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Colorectal Cancer Awareness Month 2016
03/03/2016

The Israel Cancer Association, partnering with the Ministry of Health, announced the launch of Colorectal Cancer Awareness Month 2016


Big-Bullet-SQR.gif Colorectal cancer is the second most common cancer in Israel.  On the other hand, Israel leads in survival rates compared to OECD member countries, ranking 2nd place in men and 4th place in women.


Big-Bullet-SQR.gif New global statistics show an increase in colorectal cancer incidence among young people aged 20-49, while among over 50-year-olds, there has been a decline in incidence, which is attributed to national early detection programs.
Based on contemporary trends, The American Cancer Society reports that in 2030 the colorectal cancer incidence rates among 30-34 year olds will increase by 90% and among 35-49 year olds by 28%.

Whereas in Israel, among young people aged 20-49, incidence rates are lowest, among the Jewish and Arab population alike, and among both genders alike, showing no upward trend over time.


Big-Bullet-SQR.gif There has been a decline in the number of patients with newly diagnosed metastatic disease, from 15% in 20000 to 10% in 2013, a 33% drop.

 

Big-Bullet-SQR.gif A seminar on colorectal cancer will take place on 9 March 2016 at the ICA, 7 Revivim Street, Givatayim.

 

bul3 The seminar is geared towards patients, survivors and their families; admission is free and participation is contingent upon advance registration.

 

bul3 Please click here for details and to register.

 

Big-Bullet-SQR.gif Prof. Lital Keinan Boker, Deputy Director of the National Center for Disease Control of the Ministry of Health and ICA Advisor, presented new and up-to-date statistics marking Colorectal Cancer Awareness Month 2016.


Big-Bullet-SQR.gif Incidence:


bul3 In 2013, 3,224 new patients were diagnosed with invasive colorectal cancer in Israel; of whom 2,777 were Jewish, 280 were Arabs and 'others' (Christians who are not Arabs and not affiliated with any specific religion).

 

bul3 Colorectal cancer is typically associated with older age. Incidence rates significantly increase starting from the age of 60, and they are highest in the 75+ group.

bul3 Among young people aged 20-49, incidence rates have been extremely low among the Jewish and Arab population alike, and among both genders, showing no upward trend over time.

bul3 The incidence rates are higher among Jewish men compared to women (32.8 compared to 27 respectively).

 

bul3 According to the Ministry of Health National Program for the Quality Indicators in Community Healthcare in Israel report summing up 2011-2013, about 5% of the population may develop colorectal cancer.

bul3 Colorectal cancer incidence rates have been on a downward trend among the Jewish population, since the mid-2000s. Compared to 1990, when the incidence rates were 27% lower among Jewish men and 17% lower among Jewish women.

bul3 Among the Arab population there has been a decline in incidence in recent years as well as stabilization.

bul3 There has been a decline in the percentage of patients with newly diagnosed metastatic disease, dropping from 15% in 2000, to 10% in 2013, a 33% drop.

Big-Bullet-SQR.gif Risk Factors:

 

bul3 Age

bul3 Family history of the disease
bul3 Previous benign intestinal tumor or an inflammatory bowel disease
bul3 Genetic mutations
bul3 Health behaviors: such as: overweight, sedentary lifestyle, high-fat low-fiber diet, smoking and alcohol consumption.  


Big-Bullet-SQR.gif Early Detection:

 

bul3 In Israel, a National Program for the Early Detection of Colorectal Cancer has been implemented upon the initiative of the ICA and the Ministry of Health (MoH).  Early detection improves survival and reduces mortality rates.

 

bul3 According to the Ministry of Health National Program for the Quality Indicators in Community Healthcare in Israel, in 2013, an estimated 57% of the target population has undergone an early detection screening for colorectal cancer (occult fecal blood over the past year or a colonoscopy over the past 9 years).

 

bul3 The compliance for this screening is on an upward trend compared to previous years: 51.2% in 2011 and 54.7% in 2012.

 

bul3 Screening compliance rate increases with age, and among women, the colorectal cancer screening compliance rate was slightly higher than that of men, 58% as opposed to 55% respectively.

 

bul3 In 2013, a third of new patients were diagnosed at an early stage of the disease; this rate is 61% higher than the percentage of patients diagnosed at an early stage in 2000.

 

Big-Bullet-SQR.gif Survival:

 

bul3 The survival rates are on an upward trend.

 

bul3 Among Jewish men, the survival rate stands at 67%, among Jewish women 66%, among Arab men 61%, and Arab women 57%.  A 15%-24% increase compared to those who were diagnosed from 1991-95.


Big-Bullet-SQR.gif Mortality:

 

bul3 In 2013, 1,366 patients succumbed to invasive colorectal cancer, 1,212 of whom were Jewish, 108 were Arabs, and 'others'.

bul3 Mortality was mainly observed at an older age, the median age being 78.

bul3 Mortality rates are on a downward trend.  Compared to 1990, there has been a 24% drop among men and a 18% drop among Jewish women.

bul3 In the Arab population, a slow increase in mortality rates has been observed up to the mid-2000s and since then there has been stabilization in rates.


Big-Bullet-SQR.gif Global Comparison:
 
Relative 5-year colorectal cancer survival rates in OECD countries from 2008-2013, by gender.

 

Tabel 5 year colorectal survival rates

bul3 Please click here for detailed information.

Study on Colorectal Cancer among the Arab Population in the Southern Region of Israel

 

Big-Bullet-SQR.gif Research funded by the ICA
Big-Bullet-SQR.gif Head researcher: Dr. Naim Abu Fariha, GI Tract Institute, Soroka Medical Center

 

Big-Bullet-SQR.gif Background:

 

Colorectal cancer is the second most common cancer in Israel.  Among the Arab population in Israel, there has been a constant increase in the incidence of this cancer type.
The Arab population in the Negev (southern region) numbers an estimated 200,000.
There has been a very rapid change in lifestyle the past two decades, with the Bedouin lifestyle undergoing transformation and adapting to a Western lifestyle.  This change has led to modification in morbidity and prevalence of the diseases, such as ischemic heart disease, diabetes, and inflammatory bowel diseases.
This study aims to explore and describe colorectal cancer among the Bedouin population in the Negev, including clinical and pathological factors.


Big-Bullet-SQR.gif Methods:


This study encompassed Bedouin patients diagnosed with colorectal cancer at Soroka Medical Center from 2006-2011.  The patients' files were inspected, and an interview was held with living patients about their family history of colorectal cancer.
Immunohistochemistry (IHC) tests were conducted to detect antigens - mlh1, msh2, pms2, msh6 proteins - in cells of a tissue section removed [from the patient], to rule out the possibility of Lynch Syndrome.

 

Big-Bullet-SQR.gif Results:


This study encompassed 30 Bedouin patients out of 1031 patients diagnosed with colorectal cancer at Soroka Medical Center during the study period (2.9%).
An interview was conducted among 17 (56.7%) of the patients, and immunohistochemistry (IHC) tests were conducted among 23 patients (76.7%).
The prevalence of the disease as per 31 December 2011 was calculated as 11.5 cases per 100,000.  The average age was 54±14.3, 60% were women; none of the patients had a family history of colorectal cancer in a first degree relative.
Ten patients (33.3%) were under age 50. Among 5 (16.7%) there was a mucinous component in the tumor pathology; in two patients (6.7%) it involved a second colorectal malignancy. 
Immunohistochemistry (IHC) tests on the tumor tissue did not have normal results among 5 patients (21.7%); in three patients there was a lack of mlh1 and pms2 expression, in one of the patients there was a lack of msh6 expression and in another patient, there was a lack of pms2 expression in the tumor tissue and the normal tissue.


Big-Bullet-SQR.gif Conclusions:


Colorectal cancer among Bedouin patients appears at a younger age than the average known age in scientific literature, without any family history of a high risk of a genetic component.  Genetic clarification must be completed in patients whose initial detection indicated suspected Lynch Syndrome.
Lynch Syndrome significantly increases colorectal cancer morbidity as well as other cancers, and increases incidence among family members as well.

 

The Israel Cancer Association Information Center Presents New Research Studies

 

Big-Bullet-SQR.gif Is there increased risk of colorectal cancer in patients diagnosed with breast cancer?

 

Researchers from the Karolinska Institute in Sweden and Imperial College in England sought to examine whether women who developed hormone-sensitive breast cancer have a high risk of contracting colorectal cancer and whether hormonal treatment they received for breast cancer affected this risk.

 

For the purpose of this research study, data was collected from two large databases: one database was taken from the National Swedish Cancer Register, establishing a cohort of 179,733 breast cancer patients diagnosed between 1961 and 2010, and a second database from Stockholm-Gotland Cancer Register, establishing a cohort of 20,171 breast cancer patients.  This database also encompassed data on treatments received by the patients diagnosed with breast cancer.

 

The researchers monitored the women based on the first database data, over a 10-year span, and discovered that among 179,733 breast cancer patients who developed the disease at an average age of 60.5, 2,571 patients were diagnosed with colorectal cancer at an average age of 74: 1,008 women were diagnosed with malignant tumors in the proximal intestine (the part of the intestine farthest from the rectum), 590 women with tumors in the distal intestine (the part of the intestine closest to the rectum), 808 had rectal tumors, and the rest had no site specific cancer detected.

 

The follow-up of the women in the second cohort database was conducted over an 11-year span, and it emerged, that among 20,171 breast cancer patients of an average age of 56.8, 299 cases of colorectal cancer were diagnosed at an average age of 71.5: 116 patients with adenocarcinoma in the proximal colon, 88 patients with adenocarcinoma in the distal colon, 85 patients with adenocarcinoma in the rectum, and 10 intestinal cancer patients with no site specific cancer.  

 

Based on the results of the statistical analysis of the data, it emerged that women who developed breast cancer have a 59% higher risk of developing colorectal cancer, compared to the general population.  In a data analysis of the site of the intestinal tumor, it emerged that women who developed breast cancer in the past had a 72% higher risk of adenocarcinoma in the proximal colon than the general population, and their risk of developing adenocarcinoma in the distal colon exceeded that of the general population by 46%.

 

The researchers indicate that the hormonal treatment received by women who developed breast cancer, did not alter their risk of developing colorectal cancer.

 

The researchers conclude that follow-up testing may be required to detect colorectal cancer among women who developed breast cancer; however they indicate that it is necessary to conduct additional studies in this field.

 

This article was published in the January 2016 issue of the Cancer Epidemiology Journal


Big-Bullet-SQR.gif Impact of palm date consumption on intestinal health

 

Researchers from the University of Reading in the UK, sought to examine the association between the intake of palm dates, which are rich in soluble fibres and polyphenols (anti-oxidant-rich plant-based foods), and the development of different processes that increase the risk of colorectal cancer and the growth of colonic microbiota, which in turn impact intestinal health.

 

22 healthy volunteers, aged 18-55, were recruited for this study, with an equal number of men and women who were adapted to the research based on a medical questionnaire and various indices such as BMI, blood pressure, cholesterol levels, blood sugar and lifestyle behaviors.

 

The subjects were randomly divided into two groups: a group that consumed palm dates (7 palm dates a day, weighing about 50 gm), and the control group which consumed a different product with fruit sugar. 

 

After a 3-week follow-up, and after a 2-week break, the group participants switched for another 3 weeks of follow-up.  The subjects from both groups were asked to document their bowel movement on a daily basis, their sense of swollenness, stomach pains and psychological state, and they were also asked to undergo blood tests while fasting, as well as fecal tests.

 

This study performed an analysis of indices such as nutritional habits, subjects' bowel movement, as well as clinical biochemistry, and various fecal tests such as: the presence of intestinal microbiota, 'genotoxicity' of faecal water and stool ammonia concentration - components which may have an impact on the risk of developing malignant colonic lesions.

 

The research results have shown that among the group that consumed palm dates, a significant increase in intestinal activity and stool frequency was observed, and a significant decrease was also observed in stool ammonia concentration.    In a faecal water test, decreased genotoxicity was observed, and proliferation of cancerous cells was hindered.  No growth of colonic microbiota was observed among this group.

 

The researchers assert that this initial study demonstrates that specific characteristics of the palm date may potentially contribute to intestinal health and reduce the risk of processes that may cause colorectal cancer.

 

This study was published in the October 2015 issue of the British Journal of Nutrition

 

Big-Bullet-SQR.gif Does the Presence of Endometrial Polyps Predict Colorectal Polyps?

 

Endometrial polyps and colorectal polyps are common disorders and the risk of both increases with aging. These benign findings may develop into malignant tumors over time. 

 

Researchers from the Konya Baskent University Hospital in Turkey sought to examine whether the presence of endometrial polyps predicts colorectal polyps, as they share similar genetic and clinical factors.

 

In a study conducted from 2010-2013, the researchers compared a group of 57 women diagnosed with endometrial polyps to a control group consisting of 71 women who underwent a hysterectomy, and in whose histological examination (tissue test), no endometrial polyps had been detected.      Endometrial and colorectal tissue was examined in a lab test by the same pathologist.

 

In the data analysis, pathological factors of the polyps, their number and size were taken into consideration.  Similarly, additional factors were taken into account, including; age, menopause, BMI, other diseases, smoking history, use of contraceptives or aspirin and family history of endometrial or colorectal polyps, or family history of cancer.

 

Based on the findings, it emerged that women who were diagnosed with endometrial polyps had a 5-fold greater risk of developing colorectal polyps compared to women from the control group: 18 out of 57 women in the research group and 6 women out of 761 women in the control group - were diagnosed with colorectal polyps.  Similarly, it emerged that post-menopausal women who had been diagnosed with endometrial polyps had a 4.5-fold higher risk for the development of colorectal polyps compared to pre-menopausal women.

 

In short, the researchers indicate that post-menopausal women who have endometrial polyps are at higher risk of developing colorectal polyps, regardless of their age, and recommend periodical colonoscopy tests among these women, in order to reduce the risk of colorectal cancer.  The researchers indicate that it is necessary to conduct additional studies.

 

This study was published in the February 2016 issue of The American Journal of Medical Sciences

 

Big-Bullet-SQR.gif Exercise Program as an Effective Means of Reducing Fatigue in Colorectal Cancer Patients Undergoing Chemotherapy


Fatigue is a common problem among colon cancer patients and increases during chemotherapy.  Researchers from different medical centers in Holland sought to examine whether a regular and supervised exercise program may potentially have an optimal effect on the level of fatigue of colorectal cancer patients undergoing chemotherapy.

 

33 patients were recruited for this study - 21 men and 12 women, aged 25-75, who were diagnosed with colorectal cancer and are undergoing adjuvant chemotherapy following tumor removal.

 

The researchers randomly divided the subjects into two groups: the research group in which the subjects participated in an 18-week exercise program, twice a week.  Each workout lasted one hour, and encompassed a 10-minute warm-up, 40 minutes of aerobic exercise, and resistance training to strengthen muscles and 10 minutes of relaxation.  In addition, the patients were instructed to be physically active for at least 30 minutes a day, on a daily basis on 3 other days of the week.  The exercise program was personally adapted to patient according to physical fitness level and personal preferences.  In the control group the subjects did not participate in any exercise program, and they were asked to maintain their exercise habits with no changes.

 

The subjects in both groups were asked to complete questionnaires at three points in time during the research study: at the beginning of the study, upon the completion of the exercise program after 18 weeks, and after 36 weeks, since the inception of the follow-up.  These questionnaires examined the following indices: physical fatigue, emotional fatigue, general combined fatigue, decreased activity level, social function, depression, anxiety, pain and other factors.

 

Based on the research findings, it emerges that patients who participated in the physical exercise program, reported a significantly lower level of physical fatigue, - 3.2-fold lower at 18 weeks, upon the completion of the exercise program - compared to patients from the control group, and 2-fold lower at 36 weeks, as well as a general fatigue level that is 2.3-fold lower compared to the members of the control group at 18 weeks, and 2.7 lower at 36 weeks.

 

Moreover, the subjects in the research group reported a significant increase in physical functioning and in physical fitness levels, as opposed to the control group.  No significant differences vis-a-vis other quality of life indicators were observed between the two groups.

 

To conclusion, the researchers indicate that an 18-week supervised exercise program, for colorectal patients undergoing adjuvant chemotherapy, significantly reduces physical fatigue and general fatigue and increases the level of activity and physical functioning, even during the workout period and even after 36 months.  The researchers recommend that these findings be further reinforced in a multi-participant study.

 

This article was published in the December 2015 issue of the Medicine & Science in Sports & Exercise Journal

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