The Israel Cancer Association, partnering with the Ministry of Health, announced the launch of "Colorectal Cancer Awareness Month 2015"
Is colorectal cancer significantly more prevalent among men?
The public thinks so, what do the statistics tell us?
The public believes that colorectal cancer is significantly more prevalent in men, although statistics show that this is not the case.
40% of the men participating in the new ICA survey, and 28% of the women, are convinced that colorectal cancer is more prevalent among men. In fact, the differences are negligible, and the morbidity rate is only 14% higher among men.
Israel ranks third in survival rates among 67 countries worldwide, and exceeds the OECD average by a considerable margin.
In 2012, 34% of new patients were diagnosed at an early stage of the disease, compared to 20% at the outset of the decade.
The new ICA survey indicates that among Jewish interviewees there is an increase in awareness (95%) of the need to undergo screening for the early detection of colorectal cancer. In addition, there has been an increase in actual compliance (72%) compared to previous years. Among Arab interviewees, 63% were aware of the need to undergo screening, and 43% actually underwent mammography screening.
Key Facts and Figures:
Dr. Lital Keinan Boker, Deputy Director of the National Center for Disease Control of the Ministry of Health presented new National Cancer Registry Statistics marking Colorectal Cancer Awareness Month 2015
In 2012, 3,139 new patients were diagnosed with invasive colorectal cancer in Israel; 1,453 Jewish men, 1,274 Jewish women, 131 Arab men, 126 Arab women, and the rest 'others' (Christians who are not Arabs and those who are not affiliated with any specific religion).
Colorectal cancer is the second most common cancer among Jewish men (after prostate cancer), and among Jewish and Arab women (after breast cancer), and it is the third most common cancer among Arab men, after lung and prostate cancer.
Morbidity rates increase considerably starting from age 60, and the median age at diagnosis is 72 among Jewish men and women.
In 2012, the incidence rates (new cases) dropped by 22% among Jewish men and by 24% among Jewish women. Compared to 1990, the rates have stabilized among the Arab population, and there has even been a decrease as of 2010.
Over the course of the years, there has been no increase in incidence in the under-50 age group.
Relative survival rates increased by 20% among Jewish men (from 56% to 67%), and among Jewish women (from 55% to 66%); rates increased by 15% among Arab men, and by 24% among Arab women.
In 2012, 1,355 individuals succumbed to invasive colorectal cancer. 611 Jewish men, 602 Jewish women, 50 Arab men, 43 Arab women.
Colorectal cancer is the second most common cause of mortality in both population groups and among both sexes.
Mortality is mainly observed at an older age, the median age being 78.8.
The mortality rates decreased by 20% among Jewish men, and by 19% among Jewish women, compared to 1990. The mortality rates among Arab men are higher than those observed in 1990 (a 2.8 fold increase), whereas the rate among women was lower than the rate observed in 1990 (a 10% drop). However, the downward trend among the Jewish population has been maintained and a slow downward trend has been observed among the Arab population since 2005.
In 2012, 34% of new patients were diagnosed at an early stage of the disease. This rate is 70% higher than the rate of those diagnosed at an early state at the outset of the decade. The rate at the outset of the decade stood at 20%.
At the same time, there was a decline in the percentage of patients diagnosed for the first time with metastatic disease, dropping from 15% in 2000, to 9% in 2012, a 40% decrease.
Several International Comparisons:
According to the Globocan database of the International Agency for Research on Cancer (IARC) for 2012, regarding the 20 countries with the highest rates worldwide - Israeli men rank 14th in incidence rates and 19th in mortality rates out of 20. Israeli women rank 8th in incidence rates and 10th out of 20 in mortality rates.
On the other hand, in survival rates, Israel exceeds the OECD average by a considerable margin, ranking 2nd, for those diagnosed from 2006-2011.
The Concord-2 research study published in November 2014, deals with relative cancer survival rates in 67 countries worldwide. The results indicated that Israel ranks high in 5-year relative survival rates for colorectal cancer.
The National Program for the Early Detection of Colorectal Cancer, initiated by the ICA in 2004, and currently implemented by the Ministry of Health and HMOs, coupled with ICA's extensive public information activity, have increased awareness of this issue, and the two-decade outcomes manifest themselves in the increase in colorectal cancer screening compliance, as well as in the improvement in survival rates and the drop in mortality rates.
Please click here to view the complete report.
New Israel Cancer Association Survey: Colorectal Cancer Awareness and Early Detection Screening Compliance
A telephone survey among a representative sample consisting of 300 Jewish men and women, and 100 Arab men and women aged 50 years and above, was conducted by the Mutagim Yifat Gat Ltd. Research Institute.
Did you know that over the age of 50, you must undergo a screening test for the early detection of colorectal cancer? And if so, did you undergo such a test?
Most of the Jewish interviewees (95%) are aware of the fact that over the age of 50 one must undergo a screening test for the early detection of colorectal cancer.
There has been an increase in awareness of the need to undergo screening tests for early detection, compared to 2007 (83%), and 2010 (93%).
Among Arab interviewees, lower percentages were recorded in awareness: 63% were aware of the need to undergo screening tests for early detection of colorectal cancer, over the age of 50.
No significant differences emerged in terms of sex, age and area of residence.
A third of the interviewees (33%) indicated that they were unaware of the need to undergo screening.
Is colorectal cancer a preventable disease?
About two thirds of the Jewish respondents (65%) believe that colorectal cancer is preventable, 11% believed that it was not preventable and about a fourth (24%) did not know. More men believe that it is preventable (70% men, 62% women).
Over a third (35%) of the Arab respondents believe that colorectal cancer is preventable, more women than men (40%, 30% respectively).
A significant percentage (37%), mainly men (46% compared to 28% women) were unaware that the disease is preventable.
How can colorectal cancer be prevented?
The primary way to prevent colorectal cancer, according to Jewish respondents, is to undergo screening tests for early detection (61% of the overall respondents, 75% of those who responded that the disease is preventable). Additional prevention methods indicated: proper nutrition (20%), physical activity (9%). A higher percentage of men, than women, cited physical activity as a factor which may potentially prevent the disease (12% compared to 6%).
Among Arab respondents: 43% believed that eating a healthy diet is the primary way of preventing colorectal cancer, a response which figured more frequently among women (54% compared to 32% men). Among individuals between the ages of 50 and 64, as opposed to older respondents, 32% believed that screening for early detection serves an additional means of preventing the disease.
Is colorectal cancer considerably more prevalent among men?
34% of the Jewish interviewees responded that colorectal cancer is more prevalent among men, in spite of the fact that morbidity rates are actually only 14% higher among men. 40% of men and 28% of women are convinced that colorectal cancer occurs significantly more frequently in men.
Over half of respondents (54%) were unaware whether colorectal cancer occurs significantly more frequently in men.
Similar percentages were indicated among the Arab interviewees.
Undergoing the screening test in practice
Did they undergo a screening test for the early detection of colorectal cancer?
Nowadays, more people know that they have to undergo the test, and indeed undergo screening compared to the testing frequency in previous years. Today, 72% of the Jewish respondents were aware of the need to get themselves tested, and indeed underwent screening, compared to 2007, when 48% were aware of the need and underwent screening; in 2010 62% of those who were aware of the need for the test indeed underwent screening.
More men than women are aware of the need for the test and undergo screening (80% compared to 65% respectively).
Among the Arab interviewees, 43% heard of the test and actually underwent screening.
A higher percentage of women than men underwent screening (48% compared to 38%). No differences emerged according to age or area of residence.
57% of the Arab interviewees did not undergo any kind of screening for the early detection of colorectal cancer.
What kind of test did they undergo and when?
Among the Jewish interviewees, who underwent an early detection screening, 37% underwent a colonoscopy (more men than women, and more individuals aged 60 and above) and 30% underwent a fecal occult blood test.
85% of the respondents who underwent a fecal occult blood test were screened over the past year, according to guidelines.
Among Arab respondents, who underwent an early detection test, nearly twofold underwent a fecal occult blood test, compared to colonoscopy (21% compared to 12%). Women underwent the fecal occult blood test more frequently than colonoscopy (26%, 12% respectively).
No significant differences emerged in terms of age and area of residence.
94% of the individuals who underwent a fecal occult blood test underwent screening over the past year, according to recommendations.
What are the sources of information for undergoing a screening for the early detection of colorectal cancer?
The main source of information among the Jewish population (62%) and the Arab population (74%) alike, among both sexes and in all age groups, was the family physician.
The second source of information that was cited (14%) among the Jewish interviewees was the ICA public service announcements on TV (more significant among women).
Additional sources cited: family and friends (8%), press (8%), medical staff, radio, etc.
Most of the respondents (71%) who underwent the fecal occult blood test received information from their family physician, ICA public service announcements on TV (17%), or from different members of medical staff (11%). A lower percentage of respondents who underwent a colonoscopy received information from their family physician (-54%), and relied more on information from family and/or friends.
Among the Arab interviewees, the second source of information for undergoing screening was medical personnel (16%) and family, or friends (14%).
What were the main barriers to screening?
The main barriers that were indicated by the Jewish interviewees were:
Laziness (16%), I had no time (16%), objection to screening tests "I don't believe in it" (11%), "I don't undergo tests" (11%), "I didn't receive a referral" (10%). As opposed to 2010, when barriers such as fear of test results (12%, compared to statistics from 2015, 1%) and fear of the test itself (10%, compared to 7% in 2015) prevailed.
Among Arab interviewees who did not undergo the screening, the assertion that stood out was that "they did not receive a referral, or it was not recommended that they undergo the test" (18%).
Another prevalent assertion was "I am a vegan or I engage in alternative medicine" (18%).
Other reasons that emerged "there were no complaints" (12%), "less awareness" (12%).
Compliance with colorectal cancer screening tests
According to the Ministry of Health National Program for the Quality Indicators in Community Healthcare in Israel report summing up 2013, there is a continuing trend towards improvement and an increase in the compliance to undergo screening tests for the early detection of colorectal cancer was recorded. This may be attributed to The National Program for the Early Detection of Colorectal Cancer, initiated by the Ministry of Health and the ICA.
According to 2013 reports, 57% of the overall population between the ages of 50 and 74 underwent an early detection test for colorectal cancer. There has been a significant increase since 2010, when compliance stood at 48.6%, and increased to 51% in 2011, and to 24% in 2012.
When the National Program for the Early Detection of Colorectal Cancer began in 2002, only 12% complied to undergo screening tests.
New research studies Compliance to colorectal cancer screening: the impact of text messaging-based intervention (SMS) on those summoned for screening
Dr. Lea Hagoel, Dr. Efrat Neter, Dr. Nili Stein, and Prof. Gad Rennert. This research study has been funded by the ICA
In many countries around the world, there are organized interventions for summoning target populations to test themselves with a home-use test kit to measure the presence of occult blood in stool, for the early detection of colorectal cancer. Despite the increase in awareness and compliance with screening tests throughout the years, compliance should still be encouraged to increase the number of those who undergo screening.
This research study examined the compliance of those summoned to a screening test, by sending text messages to their cellular phones after they had received an invitation to receive a home-use test kit. The SMS contained a brief text message, aimed at encouraging the recipients to order a home-use test kit and undergo the screening.
The sample consisted of 50,000 members of Clalit Health Services, men and women between the ages of 50 and 74 who were invited several times to undergo a screening for the early detection of colorectal cancer, but did not undergo the tests.
The research population was divided into 5 groups: 4 trial groups, participants who received different wordings of the text message, and the control group, participants who did not receive any text message.
Two groups of participants received SMS messages including a question regarding their intention to undergo the screening. One group was asked a question in a social context ("Further to the invitation for the screening test to detect colorectal cancer that was sent to you, did you intend to order a home-use fecal occult blood test kit and get yourself tested? Like others your age?"). The other group was asked a question not in a social context ("Further to the invitation for a screening test to detect colorectal cancer that was sent to you, do you intend to order a home-use fecal occult blood test kit and get yourself tested?").
The two other groups received text messages with a statement which was an assertion ("Further to the invitation from Clalit Health Services for a screening test to detect colorectal cancer that was sent to you - it is important to order a fecal occult blood test kit and get yourself tested"), and an assertion in a social context ("Further to the invitation from the Clalit Health Services for a screening test to detect colorectal cancer - people your age order a fecal occult blood test kit and get themselves tested".)
A week after the letter and the kit are sent out, an SMS is sent to cellular phones. Follow up of the implementation of the fecal occult blood test was conducted about 6 months after the delivery of the text messages.
The research results indicated higher compliance with the screening tests in the groups that received the SMS messages compared to the control group. In the control group the compliance was 8.5%; in the group that was asked a question that was not in a social context, the compliance was 9.8%, and in the group that was asked a question in a social context, compliance was 10.3%; in the group that was given an assertion that was not in a social context, the compliance was 9.2%, and in the group that was given an assertion in a social context, the compliance was 9.6%.
Women and participants over the age of 60 tended to get themselves tested more frequently than others. The recipients of the question-oriented text messages, tended to get themselves tested more frequently than the recipients of the assertion-oriented text messages.
Researchers' Conclusion: Despite the fact that the research population comprises a population with a low compliance to undergo screening, a higher compliance to undergo screening was obtained with the help of the text messages than would have been obtained without this intervention.
The ICA Information Center announces new research studies
Is there an association between coffee consumption and the risk of colorectal cancer?
Researchers from Carmel Medical Center, the Technion and the National Israeli Cancer Control Center of Clalit Health Services, along with researchers from the University of Southern California in the U.S., examined the association between the consumption of coffee, and the risk of developing colorectal cancer.
Previous research studies assessed the link between the consumption of coffee and the risk of contracting colorectal cancer; however they did not obtain conclusive results. The present research study examined a large number of colorectal cancer patients in this context. Data was collected by observing 8,472 individuals from the Haifa and northern region, a cohort comprising 4,933 colorectal cancer patients and 3,539 healthy individuals.
The statistics included coffee consumption habits according to serving and types of coffee that were consumed on a daily basis: decaffeinated, "black coffee" (boiled), espresso, instant coffee and filtered coffee, as well as by ethnic sub-group: Eastern and Western European descent (Ashkenazi), Oriental/Sephardic descent, and Arab society. Statistics were also collected regarding age, gender, eating habits, physical activity and medication intake.
The average daily coffee consumption among all subjects was 1.8 cups a day, with those of Eastern and Western European origin consuming an average of 1.5 cups a day. Those of Oriental/Sephardic descent consumed 1.9 cups, and among members of Arab society, the average consumption was 3.1 cups per day. The type of coffee that is most prevalent among the Jewish population is instant coffee and black coffee (boiled coffee) among the Arab society.
Upon processing the data collected, it emerges that coffee consumers' weighted risk of developing colorectal cancer is 31% lower, compared to those who do not drink coffee at all. And among those who drink decaffeinated coffee, a 26% reduction in risk was observed.
Based on the research results, it is evident that there is a significant association between the serving of coffee consumed and the risk of developing colorectal cancer: in comparison to people who consumed only one cup of coffee or less a day, those who consumed 1 to 2 cups a day, had a 22% lower risk of developing colorectal cancer. Those who consumed 2 to 2.5 cups had a 44% lower risk, whereas those who consumed 2.5 cups of coffee and more had a 59% lower risk of developing colorectal cancer. The results were consistent among all ethnic groups, however, they were strongly statistically significant among the Jewish population (both of Ashkenazi descent and Oriental/Sephardic descent).
The protective effect of coffee against colorectal cancer was observed in this study.
The investigators conclude that regardless of caffeine content, a moderate level of consumption suffices to significantly reduce the risk of developing colorectal cancer.
A summary of this research study was published in the October 2014 issue of the Cancer Research Journal, according to statistics presented at the Annual Meeting of the American Association for Cancer Research (AACR)
The association between constipation and the use of diuretics on the one hand and the risk of developing colorectal cancer on the other
Researchers from various medical centers in Seattle, U.S., examined the association between colorectal cancer morbidity on the one hand and constipation and the use of various diuretics on the other.
The cohort consisted of 75,214 women and men, who were 50-76 years of age upon the inception of this study. The participants answered detailed questionnaires regarding their lifestyle, including the consumption of food supplements and medications, smoking, alcohol consumption, physical activity, medical history, risk factors and nutrition. The participants were asked about the frequency of their bowel movements and complaints regarding constipation were also documented. Similarly, the research subjects were asked about the use of diuretics without dietary fibers and diuretics that contain dietary fibers, and frequency of use.
Diuretics that do not contain dietary fibers act on various mechanisms, for instance, by softening stool, encouraging intestinal movement by stimulating the intestinal mucosa, or with salts that assist in emptying the intestines. Diuretics that contain dietary fibers act mainly by enlarging stool volume.
The frequency of the use of diuretics without fibers was divided into three groups: low (use of less than once a year), medium (up to four times a year) and high (five times a year or more). The frequency of use of diuretics containing fibers was divided into lack of use, medium frequency (less than four times a week for a period of less than four years), and high (four or more times a week for four years and more).
During 8 years of follow-up of the research participants, 558 new cases of colorectal cancer were diagnosed.
Upon analysis of the questionnaires, the researchers reached the following conclusions:
The association between constipation or frequency of bowel movements, on the one hand, and the risk of developing colorectal cancer on the other, is not statistically significant.
The use of diuretics without dietary fibers increases the risk of developing colorectal cancer, whereas the use of diuretics containing dietary fibers reduces this risk.
Among those who frequently use diuretics without fibers, the risk of developing colorectal cancer rose by 43%, as opposed to those who used diuretics infrequently.
Among those who frequently used diuretics containing fibers, the risk of developing colorectal cancer dropped by 56%, as opposed to those who did not use these preparations at all.
The researchers estimate that the explanation for these findings lies in the fact that dietary fibers act to dilute the concentration of carcinogens (cancerous agents) in the intestine, and maintain the proper functioning and growth of the intestinal cells. Additional studies are required to verify the results of this study so that diuretic preparations may be recommended for treating constipation.
This article was published in the October 2014 issue of The American Journal of Gastroenterology
Chemopreventive effect of apple and berry fruits against colorectal cancer
Various epidemiologic studies have linked colorectal cancer with food intake. Researchers from universities in Malaysia, India and Mexico surveyed studies that investigated the chemopreventive effects of apple and berry juices against colorectal cancer.
The investigators surveyed 8 studies that examined the effect of apple juice on cancer cells. For example, a study conducted on advanced colorectal cancer cells, showed that polyphenols - anti-oxidants found in apple juice, inhibit the growth of cancer cells. The research event showed that apple extract intervened in intracellular activity, and accelerated a natural process called programmed cell death.
In another research study which investigated the effect of apple juice extract on early stage colorectal cancer cells, a delay was observed in the growth of cancer cells, and in another research study, which was conducted on lab mice, the protective effect of apple juice was observed among mice who consumed it. A carcinogenic agent was injected in all the mice which led to the development of colorectal cancer. 50% fewer benign and pre-cancerous lesions for colorectal cancer were observed among mice that consumed apple juice for 6 weeks, as opposed to mice that did not consume apple juice.
The investigators also surveyed 9 lab research studies that examined the effect of berry juices on colorectal cancer cells. A research study that examined the effect of various berry fruit juices (strawberry and various types of blueberry) found that they inhibit the growth of cancerous cells. And another research study showed that various berry ingredients may potentially intervene in biochemical processes within the cell, and prevent growth of cancerous cells.
The researchers indicate the need for additional studies, including studies on human subjects to evaluate that protective effect of these fruit juices against various types of colorectal cancer.
In short, the investigators indicate that apple and berry juices could be possible candidates in the public education efforts for colorectal cancer risk reduction.
This research study was published in the December 2014 issue of the World Journal of Gastroenterology