Colorectal cancers mortality

About 10% of all cancer deaths are a result of cancer of the colon or rectum. It is estimated that 56,290 individuals will die of colorectal cancer in the United States in 2005, despite a decline in overall combined mortality for both colon and rectal cancer observed during the last 20 years. For women, the decline in colorectal cancer mortality rates has been evident since 1950, whereas death rates among men did not start to decline until the late 1970s. These trends in mortality rates are similar to those observed in other countries. Overall mortality rates remain higher among African-American males and females, and the rates of decline are lower as compared to those for white males and females. Colorectal cancer mortality rates are lower for Hispanics, American Indians/Alaskan Natives, and Asian/Paciflc Islanders than for whites or African-Americans. Factors contributing to the overall... 

Jacobs, E.J., Connell, C.J., Patel, A.V., Chao, A., Rodriguez, C., Seymour, J., McCullough, M.L., Calle, E.E., and Thun, M.J., Vitamin C and vitamin E supplement use and colorectal cancer mortality in a large American Cancer Society cohort. Cancer Epidemiol Biomarkers... 

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. 

Newcomb PA, Norfleet RG, Storer BE, Surawicz T, Marcus PM (1992) Screening sigmoidoscopy and colorectal cancer mortality. J Natl Cancer Inst 84 1572 1575... 

M.C. Jansen, H.B Beuno-de-Mesquita, R. Buzina, F. Fidanza, A. Minotti, H. Blackburn, A.M. Nissenen, F.J. Kok, and D. Kromhout. Dietary fiber and plant foods in relation to colorectal cancer mortality The seven countries study. Int. J. Cancer, 81 174-179 (1999). 

Colorectal cancer is the third most common cancer and the second leading cause of cancer-related deaths in the United States. (77). The incidence is approx. 40 per 100,000 in men and 25-30 per 100,000 in women (78). For those with stage 111 disease with presumed micrometastatic disease, adjuvant chemotherapy is used, typically 5-fluorouracil (5-FU) and leucovorin for 6-8 mo, with a 30% reduction in disease recurrence and 22-32% reduction in mortality (79,80). 

What the above amounts to is that the absolute excess risks per 10 000 woman-years attributable to the use of an estrogen plus a progestogen were seven more coronary heart disease events, eight more strokes, eight more pulmonary embolisms, and eight more invasive breast cancers, while the risk reductions per 10 000 woman-years were six fewer colorectal cancers and five fewer hip fractures. The absolute excess risk of events included in the global index was 19 per 10 000 woman-years. The overall harms in this study thus clearly exceeded the benefits. Allcause mortality was not affected. 

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. 

Example 2. The Cancer Prevention Cohort Study (CPS II) mortality cohort consists of 1.2 million adults residing in 50 states, the District of Columbia, and Puerto Rico. Individuals in this cohort completed self-administered questionnaires in 1982 with information on race, diet, exercise, medical history, and other lifestyle factors. Findings on the relationship between colorectal cancer and meat consumption on a subset... 

Newhouse and Berry 1979 Pang et al. 1997 Raffh et al. 1989, 1996b Seidman et al. 1979, 1986). Other mortality studies (e g., Albin et al. 1990a Hughes et al. 1987 McDonald et al. 1993 Peto et al. 1985) of asbestos workers, however, found no significantly increased risk for gastrointestinal or colorectal cancer. 

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. 

Cancer is a group of more than 100 different diseases, characterized by uncontrolled cellular growth, local tissue invasion, and distant metastases. It is second only to cardiovascular disease as a cause of mortality in Americans. More than 1.3 million cases of cancer are diagnosed annually, and cancer claims an estimated 570,280 lives in the United States each year. The estimated incidence of common cancers and cancer-related deaths is illustrated in Fig. 124—1. The four most common cancers are prostate, breast, lung, and colorectal cancer. The most common cause of cancer-related deaths in the United States is lung cancer, which accounts for about 160,000 deaths each year. These cancers are discussed in further detail in the chapters that follow. 

For both adult men and women, colorectal cancer is the third leading cause of cancer-related deaths in the United States. An estimated 56,290 deaths will occur during 2005. Overall, the mortality and incidence associated with colorectal cancer has decreased during the past 30 years. Mortality rates associated with colorectal cancer in the United States are comparable to those of other industrialized areas around the world. ... 

Although it is difficult to compare trends because of large year-to-year variations in colorectal cancer incidence rates in minority population groups, downward trends in colorectal cancer incidence appear to be greater for whites, African-Americans, Asian/Paciflc Islanders, and American Indian/Alaskan Native Americans than for Hispanics. Trends for incidence and mortality rates among white and African-American males and females in the United States can be compared in Fig. 127-1. 

Allelic loss of chromosome 18q, which is located on the DCC gene, is predictive of mortality, independent of tumor differentiation, vascular invasion, and TNM stage. Five-year smvival rates decrease by 39% and 14% in patients with allelic loss of chromosome 18q and stage II or III colorectal cancer, respectively. Tumors that overexpress TS, which is responsible for converting de-oxyuridine monophosphate to deoxythymidine monophosphate, an... 

Overall, surgery for colorectal cancer is associated with a morbidity and mortality rate of 8% to 15% and 1% to 2%, respectively, depending on the type and extent of procedure. - Common complications associated with colorectal surgery include infection, anastomotic leakage, obstruction, adhesion formation, and malabsorption syndromes. 

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). 

Although fruit and, more consistently, vegetable intakes are inversely associated with colorectal cancer risk, the epidemiological evidence for vitamin C as a specific protective factor is less consistent. Since 1990, two out of four prospective studies have observed a significant inverse association between vitamin C intake and the risk of colon or rectal cancer. In a prospective cohort study that followed 4277 elderly men and 7300 elderly women over 8 years, women who consumed more than 225mg/d of vitamin C had a 39% lower risk of colon cancer than women who consumed less than 155mg/d, but no association between vitamin C intake and colon cancer risk was observed for men. A similar decrease in colon cancer risk was observed in women who took vitamin C supplements. A recent study of colon cancer mortality in more than 700,000 U.S. men and women found that the use of vitamin C supplements for at least 10 years was associated with a 60% reduction in rectal cancer risk, but was not significantly associated with colon cancer risk. ... 

Chou J, Voong LN, Mortales CL, Towlerton AM, Pollack SM, Chen X, Yee C, Robbins PF, Warren EH. Epigenetic modulation to enable antigen-specific T-cell therapy of colorectal cancer. J Immunother. 2012 35 131-41. 

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