Colorectal Cancer Prevention Tips

Overview
March is National Colorectal Cancer Awareness Month. Colorectal cancer is the third most common cancer in both men and women, and is the second leading cause of cancer-related death.¹ The American Cancer Society estimates that in 2007 52,180 deaths were due to colorectal cancer.²

Colorectal cancer refers to cancer of the colon and rectum. The colon makes up the last four to five feet of the large intestine, while the rectum makes up the last several inches of the large intestine.³ Colorectal cancer usually begins as noncancerous polyps (abnormal growths), and over time these polyps may become malignant.³ Polyps may be small and produce few, if any symptoms.

Screening for Colorectal Cancer
Routine screening for individuals age 50 and over is important because it enables doctors to detect and remove polyps before they become cancerous. Screening can also detect cancer in the beginning stages, when there is an excellent chance of full recovery with appropriate treatment. Studies show that the cost per life-year saved from colorectal cancer screening favorably compares with other interventions, such as mammography for women over age 50, or treatment for hypertension.⁴

Approved screening methods include:

• Fecal occult blood test (FOBT) (May require follow-up colonoscopy)
• Flexible sigmoidoscopy
• Combination of FOBT and flexible sigmoidoscopy
• Colonoscopy
• Double-contrast barium enema (May require follow-up colonoscopy)

Risk Factors:
Listed below are the various risk factors associated with colorectal cancer.³

• Being male.
• 50+ years of age.
• Personal history of colorectal cancer or colon polyps (overgrowth of normal cells).
• Family history of colorectal cancer or colon polyps.
• Personal history of inflammatory bowel disease.
• Obesity or overweight.
• Diabetes.
• Diet low in fiber and high in fat.
• Alcohol misuse.
• Tobacco use.
• Physical inactivity.

If an individual has a personal or family history of colorectal cancer, or has inflammatory bowel disease, he or she may want to begin routine screening at an earlier age or undergo screening at more frequent intervals.^1,3

The Cost of Colorectal Cancer
The U.S. Preventive Services Task Force states that colorectal cancer screening is likely to be cost-effective regardless of the strategy chosen.⁵

• Cost-effectiveness studies have shown that the cost-effectiveness ratio values for colorectal cancer screening are between $10,000-$25,000 per life-year saved.⁴
• Routine-screening of adults over 50 could prevent an estimated 50%-60% of colorectal cancer deaths.⁶
• The annual expenditure for colorectal cancer treatment in the United States is estimated to be $8.4 billion.⁷

Employer Action

• Ensure that health benefits include provisions for preventive, diagnostic, and treatment services.⁸
• Screening rates for colorectal cancer are low. Encourage employees aged 50 and over to have their physician conduct routine screening.
• Provide employees with free educational materials such as colorectal cancer risk assessments and fact sheets on colorectal cancer.

Resources

• A Purchaser's Guide to Clinical Preventive Services: Moving Science into Coverage
• The Value of Colorectal Cancer Screening: A Healthy Investment (Issue Brief)
• Information from the Centers for Disease Control and Prevention on Colorectal Cancer

References:

1. Centers for Disease Control and Prevention. Basic information. Available at: http://www.cdc.gov/cancer/colorectal/basic_info/. Accessed February 6, 2008.
2. American Cancer Society. How many people get colorectal cancer? Available at: http://www.cancer.org/docroot/CRI/content/CRI_2_2_1X_How_Many_People_Get_Colorectal_Cancer.asp?rnav=cri. Accessed February 7, 2008
3. Mayo Clinic. Colon cancer. Available at: http://www.mayoclinic.com/health/colon-cancer/DS00035. Accessed February 6, 2008.
4. Pignone M, Saha S, Hoerger T, Mandelblatt M. A systematic review: cost-effectiveness analyses of colorectal cancer screening. Ann Intern Med 2002;137(2):96-104.
5. Agency for Healthcare Research and Quality. Screening for colorectal cancer. Available at: http://www.ahrq.gov/clinic/uspstf/uspscolo.htm. Accessed February 13, 2008.
6. Centers for Disease Control and Prevention. Preventing chronic diseases: investing wisely in health. Available at http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/pdf/cancer.pdf. Accessed February 6, 2008.
7. National Cancer Institute. A snapshot of colorectal cancer. Available at: http://planning.cancer.gov/disease/Colorectal-Snapshot.pdf. Accessed February 13, 2008.
8. Campbell KP, Lanza A, Dixon R, Chattopadhyay S, Molinari S, Finch RA, editors. A purchasers guide to clinical preventive services: moving science into coverage. Washington, DC: National Business Group on Health; 2006.