cancer
1. High Physical Activity
2. High fruit and vegetable intake
3. High Dietary Fiber intake
  1. Appears effective in longterm prevention
  2. Does not prevent shorterm recurrent adenomas
    1. Schatzkin (2000) N Engl J Med 342:1149
  3. Sources
    1. Whole grain cereals
    2. Legumes
    3. Fruits and vegetables
    4. Water insoluble (wheat bran) fiber may be best
4. High folate or methionine intake
5. High Dietary Calcium intake (1200 mg qd)
  1. Prevents adenoma recurrence
    1. Baron (1999) N Engl J Med 340:101
  2. Decreases risk of histologically advanced polyps
    1. Wallace (2004) J Natl Cancer Inst 96:921
6. Medications
  1. General
    1. Aspirin, NSAIDs, COX-2 Inhibitors not recommended
    2. Despite effectiveness in prevention, risks are high
    3. (2007) Am Fam Physician 76:109
  2. Aspirin
    1. Reduces adenoma Incidence in high risk patients
    2. Greatest risk reduction at >14 tablets per week
    3. Chan (2004) Ann Intern Med 140:157
  3. NSAIDs
    1. Sulindac prevented neoplasia in familial polyposis
    2. Janne (2000) N Engl J Med 342:1960
  4. COX-2 Inhibitors
    1. Celecoxib prevented neoplasia in familial polyposis
    2. Steinbach (2000) N Engl J Med 342:1946
  5. Postmenopausal Hormone Replacement
References
1. Giovannucci (1995) N Engl J Med 333:609

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 5/10/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.