GI Epidemiology - Westra Flashcards
The incidence of what GI cancer has actually increased in the US in recent years?
- gastric ca has decreased
- esophageal and hepatocellular ca have increased in U.S.
- death rates from colorectal ca decreased in US
If a patient refuses a colonoscopy, how else can you screen for colorectal cancer?
- Digital rectal exam
- Hemoccult stool test
- Cologuard
- Sigmoidoscopy
Incidence and mortality of colorectal cancer have decreased in all racial/ethnic populations except _______?
AI/AN
What racial ethnic group has a higher mortality rate than all racial ethnic populations and increased incidence except for AI/AN?
African Americans
What are the primary colorectal cancer prevention methods?
- Diet-Exercise (BMI)
- ASA/NSAIDs/Cox-2 Inhibitors
- Calcium/Vitamin D
- Hormone Replacement Therapy
- Statins
What are the secondary colorectal cancer prevention methods?
- Colonoscopy + Polypectomy
- Neoplastic: Adenomatous and Serrated
- Non-neoplastic: Hyperplastic
- 95% of CRC arises in adenomatous and serrated polyps over time
At what age does colonoscopy screening for average risk African American males start?
age 45
At what age can you safely stop performing screening colonoscopies?
stop after 75
(polyps take 10-15 years to advance)
What are all of the colorectal screening options?
- Annual Fecal Occult Blood Test
- Double Contrast Barium Enema
- Flexible Sigmoidoscopy every 5 years
- FOBT and Flex Scope q 5 years
- FOBT = fecal occult blood test
- Colonoscopy q 10 years*
- Virtual Colonoscopy?
- PillCam Colonoscopy?
- DNA testing? (Cologuard or FIT)
THe USPSTF recommends against screening for colorectal cancer in adults older than what age?
85
(risks outweight the benefits)
How often should the stool DNA panel (Cologuard) test be performed to screen for colorectal cancer?
Every 3 years
How often should the immunochemical-based fecal occult blood (iFOBT) or fecal immunochemical test (FIT) be performed to screen for colorectal cancer?
Every year
What are the advantages/disadvantages of Cologuard?
- FDA approved
- No dietary restrictions
- Appropriate re-screening interval is not known
- Cost ~ $500 per test
- Patients unable to tolerate and refuse other testing
- Blood and 9 DNA biomarkers in 3 genes
- More sensitive than FIT but more false-positives
- Covered by Medicaid/Medicare (age 65)
- Not in the clinical guidelines or USPSTF yet
What are the risk factors that suggest increased and more aggressive screening?
- Age >50
- Personal Hx of CRC or adenomas
- Personal Hx of long-standing ulcerative colitis or Crohn’s disease
- Personal Hx of ovarian, endometrial, breast ca
- First-degree relative with CRC
- First-degree relative with adenoma before 60
What is the Incidence of all colorectal cancer in average risk, family history, HNPCC, FAP, and UC patients?
- Average risk (no risk factors) 75%
- Family history of CRC 15-20%
- Hereditary Nonpolyposis CRC 3-8%
- Familial Adenomatous Polyposis 1%
- Ulcerative colitis 1%
