Colorectal cancer mortality from

In the average-risk general population, yearly FOBT starting from the age of 50 years is cost-effective in reducing colorectal cancer mortality between 18 and 33% (Mandel et al. 1993 Mandel et al. 1999 Mandel et al. 2000 Kronborg et al. 1996 Hardcastle et al. 1996). However, FOBT has a low sensitivity (20% for adenomas, 40% for cancers) and compliance is low if the test is proposed on a yearly basis. 

Scholefield JH, Moss S, Sufi F, Mangham CM, Hardcastle JD (2002) Effect of faecal occult blood screening on mortality from colorectal cancer results from a randomised controlled trial. Gut 50 840-844... 

In a cohort study in 1848 British patients who received human pituitary-derived growth hormone from 1959 to 1985 (30 000 patient-years), there were two cases of colorectal cancer (0.25 expected) and two cases of Hodgkin s disease (0.85 expected) the standardized mortality ratios were 10.8 and 11.4 respectively (103). However, the number of cancers was small and the doses used were higher than typically today, and these results should be interpreted with caution. 

In 1848 patients treated with growth hormone during childhood there was an 11-fold increase in the incidence of colorectal cancer after a mean 16 years of follow-up and a 15-fold increase in mortality from colorectal cancer and Hodgkin s disease after 21 years of follow-up. However, there were too few deaths to draw any firm conclusions. 

Colon cancer is one of the main causes of cancer mortality in Western societies [150]. About 15-20% of colorectal tumors are causally determined by inheritance of genetic alterations such as the hereditary nonpolyposis colorectal cancer (HNPCC) and the syndrome familial adenomatous polyposis (FAP) [151,152]. Microsatellite instability, a characteristic of HNPCC, is caused by mutations in the genes essential for mismatch repair. The loss of mismatch repair has several consequences most crucially, the loss of proofreading and correction of small deletions and insertions. FAP is a rare autosomal dominant syndrome caused by an inherited mutation in the APC gene. The disease is characterized by the development of multiple colorectal adenomas, numbering from a few polyps to several thousands. 

Selby JV, Friedman GD, Quesenberry CP, Weiss NS. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med 1992 326 653-657. 

In Europe, epidemiological data demonstrated that mortality from breast and colorectal cancer is considerable by lower in countries where olive oil consumption is high (such as Greece, Italy and Spain) than in those where the consumption is low (such as Scotland, England and Denmark) [45). 

Colorectal adenocarcinoma is one of the most common malignancies in humans and a major cause of cancer related mortality. Colorectal adenocarcinoma develops from intestinal mucosal cells after a cascade of genetic alterations. The most important prognostic parameter for all types of carcinoma is the TNM status including tumor... 

Mandel JS, Bond JH, Chuech TR et al (1993) Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Eng J Med 328 1365-1371... 

The goal of colorectal cancer screening is to reduce the morbidity and mortality of colon cancer by early detection and resection of adenomas and cancer (Frazier et al. 2000). The screening guidelines from the National Cancer Institute, and adopted by the American Gastroenterological Association, currently call for screening of the average-risk... 

The survival reported by numerous groups is comparable with that observed with other abdomi-nopelvic malignancy such as retroperitoneal and visceral sarcoma and liver metastases from colorectal cancer. The survival is far superior to that for some cancers that are routinely resected, such as pancreatic cancer, gallbladder cancer, and cholan-giocarcinoma. By analogy with other standard of practice management plans, the efficacy of these peritoneal carcinosis treatments and the morbidity and mortality are acceptable. 

The health risks and benefits from vitamin D and calcium supplementation have been evaluated from a clinical trial and cohort study including 36,282 postmenopausal women who were given 1000 mg elemental calcium carbonate plus 400 lU of vitamin D3 daily or placebo over a 7-year period [42 ]. There was no significant effect on myocardial infarction, coronary heart disease, total heart disease, stroke, overall cardiovascular disease, colorectal cancer or overall mortality. 

Doci R, Gennari L, Bignami P, et al (1995) Morbidity and mortality after hepatic resection of metastases from colorectal cancer. Br J Surg 82 377-381 Douillard JY, Cunningham D, Roth AD, et al (2000) Iri-notecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer a multicenter randomised trial. Lancet 355 1041-1047... 

There are no published RCTs of vitamin C alone in primary prevention, but data from the small number of trials of vitamin C in combination with other nutrients have not provided any support for a role for high-dose vitamin C supplementation in cancer prevention (Table 3). The Linxian trial found no significant effect of supplementing Chinese men and women with 120 mg vitamin C and 30 pg molybdenum daily for 5 years on the risk of cancers of the oesophagus or stomach. The Polyp Prevention Study, a trial of 864 patients with previous adenoma, found no effect of either /3-carotene or a combination of vitamins E and C (1000 mg) on the incidence of subsequent colorectal adenomas. The Heart Protection Study also found no beneficial effects of supplementation with these three vitamins on cancer mortality. However, trials have generally... 

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