Exercise and its relationship to patient quality of life, cancer prevention, and impact on treatment and recurrence have been studied extensively in several types of cancer. Regular physical activity may help improve overall health and well-being as well as treatment outcomes. Experts have recommended that cancer patients and survivors continue to stay active.[2]

In order to examine the association between physical activity and cancer survival, researchers reviewed 45 studies (between 1950 and 2011) that evaluated the relationship between physical activity and mortality and/or cancer biomarkers among cancer survivors. They found consistent evidence that physical activity is associated with reduced mortality in breast and colon cancer patients and survivors (and this refers to mortality associated to any cause, not just the cancer). The studies that included biomarker endpoints provided evidence that exercise might result in beneficial changes in the circulating level of insulin, insulin-related pathways, inflammation, and possibly, immunity; however, the researchers point out that more evidence is required to make any conclusions.

The strongest evidence associated with a benefit from exercise was in breast cancer survivors, with colorectal cancer coming in a close second. Most studies showed a significant reduced risk of breast cancer mortality associated with exercise. Because the studies were so diverse, it is not possible to provide specific recommendations regarding the type and duration of exercise; however, the evidence is clear—exercise provides benefit.

References:

Infections with certain viruses, bacteria, and parasites have been identified as strong risk factors for specific cancers. To examine the link between infections and cancer, researchers performed a systematic analysis of the proportion of cancer cases attributable to infection in 2008. They used data on cancer incidence from the GLOBOCAN project along with epidemiological data regarding the causal effects of infection on cancer. The data included information on 27 types of cancer from 182 countries.

They found that of the 12.7 million new cancer cases that occurred worldwide in 2008, 16 percent—or roughly two million—were attributable to infections. The rate of infection-related cancer was about three times higher in developing countries. For example, 3.3 percent of cancers in Australia and New Zealand were infection related, whereas 32.7 percent of cancers in sub-Saharan Africa were attributable to infections. The four main infections associated with cancer were human papillomavirus, hepatitis C, hepatitis B, and Helicobacter pylori. These infections were responsible for approximately 1.9 million cancer cases in 2008, mainly gastric, liver, and cervical cancers.

Cervical cancer accounted for about half of the infection-related cancers in women. Liver and gastric cancers accounted for more than 80 percent of the infection-related cancers in men.  About 30 percent of infection-related cancers occurred in people younger than 50 years. It’s important to note that it takes decades of chronic infection before an infection progresses to cancer.

Based on the statistics, the researchers noted that approximately two million cancer cases each year might be preventable with better public health methods for preventing infection. In an accompanying editorial, Dr. Goodarz Danaei, an assistant professor of global health at Harvard School of Public Medicine in Boston, noted that vaccines for HPV and hepatitis B are effective and that increasing their availability should be a priority for higher risk countries.[2] He suggests that increasing vaccine coverage could reduce the global burden of cancer.

References:

How does cancer treatment affect fertility in men?

Chemotherapy: Chemotherapy can temporarily—and in some cases, permanently—stop sperm production by the testes.[1] The extent to which chemotherapy affects sperm production depends on several factors, including the type and dose of chemotherapy.

Radiation: Radiation to the abdomen or pelvis can also reduce or eliminate sperm production by the testes.

Surgery: Surgery that involves the removal of both testicles (an option for some men with prostate cancer) eliminates sperm production, but other types of surgery can also affect a man’s fertility. Some types of pelvic surgery, for example, can change or eliminate ejaculation.

Options for preserving fertility in men

Although many men are able to conceive naturally after cancer treatment, others are not.

If possible, men should talk with their doctor about their future fertility before beginning cancer treatment. Some options for preserving fertility require that steps be taken before cancer treatment begins.

Sperm banking is the most well-established method of preserving fertility in men.[2] It involves the collection and storage of sperm, ideally before cancer treatment begins. The samples are kept frozen at a lab or sperm bank until they are needed. Sperm can be stored in this way for many years. After being thawed, the sperm can be used for intrauterine insemination (IUI) or in vitro fertilization (IVF). During IUI, sperm are placed directly into a woman’s uterus. During IVF, mature eggs are removed from a woman’s ovary and mixed with the sperm in the lab. Embryos that result from IVF can then be placed in a woman’s uterus or frozen for later use.

If a sample contains very few viable sperm (or if a man has already undergone cancer treatment and has a low sperm count), another approach may be used to fertilize an egg. Intracytoplasmic sperm injection (ICSI) requires only a small number of healthy sperm, along with mature eggs that have been collected from a woman’s ovary. A single sperm is injected directly into each egg. The embryos that develop can then be placed in a woman’s uterus or frozen for later use.

If it is not possible to collect sperm from ejaculate, it may in some cases be possible to collect sperm directly from the testicles. This approach is still investigational.

Finally, it may also be possible to modify some cancer treatments to minimize their effects on subsequent fertility. During radiation therapy, for example, it may be possible to shield the testes in order to preserve sperm production.

Pregnancy after cancer

In the event that your fertility is not affected by cancer treatment (or recovers quickly or unexpectedly), you and your partner should use birth control if you do not wish to have a child. If you are trying to conceive a child naturally, your doctor may advise you to wait for several months after treatment; this allows for the elimination of sperm that may have been damaged during treatment.

In general, the risk of birth defects in children born to cancer survivors appears to be similar to the risk in the general population.[3] If your cancer was due to a hereditary cancer syndrome, such as Lynch syndrome (hereditary nonpolyposis colorectal cancer), your children may inherit the gene mutation responsible for your family’s increased risk of cancer. Talking with a genetic counselor may be helpful.

Other options for parenthood

Not all men have the luxury of being able to explore their reproductive options before beginning cancer treatment, and not all men will find a fertility preservation option that meets their needs. But there are still ways to become a parent. Discussion of other routes to parenthood may be a painful topic for men who want to father a child but cannot. But as cancer survivors consider how best to build their families, methods such as adoption are important options.

Adoption: Couples and individuals who wish to adopt have a range of options, including different types of domestic and international adoptions. You may wish to start by learning about the adoption laws in your state and by talking with other adoptive parents about the professionals and agencies they worked with. Before selecting an adoption agency, you may wish to talk with them about their attitudes toward placing a child with a cancer survivor. Many agencies will be receptive toward this, but it’s important to know before making a final decision.

Donor Sperm: Donor sperm is readily available from sperm banks and can be used for either intrauterine insemination or in vitro fertilization.

Individual decisions within a larger community

The decisions that you make about building a family (or about coming to terms with not building a family) will be intensely personal, but know that you are part of a larger community of patients and healthcare providers who are grappling with these issues.  To think about future parenthood is to think about life after cancer. For many people with cancer, planning for the future may provide the motivation needed to get through treatment.

More information?

Discuss with others…. http://cancerconnect.com/groups/young-adults/topics/fertility-after-cancer-treatment

Fertile Hope (www.fertilehope.org) provides a range of fertility resources for people with cancer.

References:

How does cancer treatment affect fertility in women?

Chemotherapy: Many chemotherapy drugs are toxic to the egg cells (oocytes) in the ovaries. If the number of remaining oocytes in the ovaries reaches a critically low point during treatment, women experience “acute ovarian failure.” This means that the ovaries stop functioning during or shortly after cancer treatment. If oocytes are lost during treatment but do not reach this critically low point, women are at risk for early menopause but may still be able to get pregnant for some time after treatment.

Radiation: Radiation to the pelvis can also destroy oocytes. Radiation to the pelvis can also affect uterine growth and blood flow, particularly if received before puberty.[1] A poorly developed uterus may make a woman more likely to have a miscarriage, or more likely to have a preterm or low-birthweight infant.

Surgery: Some cancers require surgical removal of the uterus, the ovaries, or both.

The effects of cancer treatment on fertility can vary substantially by age. Younger women, who have a larger pool of oocytes when they start cancer treatment, are more likely than older women to be able to get pregnant after treatment.[2]

Options for preserving fertility in women

If possible, women should talk with their doctor about their future fertility before beginning cancer treatment. Some options for preserving fertility require that steps be taken before cancer treatment begins.

One of the most established approaches for preserving fertility among female cancer patients is embryo freezing.[3] Before starting cancer treatment, a woman would be given hormones to stimulate the development of eggs in her ovaries. Mature eggs would be removed and fertilized with the sperm of her husband, partner or a sperm donor. The embryos that result from these fertilized eggs would be frozen for later use.

Although embryo freezing is an established approach to helping women become pregnant after cancer, there are downsides. A woman may not currently have a male partner and may be unwilling to use an anonymous sperm donor. It’s also important to be aware that embryo freezing takes approximately two weeks after the start of a woman’s period. If a woman needs to begin cancer treatment immediately, she may not be able to go through this process. Finally, this approach is only an option for women of childbearing age; stimulating the ovaries to produce mature eggs is not an option for girls who develop cancer during childhood.

Several other options are still in the experimental phase. One approach being explored is the freezing of unfertilized eggs.3 Once again, the ovaries would be stimulated to produce mature eggs before cancer treatment begins. The eggs would then be frozen without being fertilized by sperm. Currently, freezing unfertilized eggs is less likely to result in pregnancy than freezing embryos, largely because unfertilized eggs are less likely than embryos to survive the process of freezing and thawing. Nevertheless, it may be an option for women who do not have a male partner at the time of their cancer diagnosis, and it avoids the difficult issue of what to do with unused embryos.

Another promising but still experimental approach is to freeze all or a part of an ovary before cancer treatment.[4] After treatment, the ovarian tissue is implanted either back in the woman’s pelvis or in another location (such as under her skin). If this process is successful, the ovarian tissue will begin producing eggs. A safety concern with this approach is the possibility of reintroducing cancer cells along with the ovarian tissue, and the tissue will need to be carefully screened for cancer before it is transplanted.4

Finally, it may also be possible to modify some cancer treatments to minimize their effects on subsequent fertility. For example, shielding the ovaries during radiation, or moving the ovaries out of the radiation field, may protect them from the effects of radiation. Scientists are also exploring whether using drugs to suppress the activity of the ovaries during chemotherapy will make the ovaries less susceptible to damage by chemotherapy.[5] For women with certain types of cervical or ovarian cancer, fertility-preserving surgery may also be an option.[6] It’s important to understand that only specific subsets of patients will be candidates for these approaches, and that some of the methods are still in the early stages of evaluation.

Pregnancy after cancer

In addition to having concerns about their ability to get pregnant, women may have concerns about whether pregnancy after cancer treatment will be safe for themselves and their children. While there is a limited amount of information about these topics, the news is generally good.

The risk of cancer recurrence during or after pregnancy has been most studied in women with breast cancer, and these studies generally have reported that pregnancy does not increase the risk of breast cancer recurrence. [7] Many doctors, however, suggest waiting for a period of time after treatment before becoming pregnant. [8]

If chemotherapy or radiation therapy has damaged her heart or lungs, a woman may also have concerns about the strain that pregnancy will put on her body. Studies of breast cancer survivors suggest that long-term heart problems are uncommon after chemotherapy or radiation therapy, [9] but a woman may wish to talk with her doctor about her current health status and the likely effects of pregnancy.

Children born after their mother’s cancer treatment do not appear to be more likely than other children to have birth defects or cancer.[10] If a woman’s cancer was due to a hereditary cancer syndrome, such as Lynch syndrome (hereditary nonpolyposis colorectal cancer), her child may inherit the gene mutation responsible for her family’s increased risk of cancer. Talking with a genetic counselor may help clarify the child’s risk.

When planning for pregnancy, be aware that some cancer treatments may cause you to have an early menopause even if your periods resume after treatment. Also be aware that you may be capable of conceiving even if your periods do not resume; continue to use birth control if you do not wish to become pregnant.

Other Options for Parenthood

Not all women have the luxury of being able to explore their reproductive options before beginning cancer treatment, and not all women will find a fertility preservation option that meets their needs. But there are still ways to become a parent. Discussion of other routes to parenthood may be a painful topic for women who want to become pregnant and cannot. But as cancer survivors consider how best to build their families, methods such as adoption are important options.

Adoption: Couples and individuals who wish to adopt have a range of options, including different types of domestic and international adoptions. You may wish to start by learning about the adoption laws in your state and by talking with other adoptive parents about the professionals and agencies they worked with. Before selecting an adoption agency, women may wish to talk with them about their attitudes toward placing a child with a cancer survivor. Many agencies will be receptive toward this, but it’s important to know before making a final decision.

Egg Donation: Women who still have a uterus may be able to become pregnant using an egg donated by another woman. Through in vitro fertilization, the donated egg would be fertilized by the cancer survivor’s male partner or a sperm donor, and implanted in her uterus. Alternatively, another couple may donate a frozen embryo that could be implanted in her uterus.

Gestational Carrier or Surrogate: Women who do not have a uterus, or who are otherwise unable to sustain a pregnancy, may be able to have another woman carry a pregnancy for them. If the cancer survivor has functioning ovaries, her own egg can be fertilized by her male partner’s sperm and transferred to the uterus of another woman. In this case, the woman who carries the pregnancy is known as a gestational carrier. If the cancer survivor does not have functioning ovaries, another woman can both donate an egg and carry the pregnancy. This is the arrangement traditionally known as surrogacy.

Individual Decisions Within a Larger Community

The decisions that you make about building a family (or about coming to terms with not building a family) will be intensely personal, but know that you are part of a larger community of patients and healthcare providers who are grappling with these issues.

To think about future parenthood is to think about life after cancer. For many people with cancer, planning for the future may provide the motivation needed to get through treatment.

More Information?

Discuss with others….. http://cancerconnect.com/groups/young-adults/topics/fertility-after-cancer-treatment

Fertile Hope (www.fertilehope.org) provides a range of fertility resources for people with cancer.

References:

Overview of Bowel Anatomy

In order to understand that different types of ostomies that may be used for patients with disease of the colon or rectum, it helps to understand the structure and function of the small and large intestines.

The small intestine plays an important role in the digestion of food. It connects the stomach to the large intestine and consists of three parts: the duodenum (the part closest to the stomach), the jejunum (the middle part), and the ileum (the part that connects to the large intestine).

The large intestine consists of the colon, the rectum, and the anal canal. The large intestine is where stool is formed and stored before being passed from the body through the anus. Fluids and some nutrients are absorbed from the large intestine before stool leaves the body.

Types of Ostomies

Depending on what part and how much of the large intestine has been surgically removed, different approaches may be used to divert stool to the outside of the body.[1] Each of these approaches involves the creation of a stoma. To create a stoma, the surgeon brings a cut end of the small or large intestine to the surface of the body through an opening in the abdomen. Once at the surface, the end of the intestine is rolled back on itself (somewhat like a turtleneck sweater) and stitched to the wall of the abdomen. This portion of bowel that is visible on the surface of the abdomen is the stoma. Stool leaves the body through the stoma.

Ileostomy: An ileostomy connects the last part of the small intestine (the ileum) to the outside of the body, completely bypassing the colon, rectum, and anus. The waste that leaves the body at this point in the digestive system is only semi-solid. Waste passes through the stoma into a collection bag (an ostomy pouch) that is worn on the outside of the body. This bag must be emptied several times a day.

Colostomy: A colostomy is similar to an ileostomy, but it is a part of the colon that is diverted to a stoma. As with an ileostomy, waste can be collected outside of the body in an ostomy pouch. Some patients may also have the option of irrigation (insertion of water through the stoma) to have more regulated bowel movements.

Continent Ileostomy: This is a procedure that allows some patients to avoid wearing an ostomy bag. After surgery to remove the large intestine, an internal pouch is made from the end of the ileum. The pouch is connected to a stoma. Stool collects in the pouch inside of the body and is drained using a tube inserted through the stoma.

Living with an Ostomy

Ostomy appliances: Many patients with a colostomy or ileostomy will need to wear pouches over their stoma to collect waste. There are several different types and sizes of pouches, and patients may find that they use different types at different times. Some pouches are drainable (able to be opened at the end so that stool can be discarded) and others are closed (meant to be removed and discarded when filled). The pouch is connected to a faceplate that adheres to (and protects) the skin around the stoma. Because there are many different pouching systems available, talk with your doctor or ostomy nurse about the types that will best fit your body and your lifestyle.

Irrigation supplies: Irrigation is a process that allows some patients with a colostomy to regulate their bowel movements. Water is inserted through the stoma and causes stool to be expelled. This process requires specific supplies, and you should work with your doctor or ostomy nurse to learn to use them properly.

Dietary considerations: For several weeks after surgery, your doctor may recommend a limited diet. After this recovery period, however, you will probably be able to gradually return to your regular diet. Some foods are more likely than others to cause gas or odor in stool, so you may want to start with small servings of these foods until you learn how your body reacts to them. Foods that may cause gas, for example, include beans, cabbage, and carbonated beverages. Eating at regular intervals can also help to reduce gas.

Returning to the activities that you enjoyed before: Once you heal from surgery and learn to use your pouching or irrigation system, you are likely to be able to return to the activities that you enjoyed before having an ostomy. These activities may include sex, work, exercise (including swimming), and travel. It’s natural to feel hesitant or self-conscious when you first return to normal activities, but these feelings generally diminish as you become comfortable with your ostomy appliance and learn which pouching systems or ostomy accessories you prefer for which activities. During sex, for example, some people choose small, closed pouches, or use pouch covers.

In some cases, you may need some extra help to get back to your normal activities. After surgery for rectal cancer, for example, some men have difficulty achieving or maintaining an erection, and some women may experience discomfort during intercourse. Sexual problems (as well as other problems that you may experience) can often be effectively managed, so don’t hesitate to discuss your concerns with your doctor.

Ostomy Support

The good news for people with an ostomy is that support networks are available. These networks can provide practical advice on many aspects of living with an ostomy, and can also be an important source of emotional support. Sources of ostomy information and support include ostomy nurses, local support groups within your hospital or community, and national groups such as the United Ostomy Associations of America (www.ostomy.org).

Reference:

Lynch Syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC), results from inherited mutations in genes involved in DNA mismatch repair. These mutations greatly increase the risk of developing colorectal cancer. In individuals with Lynch Syndrome, the average age at diagnosis of colorectal cancer is about 44 years, compared with 64 years in the general population. Overall, roughly 3% to 5% of all colorectal cancers are thought to result from Lynch Syndrome. Other cancers that are more common in Lynch Syndrome families include cancers of the endometrium (the lining of the uterus), ovary, small intestine, ureter, and renal pelvis.

Aspirin has been linked with a reduced risk of colon polyps in previous randomized trials, but the current trial is the first to focus on colorectal cancer as an outcome. The study—known as CAPP2—enrolled 861 people with Lynch Syndrome. Study participants received 600 mg per day of aspirin or a placebo. The study also explored the effect of resistant starch.

An earlier report from this trial, published in 2008, did not find a benefit of benefit of aspirin or resistant starch.[1] Longer follow-up, however, has revealed a substantial benefit from aspirin. Patients have now been followed for an average of 56 months.[2]

• After accounting for the fact that some people developed more than one colorectal cancer, daily aspirin reduced the risk of colorectal cancer by 44%.
• In the subset of study participants who took aspirin for at least two years, the risk of colorectal cancer was reduced by more than half.

These results suggest that daily aspirin can reduce the risk of colorectal cancer in people with Lynch Syndrome. Aspirin does not replace other measures used to manage cancer risk in this population, but may be a useful addition. Because regular aspirin use has some risks, however, people should talk with their doctor before they begin using aspirin. Ongoing research will explore the optimal dose and duration of aspirin use for people with Lynch Syndrome. Doses lower than the 600 mg per day used in the current study may prove to be sufficient.

References:

[2] Burn J, Gerdes A-M, Macrae F et al. Long-term effect of aspirin on cancer risk in carriers of hereditary colorectal cancer: an analysis from the CAPP2 randomised controlled trial. Lancet. Early online publication October 28, 2011.

Screening is crucial for the prevention and early detection of colorectal cancer. The American Cancer Society currently recommends that people at average risk of colorectal cancer begin being screened for colorectal cancer at the age of 50.  Screening may need to begin at a much earlier age for people with a personal or family history of adenomatous polyps, FAP, HNPCC, colorectal cancer, or chronic inflammatory bowel disease.

There are several available screening strategies for colorectal cancer, including FOBT, which checks for hidden blood in the stool and colonoscopy, which is a more invasive procedure that requires patients to be sedated while a physician inserts a flexible camera into the rectum to examine the colon.

Colonoscopy has become the gold standard for colorectal screening because it allows the physician to view the entire colon and rectum and on average, need only be performed every 10 years. FOBT, on the other hand, must be performed on a yearly basis. Both tests are effective ways to screen for colorectal cancer; however, most doctors recommend colonoscopy.

This study included a racially diverse group of 997 people at average risk for developing colorectal cancer. The participants were randomized to receive recommendation for screening with FOBT, colonoscopy, or their choice of FOBT or colonoscopy. The primary outcome of the study was completion of colorectal screening within 12 months and secondary analyses evaluated the sociodemographic factors associated with completion of screening.

The results—when given a choice of screening method, 69 percent of people get screened within the year. In contrast, when the doctor recommended colonoscopy, only 38 percent of people followed through with screening. When FOBT was recommended, 67 percent of people completed the screening test. Overall, when given a choice, 31 percent of people chose colonoscopy and 38 percent chose FOBT.

The researchers found that cultural influences may play a role in adherence to colorectal screening. In this study, African-American, Latino, and Asian participants preferred the FOBT, while white participants more often adhered to colonoscopy.

The bottom line—one size does not fit all when it comes to colorectal cancer screening. Universally recommending colonoscopy may actually be reducing compliance to colorectal cancer screening, especially among ethnic minorities. Providing choices may improve colorectal cancer screening rates.

Reference:

Stage III colon cancer refers to cancer that has spread to lymph nodes surrounding the colon but not to other parts of the body.

Erbitux is a targeted therapy that inhibits growth of the cancer by binding to a portion of the epidermal growth factor receptor (EGFR), a protein located on the surface of many cancer cells. Erbitux is currently approved for the treatment of selected patients with advanced head and neck cancer or advanced colorectal cancer.

Among patients with metastatic colorectal cancer, response to Erbitux appears to vary by whether or not the tumor contains a mutation in a gene known as KRAS. Erbitux does not appear to benefit patients with KRAS gene mutations, but has been found to benefit patients with normal KRAS. This benefit among patients with metastatic colorectal cancer and normal KRAS prompted interest in the role of Erbitux among patients with earlier-stage colorectal cancer and normal KRAS.

To evaluate Erbitux among patients with Stage III colon cancer, researchers in North American conducted a Phase III clinical trial among 2,686 patients. After surgery, patients received FOLFOX chemotherapy (mFOLFOX6) alone or in combination with Erbitux.

• Among patients with normal KRAS, three-year disease-free survival was 74.6% among patients who received chemotherapy alone, and 71.5% among patients who received chemotherapy plus Erbitux.
• Among patients with a KRAS mutation, disease-free survival was 67.1% among patients who received chemotherapy alone, and 65.0% among patients who received chemotherapy plus Erbitux.
• The addition of Erbitux increased serious side effects.

These results suggest that the addition of Erbitux to adjuvant chemotherapy does not improve outcomes among patients with Stage III colon cancer. The benefit seen in patients with metastatic colorectal cancer may not apply to patients with earlier-stage disease.

Reference: Alberts SR, Sargent DJ, Nair S et al. Effect of oxaliplatin, fluorouracil, and leucovorin with or without cetuximab on survival among patients with resected stage III colon cancer. JAMA. 307:1383-1393.

A growing body of evidence suggests that aspirin may reduce the risk of several types of cancer, with particularly strong evidence for colorectal cancer. Not all studies have found a benefit, however, and any potential benefits of aspirin must be weighed against risks such as bleeding.

To further explore the relationships between daily aspirin and cancer, researchers conducted a combined analysis of 51 previous randomized trials.[1] The trials were originally designed to evaluate the effect of daily aspirin on outcomes such as heart disease, but information about cancer was also available.

• Daily aspirin reduced cancer deaths. After five years, aspirin users had a 37 percent reduction in risk of cancer death.
• Aspirin also reduced the likelihood of developing cancer. From three years onward, aspirin users had a 24 percent reduction in the risk of being diagnosed with cancer.
• As expected, aspirin carried a risk of major bleeding, but this risk appeared to diminish over time.

Another study published in the same issue of The Lancet evaluated the effect of daily aspirin on cancer metastasis (the spread of cancer from its original site to other parts of the body). The study focused on 987 people who were diagnosed with cancer while participating in one of five trials of aspirin use. Those who were taking aspirin were less likely to have metastatic cancer than those who were not taking aspirin.[2]

These results suggest that regular aspirin use may reduce cancer incidence and mortality, but concerns remain about the risks of regular aspirin use in healthy individuals. People who are considering using aspirin on a regular basis are advised to discuss the risks and benefits with their physician.

References:

Colorectal cancer is the second leading cause of cancer death in theUnited States. For people at average risk of colorectal cancer, the American Cancer Society recommends that routine screening begin at age 50. Recommended options for screening include colonoscopy, sigmoidoscopy, double-contrast barium enema, fecal occult blood tests, fecal immunochemical tests, and stool DNA tests. In addition to detecting cancer at an early stage, colorectal cancer screening can also help to prevent the development of colorectal cancer; some screening tests can identify precancerous polyps that can be removed before they become cancerous.

During a colonoscopy, a flexible tube attached to a camera is inserted through the rectum, allowing physicians to examine the internal lining of the colon and rectum for polyps or other abnormalities. If polyps are identified, they can be removed during the colonoscopy.

Previous studies have indicated that removal of polyps during colonoscopy reduces the occurrence of colorectal cancer. The effect of polyp removal on colorectal cancer deaths, however, has been less certain.

To assess the long-term effects of polyp removal, researchers evaluated information from the National Polyp Study. Information was available about 2,602 people who had precancerous (adenomatous) polyps removed during colonoscopy.

During more than 15 years of follow-up, people who had had colorectal polyps removed during colonoscopy were roughly half as likely to die of colorectal cancer as people in the general population.

Although this study was not a randomized clinical trial (the most definitive type of study), these results provide the best evidence to date that colonoscopy and polyp removal reduce the likelihood of death from colorectal cancer.

Reference: Zauber AG, Winawer SJ, O’Brien MJ et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. New England Journal of Medicine. 2012;366:687-96.