Departments of Nursing/ Health, Nutrition and Exercise Sciences
Objectives <ul><li>Review guidelines to  prevent colorectal cancer (CRC) with “healthy living” </li></ul><ul><li>Review sc...
Cancer Deaths North Dakota <ul><li>Cancer (all types) second-leading cause of death </li></ul><ul><li>Colorectal cancer ra...
Preventable and treatable   Colorectal cancer <ul><li>On average, 13 years of life lost </li></ul><ul><li>93% of cases in ...
What is the “prescription”  for  healthy living ? <ul><li>Don’t smoke </li></ul><ul><li>Eat a healthy diet </li></ul><ul><...
Smoking  Increases CRC risk <ul><li>1. Stop smoking! </li></ul><ul><li>Tobacco use </li></ul><ul><ul><li>Single largest pr...
The New American Plate American Institute of Cancer Research <ul><li>Meal patterns for a healthful life! </li></ul>Vegetab...
Emphasize Plant Sources Reduces risk of CRC <ul><li>Include fruits and  vegetables </li></ul><ul><ul><li>Dietary Guideline...
Meat Variety and Moderation Reduces risk of CRC   <ul><li>Follow Dietary Guidelines  </li></ul><ul><ul><li>Include a varie...
Calcium and Vitamin D   Reduces risk of CRC <ul><li>Vitamin D -“sunshine vitamin”  </li></ul><ul><ul><li>Produced in the s...
Folic Acid   Reduces risk of CRC <ul><li>Include food sources   </li></ul><ul><li>Fortified breakfast cereals </li></ul><u...
Selenium Reduces risk of CRC <ul><li>Include food sources </li></ul><ul><ul><li>Protein-rich foods  (meats, fish, beans, s...
Alcohol  Moderation reduces risk of CRC <ul><li>Limit alcohol intake   </li></ul><ul><ul><li>Women  - One drink or less   ...
Maintain a Healthy Weight   Reduces risk of CRC <ul><li>Overweight and Obesity </li></ul><ul><li>Associated with up to 2/3...
Physical Activity  (PA) Reduces risk of CRC <ul><li>Recommend   </li></ul><ul><ul><li>30 minutes or more  </li></ul></ul><...
Screening Reduces risk of CRC <ul><li>Early detection and removal  of polyps provides a greater than 90%  cure  rate! </li...
  CRC Screening Methods -  Age 50+ <ul><li>Annual -  Fecal Occult Blood Test   -OR </li></ul><ul><li>Every 5 years -  Flex...
Fecal Occult Blood Test   (FOBT) CRC screening procedure <ul><li>FOBT detects blood in stool </li></ul><ul><ul><li>Polyps ...
Endoscope Procedures Visualization of the colon <ul><li>Flexible sigmoidoscopy </li></ul><ul><ul><li>Examines lower third ...
Double Contrast Barium Enema CRC screening procedure <ul><li>Barium added to the enema solution </li></ul><ul><li>X-rays t...
What are polyps? <ul><li>Start small and grow larger over time </li></ul><ul><li>May bleed into  the colon </li></ul><ul><...
Removal of polyps Outpatient endoscope procedure <ul><li>Visualize  </li></ul><ul><ul><li>May appear like a  mushroom on a...
Early cancerous polyps   Cured by wire loop David M. Martin, M.D. and Atlanta South Gastroenterology, P.C. - www.endoatlas...
Screening statistics North Dakota (Age 50+) <ul><li>FOBT  in past two years —  21%   </li></ul><ul><li>Ever had a  sigmoid...
People at high risk for CRC Start screening before age 50 <ul><li>Personal or family history </li></ul><ul><li>Polyps or c...
Ask your doctor! Arrange to be screened for CRC <ul><li>Now that I’m 50, what tests for cancer should I have? </li></ul><u...
Symptoms of late CRC See your doctor for a diagnostic workup!!! <ul><li>A change in bowel habits </li></ul><ul><li>Diarrhe...
Late CRC Only an 8% survival rate David M. Martin, M.D. and Atlanta South Gastroenterology, P.C. - www.endoatlas.com
Screening saves lives! <ul><li>More than 90% of CRC deaths are   preventable   </li></ul><ul><ul><li>With healthy lifestyl...
<ul><li>Thank you! </li></ul><ul><li>Developed by  </li></ul><ul><ul><li>Beverly Greenwald,  PhD,   RN </li></ul></ul><ul>...
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CRC Prevention and Screening

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CRC Prevention and Screening

  1. 1. Departments of Nursing/ Health, Nutrition and Exercise Sciences
  2. 2. Objectives <ul><li>Review guidelines to prevent colorectal cancer (CRC) with “healthy living” </li></ul><ul><li>Review screening recommendations for CRC </li></ul><ul><li>Encourage discussion of CRC screening at physician appointments </li></ul>
  3. 3. Cancer Deaths North Dakota <ul><li>Cancer (all types) second-leading cause of death </li></ul><ul><li>Colorectal cancer ranks second </li></ul><ul><ul><li>Lung Cancer 1st </li></ul></ul><ul><ul><li>Colorectal Cancer 2nd </li></ul></ul><ul><ul><li>Breast Cancer 3rd </li></ul></ul><ul><ul><li>Prostate Cancer 4th </li></ul></ul><ul><li>www.cdc.gov/cancer/CancerBurden/nd.htm </li></ul>
  4. 4. Preventable and treatable Colorectal cancer <ul><li>On average, 13 years of life lost </li></ul><ul><li>93% of cases in people over 50 </li></ul><ul><li>75% of cases in people of average risk </li></ul><ul><li>“ The disease no one has to die from.” </li></ul>
  5. 5. What is the “prescription” for healthy living ? <ul><li>Don’t smoke </li></ul><ul><li>Eat a healthy diet </li></ul><ul><li>Maintain a healthy weight </li></ul><ul><li>Exercise regularly </li></ul><ul><li>Limit alcoholic beverages </li></ul><ul><li>Helps prevent cancer, heart disease and diabetes </li></ul><ul><li>Eyre H et al. Cancer J Clin. 2004;54:190-207. Byers T et al., CA Cancer J Clin 2002;52:92-119. </li></ul>
  6. 6. Smoking Increases CRC risk <ul><li>1. Stop smoking! </li></ul><ul><li>Tobacco use </li></ul><ul><ul><li>Single largest preventable cause of disease and premature death in the U.S. </li></ul></ul><ul><li>Smoking </li></ul><ul><ul><li>Shown to cause CRC and 13 other cancers </li></ul></ul>
  7. 7. The New American Plate American Institute of Cancer Research <ul><li>Meal patterns for a healthful life! </li></ul>Vegetables 1½ cups Milk 8 fl. oz. Meat, Beans, Seeds 2-3 oz. equivalents Fruits ½ cup Whole Grains 2 oz. equivalents www.aicr.org Healthy Oils 2 tsp. equivalents
  8. 8. Emphasize Plant Sources Reduces risk of CRC <ul><li>Include fruits and vegetables </li></ul><ul><ul><li>Dietary Guidelines </li></ul></ul><ul><ul><ul><li>1½-2 cups fruits </li></ul></ul></ul><ul><ul><ul><li>2½-3 cups vegetables </li></ul></ul></ul><ul><li>Include whole grains, beans, seeds and nuts </li></ul>
  9. 9. Meat Variety and Moderation Reduces risk of CRC <ul><li>Follow Dietary Guidelines </li></ul><ul><ul><li>Include a variety of lean meat/protein sources </li></ul></ul><ul><ul><li>Use smaller portions for a total of 5-6½ oz./day </li></ul></ul><ul><li>Limit high-fat, processed meats </li></ul><ul><li>Limit cooking at high temperatures </li></ul><ul><ul><li>Suggest braising, steaming, poaching, stewing, microwaving meats </li></ul></ul>
  10. 10. Calcium and Vitamin D Reduces risk of CRC <ul><li>Vitamin D -“sunshine vitamin” </li></ul><ul><ul><li>Produced in the skin in sunlight </li></ul></ul><ul><li>Calcium sources </li></ul><ul><ul><li>Dairy products (milk, yogurt, cheese) </li></ul></ul><ul><ul><li>Fortified grains and orange juice </li></ul></ul><ul><ul><li>Calcium supplements </li></ul></ul>Fortified fluid milk Most reliable daily source for both
  11. 11. Folic Acid Reduces risk of CRC <ul><li>Include food sources </li></ul><ul><li>Fortified breakfast cereals </li></ul><ul><li>Enriched grain products </li></ul><ul><li>Orange juice and other fruits </li></ul><ul><li>Green, leafy vegetables </li></ul><ul><li>Beans, nuts and seeds </li></ul>
  12. 12. Selenium Reduces risk of CRC <ul><li>Include food sources </li></ul><ul><ul><li>Protein-rich foods (meats, fish, beans, seeds, breads and cereals, milk) </li></ul></ul><ul><ul><li>Content of food varies depending on the selenium content of soil </li></ul></ul>
  13. 13. Alcohol Moderation reduces risk of CRC <ul><li>Limit alcohol intake </li></ul><ul><ul><li>Women - One drink or less per day </li></ul></ul><ul><ul><li>Men - Two drinks or less per day </li></ul></ul><ul><li>CRC risk increases substantially </li></ul><ul><ul><li>More than two drinks per day </li></ul></ul>
  14. 14. Maintain a Healthy Weight Reduces risk of CRC <ul><li>Overweight and Obesity </li></ul><ul><li>Associated with up to 2/3 of all cancers </li></ul><ul><li>Associated with a greater risk for colon cancer </li></ul><ul><li>North Dakota statistics </li></ul><ul><li>More than 60% of adults either overweight or obese </li></ul>
  15. 15. Physical Activity (PA) Reduces risk of CRC <ul><li>Recommend </li></ul><ul><ul><li>30 minutes or more </li></ul></ul><ul><ul><li>5 or more days each week </li></ul></ul><ul><li>Best reduction of risk </li></ul><ul><ul><li>45 minutes or more of moderate to vigorous PA </li></ul></ul><ul><ul><li>5 or more days each week </li></ul></ul>
  16. 16. Screening Reduces risk of CRC <ul><li>Early detection and removal of polyps provides a greater than 90% cure rate! </li></ul>
  17. 17. CRC Screening Methods - Age 50+ <ul><li>Annual - Fecal Occult Blood Test -OR </li></ul><ul><li>Every 5 years - Flexible Sigmoidoscopy -OR </li></ul><ul><li>Combination of tests </li></ul><ul><ul><li>Annual - Fecal Occult Blood Test </li></ul></ul><ul><ul><li>Every 5 years - Flexible Sigmoidoscopy </li></ul></ul><ul><li>-OR </li></ul><ul><li>Every 10 years - Colonoscopy </li></ul><ul><li>-OR </li></ul><ul><li>Every 5 years - Double Contrast Barium Enema </li></ul>
  18. 18. Fecal Occult Blood Test (FOBT) CRC screening procedure <ul><li>FOBT detects blood in stool </li></ul><ul><ul><li>Polyps and CRC can bleed slowly </li></ul></ul><ul><ul><li>Blood “hidden” in the stool </li></ul></ul><ul><li>Convenient - done at home </li></ul><ul><li>Costs $3.50 </li></ul><ul><ul><li>Medicare pays </li></ul></ul><ul><ul><li>Most health insurances cover cost </li></ul></ul><ul><li>Ouyang DL et al., Am J Gastroenterol. 2005;100:1393-1403. </li></ul>
  19. 19. Endoscope Procedures Visualization of the colon <ul><li>Flexible sigmoidoscopy </li></ul><ul><ul><li>Examines lower third </li></ul></ul><ul><li>Colonoscopy </li></ul><ul><ul><li>Examines entire length </li></ul></ul>
  20. 20. Double Contrast Barium Enema CRC screening procedure <ul><li>Barium added to the enema solution </li></ul><ul><li>X-rays taken of colon </li></ul><ul><ul><li>Barium outlines lining of the colon to detect polyps or abnormalities </li></ul></ul><ul><ul><li>Suggested once every 5 years </li></ul></ul>
  21. 21. What are polyps? <ul><li>Start small and grow larger over time </li></ul><ul><li>May bleed into the colon </li></ul><ul><ul><li>Use FOBT to check </li></ul></ul><ul><li>May become cancerous </li></ul>David M. Martin, M.D. and Atlanta South Gastroenterology, P.C. - www.endoatlas.com
  22. 22. Removal of polyps Outpatient endoscope procedure <ul><li>Visualize </li></ul><ul><ul><li>May appear like a mushroom on a “stalk” </li></ul></ul><ul><li>Remove with a wire loop </li></ul><ul><ul><li>Painless </li></ul></ul><ul><ul><li>Takes only minutes </li></ul></ul><ul><li>Analyze </li></ul><ul><ul><li>To determine if cancerous </li></ul></ul>Benign polyp (noncancerous) David M. Martin, M.D. and Atlanta South Gastroenterology, P.C. - www.endoatlas.com
  23. 23. Early cancerous polyps Cured by wire loop David M. Martin, M.D. and Atlanta South Gastroenterology, P.C. - www.endoatlas.com
  24. 24. Screening statistics North Dakota (Age 50+) <ul><li>FOBT in past two years — 21% </li></ul><ul><li>Ever had a sigmoidoscopy or colonoscopy — 54% </li></ul>Screening needed for early detection! http:// apps.nccd.cdc.gov/brfss (2004)
  25. 25. People at high risk for CRC Start screening before age 50 <ul><li>Personal or family history </li></ul><ul><li>Polyps or colorectal cancer </li></ul><ul><li>Ulcerative colitis or Crohn’s disease </li></ul>
  26. 26. Ask your doctor! Arrange to be screened for CRC <ul><li>Now that I’m 50, what tests for cancer should I have? </li></ul><ul><li>I’ve read that there’s more than one test for colon cancer. Which one do you think is right for me? </li></ul><ul><li>www.cancer.org </li></ul>
  27. 27. Symptoms of late CRC See your doctor for a diagnostic workup!!! <ul><li>A change in bowel habits </li></ul><ul><li>Diarrhea or constipation </li></ul><ul><li>Feeling the bowel does not completely empty </li></ul><ul><li>Vomiting </li></ul><ul><li>Abdominal discomfort (gas, bloating, cramps) </li></ul><ul><li>Weight loss for no known reason </li></ul><ul><li>Unexplained anemia </li></ul><ul><li>Any blood in the stool - merits a follow-up! </li></ul><ul><ul><li>(Do not assume blood is from hemorrhoids) </li></ul></ul>Symptoms persisting for more than two weeks
  28. 28. Late CRC Only an 8% survival rate David M. Martin, M.D. and Atlanta South Gastroenterology, P.C. - www.endoatlas.com
  29. 29. Screening saves lives! <ul><li>More than 90% of CRC deaths are preventable </li></ul><ul><ul><li>With healthy lifestyles </li></ul></ul><ul><ul><li>With removal of benign or precancerous polyps </li></ul></ul><ul><ul><li>With early detection of cancer and treatment </li></ul></ul>
  30. 30. <ul><li>Thank you! </li></ul><ul><li>Developed by </li></ul><ul><ul><li>Beverly Greenwald, PhD, RN </li></ul></ul><ul><li>Assisted by </li></ul><ul><ul><li>Jane U. Edwards, PhD, LRD </li></ul></ul>

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