The Israel Cancer Association partnering with the Ministry of Health announced the launch of "Colorectal Cancer Awareness Month 2013", held in March in Israel, as well as in other countries.
Key Facts and Figures:
According to the Ministry of Health's National Cancer Registry and National Center for Disease Control statistics:
Colorectal cancer incidence rates (invasive tumors) among the Jewish population have decreased over the past two decades: a 17% drop in incidence among males and a 13% drop among females. An increase in incidence rates and a trend towards stabilization have been observed among the Arab population over the past five years.
The rate for early stage diagnosis of the disease has nearly doubled (from 18% to 34%) over the past twenty years, as a result of the increase in compliance with the National Colorectal Cancer Screening Program, jointly initiated by the Israel Cancer Association and the Ministry of Health.
Mortality rates have dropped by 17% in males and by 11.4% in females. Among the Arab population, there has been an increase in mortality rates, and a trend towards stabilization has been noted over the past five years.
Israel ranks fourth in colorectal cancer incidence rates as compared to countries with the top 20 highest incidence of colorectal cancer, and ranks 15th in world [colorectal cancer] mortality rates (tied with Germany).
The national compliance for fecal occult blood tests is constantly on the rise, and currently stands at 41%, compared to the figures reported last year relating to screening compliance, which stood at 36.7%.
In total, over 50% of the target population for early detection tests undergoes any kind of screening test for early detection.
The Ministry of Health's National Cancer Registry and National Center for Disease Control, under the direction of Dr. Lital Keinan-Boker, Ms. Irena Lifshitz, Ms. Yehudit Fishler and Ms. Rita Dichtiar, presented relevant and up-to-date statistics:
Colorectal cancer is the second most common cancer in Israel, after breast cancer in women and prostate cancer in men.
Invasive Colorectal Cancer Incidence
In 2010, 3,247 Israelis were diagnosed with invasive colorectal cancer, of whom 1,437 were Jewish men, 1,392 were Jewish women, 154 were Arab men, 127 were Arab women, and 137 defined as "others" (Christians).
The age-standardized incidence rates in 2010 are lower than those observed in 1990. Incidence rates dropped by 17% among Jewish men, and a drop of 13% was observed among Jewish women. Whereas, among the Arab population, an increase in incidence rates was observed in comparison to the rates recorded in 1990; among men there was a 3.6 fold increase and among women a 2.6 fold increase. However, over the past five years, incidence rates have remained stable among the Arab population.
Gender- and age-specific incidence
Colorectal cancer incidence rates significantly increase starting around the age of 60, and they are highest in the 75+ year-old age group. Among the Jewish population, those of European-American descent have the highest incidence rates, both in men and in women.
Incidence by stage of disease at time of diagnosis
In 2010, over a third (34%) of new patients were diagnosed at an early stage of the disease. This percentage is nearly 2 fold higher than the percentage of patients diagnosed at an early stage (in situ and stage 1) in 2000 (18%).
At the same time, a 20% drop was observed in the number of patients who were diagnosed for the first time with metastatic disease. This accomplishment may be attributed to the National Colorectal Cancer Screening Program initiated by the Israel Cancer Association and the Ministry of Health, and which is operated by the health care funds. Early detection improves chances of survival and reduces mortality rates.
Colorectal Cancer Survival Rates
For those diagnosed from 2003-2008, relative survival rates increased, compared to those diagnosed from 1993-1997 (67% in men and 68% in women, compared to 57% in men and women).
Colorectal Cancer Mortality Rates
In 2010, 1,363 Israelis died of invasive colorectal cancer, of whom 595 were Jewish men, 629 Jewish women, 38 Arab men, 47 Arab women, and 54 defined as "others". The morality rates were 17% lower in men and 11.4% lower in women, compared to rates observed in 1990. A 130% increase was observed among Arab men and an 8% increase among Arab women, compared to rates dating from 1990.
It is important to note that over the past five years mortality rates among the Arab population have remained stable.
Colorectal incidence rates in Israel were compared to those of 20 countries with the highest incidence rates worldwide, through the Globocan database of the International Agency for Research on Cancer (IARC), for 2008.
Based on the data, it emerges that Israel ranks fourth in colorectal cancer incidence rates worldwide, and has the 15th highest morality rate in the world, along with Germany.
Prof. Gadi Rennert, Director of the National Colorectal Screening Program, reports an increase in compliance with fecal occult blood tests, which currently stands at 41%, compared to last year's 36.7%.
In total, over 50% of the target population for early detection tests undergoes one of the screening tests, either fecal occult blood or a colonoscopy exam. According to the National Program estimate, about two thirds of the colonoscopy exams were performed as a test for high risk groups.
Prof. Rennert indicates that the implementation rate of early detection tests for colorectal cancer in Israel is still relatively low, however it is similar to the percentage reported by other Western countries.
In March, the ICA is holding various and diverse activities to increase awareness of prevention, early detection, treatment modalities, and ways of curing colorectal cancer.
The ICA will hold an Open Line on Galei Tzahal (IDF radio station) on March 11, 2013, from 2pm to 3pm, featuring experts in the field who will respond to questions from the general population:
Mrs. Miri Ziv, ICA Director General, Prof. Baruch Brenner, Director of The Gastrointestinal Malignancy Unit, Davidoff Center for the Research and Treatment of Cancer, Rabin Medical Center, Beilinson Campus; Dr. Revital Kariv, Director of the Digestive System Tumor Service, Center for Digestive Tract and Liver Diseases, Tel Aviv Sourasky Medical Center.
A seminar for colorectal cancer patients will be held on March 12, 2013, free of charge, for patients, survivors and their families.
The seminar is made possible courtesy of Roche Pharmaceuticals which runs the "Roche lends a hand to Patients" project.
Additionally, the ICA will hold an extensive information campaign in the various media channels, in the newspapers, and on the internet during the month of March, focusing on the importance of early detection.
General information and written material may be accessed via the ICA Telemeida information hotline: Telephone: 1-800-599-995.
Colorectal Cancer - New Research Studies
The Potential of Resistant Starch in Preventing Colorectal Cancer
Researchers of the University of Colorado in the U.S. reviewed new articles that investigated the physiological benefits of consuming resistant starches, and their possible influence on prevention, or improvement in the conditions of patients suffering from various diseases, including colorectal cancer and diabetes.
Resistant starches are found in a wide variety of fruits, vegetables and other plant foods. They represent a wide range of nutritional carbohydrates that cannot be absorbed or broken apart by the small intestine, such that they escape nearly intact to the large intestine. This nutritional component may be found in whole grains, beans, green bananas, wheat, barley and rice, cooked and cooled starches, such as rice or pasta, corn starch, genetically modified starches and other forms of starch.
The research studies that were reviewed verify previous evidence of the health benefits of the consumption of resistant starches. The researchers discovered that it has physiological benefits for the intestine, it helps reduce body weight, and among those who have lost weight, it prevents weight gain. Resistant starch plays an important role in reducing chronic inflammation as well as in preventing colorectal cancer. Investigators have established that additional research studies with human subjects are necessary to confirm these results.
Research scientists have established that resistant starches may be used for oriented colorectal cancer therapy by coating chemotherapy drugs with this component, which provides sustained release of the anti-tumor drug inside the tumor itself. Additionally, resistant starch may be added to foods such as breakfast cereals, breads, sweets, pasta, yoghurt, cheese and fruit shakes.
Investigators emphasize that the information regarding the effect of resistant starches on cancer is about to quickly expand, and initial information from the research study that demonstrated the positive results in rats, is indicative of this component's capacity to treat other cancers, such as breast cancer.
The survey was published in the March 2013 issue of the journal: Current Opinion in Gastroenterology.
Does low alcohol consumption or increased fiber intake modify the risk of developing colorectal cancer? New model
Investigators have found that a combination of environmental risk factors for colorectal cancer include alcohol consumption, nutrition and a sedentary lifestyle, coupled with known genetic risk factors, may present a model that can be used to assess the weighted risk of developing colorectal cancer, thereby increasing the chances for behavioral modification among the general population.
The research scientists of the Division of Genetics and Molecular Medicine at Kings College London were assisted by research studies conducted by the GWAS - Genome-Wide Association Study, which compiled the genetic risk factors for developing colorectal cancer. Additionally, the researchers chose 6 environmental risk factors for developing colorectal cancer: high alcohol consumption, smoking, low physical activity levels, high Body Mass Index (BMI), low fiber intake and high consumption of red and processed meats.
With the help of a simulation program, the investigators assessed the potential effect of behavioral changes on the risk of developing colorectal cancer. The results showed that with the help of a genetic model only, 24% of the population tested was defined at low risk, 60% were at a regular risk, 10% were at increased risk, and 6% were at high risk of developing the disease.
By adding one risk factor to the model - decreasing alcohol consumption, some of the increased risk group and high risk groups dropped to 9% and 5% respectively.
When the sub-groups of alcohol consumption were tested (low consumption, moderate consumption, increased consumption, etc.), it emerged that heavy alcohol consumers constituted 27.2% of the population at increased risk and high risk, as opposed to 4.5% among those who rarely, or never consumed alcohol.
When they added the consumption of nutritional fiber to the model, those who consumed 3 servings of nutritional fiber a day constituted 7.3% of the increased and high risk group, as opposed to 20.9% of the those who consumed one serving of fiber a day.
In short, the research scientists conclude that with the help of this model, we may distinguish the factors that cannot be changed (the genetic factors), from the factors that may be modified (environmental), and it may be used to explain to men and women the inherent benefits of lifestyle modification, which could in turn increase their motivation to change their lifestyle, in order to prevent the disease.
This research study was published online in the journal Cancer Epidemiology on January 30, 2013.
Does 'personalized' intervention have an impact on colorectal cancer screening compliance?
In a research study that was published online in November 2012, in the journal Cancer Epidemiology Biomarkers & Prevention, research scientists of the Thomas Jefferson University in the United States examined the effect of personalized intervention as compared to standard intervention on compliance with screening for colorectal cancer and screening in practice.
The study was conducted between 2007 and 2011, involving 945 subjects ages 50-79 from ten family and community medicine clinics, who were randomly divided into three groups of identical size:
The 'personalized intervention' group was sent information by email regarding the preferred test for them (colonoscopy or fecal occult blood test). Similarly, these participants received a phone call that encouraged them to go get themselves checked. In the 'standard intervention' group, the participants received mailings about the two screening tests: colonoscopy and fecal occult blood test. In the control group, the participants did not receive any initiated information.
Following the intervention, the research scientists examined the respondents' desire or willingness to undergo the screening. 45% of the personalized intervention group expressed a willingness and intention to undergo their preferred screening test, 37% of the participants in the standard intervention group, and 23% of those in the control group.
6 months after the transfer of the initiated information regarding the screening choices, the researchers examined the actual compliance of the participants with the screening test of their choice. More participants in both intervention groups showed actual compliance with screening tests as compared to the control group: 38% of the personalized intervention group and 33% of the participants in the standard intervention group underwent the screening test, while only 12% of the control group underwent the screening test. In other words, there was no significant difference between the two intervention groups; however, there was a difference between the intervention groups and the control group.
To sum up, both types of intervention, personalized and standard, had a positive impact on the decision to undergo the screening test as well as on screening compliance in practice, compared to the control group. Personalized intervention, vs. standard intervention, succeeded in distinctly impacting/affecting the decision-making stage in terms of the preferred screening test; however, it had only a slight impact on screening compliance in practice, as compared to the standard intervention. Both interventions were effective in improving compliance vis-à-vis the control group.
The ICA has recently awarded a research fellowship to Dr. Lea Hagoel, of the Epidemiology Dept. at Carmel Hospital, to examine intervention with the help of text messages (SMS), with the aim of increasing compliance with screening for the early detection of colorectal cancer in Israel.