People with a family history of colon cancer carry the emotional burden of knowing they have twice the risk of developing the disease themselves. But now, a new study may ease some of their anxiety. Patients with a family history of` colon cancer are also more likely to survive the disease.
The surprising paradox, published in Wednesday’s Journal of the American Medical Association, may ultimately steer researchers toward new treatments and a better understanding of the disease.
An estimated 153,000 cases of colon and rectal cancer will be diagnosed in 2008, according to the American Cancer Society, and about 50,000 people will die from the disease. Studies of twins show that about 35 percent of colon cancers are inherited, and about 11 percent of patients have at least two close relatives with the disease. An individual who has a first-degree relative with colorectal cancer faces about a 1 in 10 chance of being diagnosed with colon cancer, compared to 1 in 20 for those with no family history.
The latest study, conducted by researchers at the Dana-Farber Cancer Institute in Boston, followed 1,087 patients being treated for Stage III colon cancer, which means the cancer had spread to nearby lymph nodes but not to other organs. Of those patients, 195, or about 18 percent, had a parent or sibling with the disease. Those who had at least one close family member with colon cancer were 25 percent less likely to die from the disease during the 5.6 years of patient follow-up than those with no close relatives with colon cancer.
The risk of dying was even lower for those with two or more relatives with the disease. Those patients had a 51 percent lower risk for cancer recurrence or death.
“This news may be reassuring to people with a family history, but our hope is that we can discover what underlies this effect of family history in biological terms,” said the study’s first author, Dr. Jennifer Chan, from Dana-Farber’s Center for Gastrointestinal Oncology.
Why a person has a better prognosis if they have a family history of colon cancer isn’t clear. The scientists ruled out several explanations for the difference, including the possibility that people with a family risk for colon cancer have adopted healthier lifestyles or take part in additional screening. Dr. Chan said the researchers looked at important lifestyle factors like diet, exercise and smoking and found no association with improved survival. And because all the patients had stage III cancers, more frequent screening and an earlier diagnosis also couldn’t explain the difference.
However, there is other evidence that genetic factors play an important role in colon cancer prognosis. It’s known, for example, that colon cancer that develops as a result of a rare inherited condition called Lynch syndrome — also called hereditary nonpolyposis colorectal cancer — is less aggressive than the cancers found in patients with no genetic risk.
The study was paid for with grants from the National Cancer Institute and Pharmacia & Upjohn Co., now Pfizer Oncology.
If there was was a delay in diagnosis of your colon cancer, or it was missed or misdiagnosed, contact the
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Patients coping with
metabolic syndrome have a 75 percent higher risk for developing
colorectal cancer sometime in their lives, a new study suggests.
"Metabolic syndrome is a conglomeration of three or four diseases, that together can portend a worse prognosis for certain illnesses, including a number of cancers," said study co-author Dr. Donald Garrow, a clinical gastroenterology fellow at the Medical University of South Carolina in Charleston.
"But what has not been well-defined," he added, "is the associated risk for colorectal cancer. So this is one of the first -- and certainly the largest -- study to look specifically at this risk. And we found that there is indeed a higher risk for colorectal cancer in this population."
Garrow and his colleague, Dr. Mark Delegge, presented their findings last week at the American College of Gastroenterology scientific meeting, in Orlando, Fla.
The researchers noted that metabolic syndrome is a combination of three chronic conditions that are linked to being either overweight or obese: high blood pressure, diabetes and elevated cholesterol. The syndrome is already known to increase the risk for developing heart disease and stroke.
To gauge the degree to which having these conditions in concert might raise colon cancer risk as well, the authors reviewed data collected between 2000 and 2003 by the National Health Interview Survey. The nationwide survey is conducted annually by the National Center for Health Statistics.
The team focused on survey participants who had reported having a history of metabolic syndrome --almost 1,200 patients -- and those with a history of colorectal cancer -- 350 patients.
After controlling for mitigating factors such as age, race, gender, obesity, and smoking and drinking habits, a cross-referencing of disease data revealed that patients with metabolic syndrome did, in fact, bear a significantly higher risk for colorectal cancer.
"This is concerning, because colon cancer is a disease that is preventable if patients get screened as recommended," said Garrow. "So, we hope with this study will encourage patients with metabolic syndrome to adhere to screening guidelines."
Dr. George Chang, an assistant professor of surgical oncology at M.D. Anderson Cancer Center at the University of Texas in Houston, agreed.
"I think this kind of a study emphasizes the importance of screening, and importance of adhering to the current guidelines," he said. "What the study does not do is evaluate if patients with metabolic syndrome develop colon cancer at an earlier age. So, there is insufficient evidence here to necessarily change our screening recommendations to encourage metabolic syndrome patients specifically to go in for earlier screening than they would otherwise if they followed current guidelines."
"However, I think this certainly is an area that warrants further investigation," added Chang, "to see if we can better identify those patients who are at higher risk for colorectal cancer."
In a second study also presented at the meeting, researchers revealed that initiating colon cancer screening 10 years prior to Medicare eligibility at 65 appears to save $2 in health-care costs for every $1 spent.
The finding stems from an analysis conducted by Scott Tenner and his colleagues from the State University of New York and New York College of Osteopathic Medicine, after they administered free colonoscopies to 248 Brooklyn residents who had an average age of 55. The initiative was launched as part of a colon cancer screening program.
The program -- which determined that 45 percent of the patients had polyps of varying sizes, while five patients had early-stage colon cancer -- cost $390,000 to run. The team concluded that had the same patients waited until the age of 65 to get screened, the cost of screening and treating those who needed care a decade later would have ballooned to $1.3 million.
For more information about colorectal cancer, or if you believe you may have been misdiagnosed or had a delay in diagnosis of colorectal cancer, contact the
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