The COVID-19 pandemic has affected nearly every aspect of life from schools to offices and, most importantly, healthcare. While certain things may have gone back to normal, the healthcare space continues to struggle. During a discussion at the National Colorectal Cancer Roundtable (NCCRT) Annual Meeting, panelists shared how their respective organizations adapted to the pandemic to ensure continued delivery of colorectal cancer (CRC) screening.
Rachel Issaka from the Fred Hutchinson Cancer Research Center kicked off the discussion with the history of the COVID-19 pandemic in the U.S., starting with when the SARS-CoV-2 virus reached the U.S and the government declared a national emergency on March 13th, 2020, due to the rapid spread of the virus. A day later, on March 14th, the office of the U.S. Surgeon General advised hospitals to reschedule all elective procedures. Subsequently, the Gastroenterology Society released a statement that recommended all endoscopies and clinical practices be rescheduled along with other non-urgent procedures and the Centers for Disease Control & Prevention (CDC) recommended that healthcare systems prioritize urgent visits and delay elective care. The American Cancer Society (ACS) advised patients to postpone elective care, including cancer screenings, if they are at average risk for cancer and did not have any signs or symptoms.
Following these recommendations, many adults delayed or avoided medical care. A study conducted in June 2020 by the CDC found that:
- 41% of U.S. adults had delayed or avoided treatment
- 12% had avoided urgent and emergency care
- 32% avoided routine care
Another study conducted in April 2020 found that cancer diagnoses decreased by 46% as compared to the year before, and CRC diagnoses dropped by 49%. The primary cause for this drop in diagnoses was delayed screenings for individuals who had symptoms but did not want to use the healthcare system during the pandemic. CRC screenings were down 25% between March of 2020 and March of 2021. It is estimated that these delays in screening and diagnoses will be responsible for an additional 4,500 deaths from CRC by the year 2030.
Fortunately, organizations such as the Lincoln Community Health System in Newport, Oregon, recognized this growing gap in screening and diagnosis of CRC and came up with solutions. Jaraka Carver, LPN, from Lincoln Community Health Center, who was planning on running a CRC awareness campaign in March 2020, witnessed the project being derailed by the pandemic. Instead, after seeing the growing gap in CRC diagnosis she and her team implemented a bi-annual FIT mailing program to reach out to individuals and remind them that they were overdue for a CRC screening, and then sent them an at-home FIT test. Of the kits that were sent out:
- 33.5% came back for testing, of which 15 came back as abnormal
- 30 individuals were referred for colonoscopies, 20 of whom completed the colonoscopy and 1 was diagnosed with cancer
Virginia Mason Franciscan Health in the Pacific Northwest was also looking to increase CRC screenings among their constituents. Their divisional vice president, Michael Anderson, had partnered with ACS on a program to increase CRC screenings to 70%. However, once the pandemic hit, they had to change directions. With the goal of scheduling annual wellness visits during the pandemic, they specifically focused on vulnerable populations and clearly communicated Medicare’s new rule that a patient could complete a visit in person, online, or by phone.
The organization also began reaching out to patients who were overdue for an annual visit and implemented a digital tool that helped prioritize patients by their likelihood of completing a CRC screening test. The program had a 40% success rate: they scheduled 5,300 annual wellness visits, completed 1,325 cancer screenings, and saved nearly 8.16 years of life. On a population level, this program allowed 41 more men and women to spend an extra year of life with their friends and family because they were screened for CRC.
The panel concluded with a question and answer session where participants were able to ask the presenters questions regarding the effects of SARS-CoV-2 on CRC screenings. This meeting stressed the importance of annual screenings as well as the importance of adapting to different situations and needs, with a focus on ensuring that patients are able to achieve the best health outcome possible.
*Additional Information on the NCCRT annual meeting can be found at 2021 80% in Every Community Conference & NCCRT Annual Meeting – National Colorectal Cancer Roundtable
Presenters slides can be downloaded using this link https://nccrt.org/download/101349/
Abigail Parker is a Colon Cancer Prevention Intern with the Colon Cancer Foundation.
mt-sDNA is More Cost-Effective than FIT or FOBT for Colorectal Cancer Screening
A study published in the Journal of Medical Economics simulating a cohort of one million Medicare patients—US adults aged 65 years and older—with average risk of colorectal cancer, investigated the cost-effectiveness of non-invasive fecal tests (fecal immunochemical test (FIT), fecal occult blood test (FOBT), and multi target stool DNA test (mt-sDNA)). The researchers used the Colorectal Cancer and Adenoma Incidence and Mortality Microsimulation Model (CRC-AIM) with test-specific adherence data to estimate the cost-effectiveness of the various options.
Assuming 100% adherence follow-up colonoscopies and using real-world screening adherence data, the researchers found that mt-sDNA was cost-effective when compared to FOBT but not FIT. Cost-effectiveness was defined at the $100,000/quality adjusted life-year (QALY) threshold.
The assumption of100% adherence to follow-up colonoscopies is not a significant limitation to this study because this is just one scenario and also because follow-up colonoscopies are covered under Medicare. Since follow-up colonoscopies are covered under Medicare there is not a financial disincentive to get a colonoscopy and therefore most people under Medicare do get the colonoscopy. Moreover, when the authors ran the model using real-world follow up-colonoscopy and screening adherence rates, they found that mt-sDNA was even more cost-effective:
Generally an incremental cost-effectiveness ratio (ICER) of less than $100,000 is considered good value, and those under $61,000/QALY is considered cost-effective. Therefore, when real-world adherence rates were considered, mt-sDNA was the more cost-effective option compared to both FIT and FOBT and resulted in greater reductions in CRC incidence and mortality.
Cost-effectiveness analyses are important for determining which screening test performs better than the others, and where to relocate resources to achieve the best health outcomes for the lowest possible cost. These types of studies on Medicare populations are important because they help policy makers make informed decisions on resource allocation.
Gargi Patel is a Colon Cancer Prevention Intern with the Colon Cancer Foundation.
A Note from Nick Weber on Saving Lives from Colon Cancer
My late father Dr. Thomas Weber founded the Colon Cancer Foundation (CCF) because he recognized the power of preventing colorectal cancer and diagnosing it early through screenings. The screenings identify precancerous polyps and early stage growths that doctors can remove.
The CCF has now led the mission of raising awareness and increasing screenings for 19 years.
As we enter Colorectal Cancer Awareness Month in March, you can take direct action today to solve the colorectal cancer problem and save lives:
Talk to your doctor about getting a colonoscopy if you are 45 years or older. If you are younger than 45 but have one or more family members that were diagnosed with colorectal cancer, ask your doctor if you should start screening earlier.
Participate and help increase visibility for CCF’s awareness campaigns and fund colorectal cancer screenings.
Donate Now: The funds collected through your fundraising efforts enable us to reach more people with life saving public awareness, prevention, and research programs.
Two Reasons to Show Your Support
Reason #1: Screenings were down due to COVID-19 but are beginning to pick up again. That’s great news, but it is critical that colonoscopy rates grow past pre-pandemic levels to save lives.
Reason #2: Deaths from colorectal cancer in people ages 0-49 are increasing. Educating our friends and family with high risk factors can help identify and treat the disease in young people.
CCF’s March Awareness events, tools, and resources are designed to maximize the impact of your donations.
Thank you for taking action!
Sincerely,
Nick Weber
P.S. Your support, plus our ongoing work to mobilize the medical community to address colorectal cancer in young people with the Early-Age Onset Colorectal Cancer Summit, will make a difference!
Healthy Inside and Out: How Diet and Lifestyle Impact Colorectal Cancer
Diet and lifestyle play a large role in colorectal cancer (CRC) prevention and prognosis. Dietary factors such as consumption of meat, sugary drinks, and alcohol, and lifestyle factors such as western diet patterns, being overweight or obese, physical inactivity, and smoking can add to the risk of CRC.
Diet and the Risk of CRC
A systematic review of multiple research studies has shown that a diet high in red and processed meats and low in fiber is a prominent risk factor for CRC and can lead to DNA damage, gut epithelial damage, cell proliferation, and genotoxicity from the nitrates that are added as a preservative. A diet high in red meat and processed food can be damaging for CRC patients and survivors and can increase the risk of mortality.
Including fiber, vegetables, and fruits in the diet is definitely healthy and can also prevent CRC. The Mediterranean diet—which includes fruits, vegetables, fish, and whole grains is a healthy preventive option to adopt in your food habits.
Research also points to a significant relationship between the consumption of processed meat and the development of early-age onset CRC (EAO-CRC), which developed among those younger than 50 years. A rapidly rising cancer across the globe, about 20% of EAO-CRC cases can be attributed to family history, and the remaining to other factors including diet and lifestyle.
Lifestyle Habits and the Risk of CRC
It is a well-known fact that a healthy lifestyle promotes health and well-being, while an unhealthy lifestyle can lead to health problems. Physical activity is important for overall health and studies point to physical inactivity and a sedentary lifestyle as major risk factors for CRC. Women who reported little to no physical activity after the age of 20 had a heightened risk of developing EAO-CRC.
Reduced physical activity can contribute to several different health problems, the most evident being obesity. Obesity modifies the gut microbiota leading to an increase in inflammation that damages the intestinal barrier. Obese and overweight individuals have a 42% higher risk of developing EAO-CRC than those at a healthy weight (an individual is considered to be a healthy weight if their BMI is between 18.5 and 24.9). There is also a correlation between obesity and the development of metabolic syndrome, which is a combination of multiple conditions that increase the risk of heart disease, stroke, and diabetes. Metabolic syndrome has been identified as a leading comorbidity in the development of EAO-CRC.
Smoking is also a significant risk factor in multiple cancers including CRC. Current smokers are at a higher risk of developing EAO-CRC, while past smokers may find their risk reduced.
It is important to understand the significant role of diet and lifestyle in disease development. Maintaining a healthy diet, such as increasing fruit, vegetable, and fiber intake as well as decreasing one’s consumption of red meat, processed meat, and sugary beverages can prevent CRC. This, coupled with a healthy and active lifestyle can significantly reduce the risk of developing CRC.
Abigail Parker is a Colon Cancer Prevention Intern with the Colon Cancer Foundation.
How Bourbon Enthusiasts Support Colorectal Cancer Awareness
In 2013, The Bourbon Mafia was formed when a group of bourbon enthusiasts and industry professionals came together in their search for rare bourbon. About a year in, they realized that they could utilize their platform to raise money for causes that are near and dear to their hearts. With 42 members spanning 11 U.S. states, and two members in Australia, the organization has raised approximately $150,000 since 2014 for various charities, including the Colon Cancer Foundation (CCF). The Bourbon Mafia raises money through events, including bourbon raffles, dinners, and bottle auctions.
Brian Gelfo, one of the founding members and the treasurer and secretary of the Bourbon Mafia, spoke with the Colon Cancer Foundation about their organization’s motivation for donating to CCF. Omar Marshall was one of the first classes brought into The Bourbon Mafia. Following his diagnosis of colorectal cancer (CRC) in 2020, he and his wife, Pam Marshall, decided they wanted to raise awareness around this disease. The initial goal of The Bourbon Mafia was to donate in his honor while Omar was still with them. Unfortunately, Omar lost his battle with CRC on January 18, 2021.
Robert Diaz (second from left) receiving a donation from The Bourbon Mafia on behalf of the Colon Cancer Foundation.
Nevertheless, a $30,000 donation was made to CCF in April 2021. Before Omar passed, he participated in a selection of a Four Roses Bourbon barrel that would be used for the donation. Mr. Gelfo highlighted an impactful statement by Robert Diaz who represented CCF at the engagement event: “This $30,000 donation can fund 1,000 colon cancer screenings.” Members of The Bourbon Mafia were gratified that their efforts could impact the lives of a thousand people. “Even if one finds out early and gets treated, it’s well worth it,” Mr. Gelfo said.
According to Mr. Gelfo, many members in the bourbon industry, including fans and supporters, are predominantly older men. Through these events, The Bourbon Mafia hopes to raise awareness in the community for them to get screened.
This year, their event was held on 25th February, 2022, in Louisville, Kentucky, where they expected to raise a minimum of $10,000. Barrels will be hand selected from Starlight Distillery and guests will receive a sample of bourbon, a beer, and a bottle of bourbon to take home. Silent auction items will be donated by Mrs. Marshall and the family as well as other distilleries.
Mr. Marshall was buried on the farm under an oak tree from where he can watch over the farm, as he always wanted to. Mrs. Marshall emphasized the importance of early detection and being proactive for any type of cancer. “The Bourbon Mafia and bourbon itself has brought me into contact with so many wonderful people who share the same passion for bourbon and helping others,” she said.
Kenadi Kaewmanaprasert is an intern with the Colon Cancer Foundation.
Have You Had Your Fiber Yet? Food Habits and the Risk of Colorectal Cancer
We learn time and again that prevention is the best medicine, and this holds true for colorectal cancer (CRC). It is estimated that 50% of CRC cases can be prevented with diet and lifestyle modifications. Previous studies that looked at the relationship between CRC development and nutrition concluded that there is a strong correlation between diet and the development of certain types of cancer, specifically CRC.
A recent study published in Preventive Medicine Reports investigated the impact that an insufficient diet plays in the development and prevalence of certain cancers as well as the effect that race and ethnicity has on diet. Wholegrains, dietary fiber, non-starchy fruits, and vegetables, dairy products, milk, cheese, dietary calcium, coffee, and calcium supplements were found to be associated with preventing cancer development. The study examined population attributable factors and the number of excessive cases diagnosed in Texas in 2015 that were attributed to an inadequate diet, defined as a diet that does not meet or conform to the national or global dietary recommendations.
With a diverse study population, the researchers had the opportunity to explore how race and ethnicity play into diet and thus contribute to the prevalence of cancers, specifically colorectal cancer (CRC).
The study found:
There has been additional research conducted to show that there is a link between dietary fiber intake, and dietary calcium intake and the prevention of CRC. Looking at the racial and ethnic difference the study found that Non-Hispanic Whites consumed higher than the recommended dietary intake of red and processed meats. While it was found that Non-Hispanic Blacks were the most likely to have insufficient fiber and calcium intake.
In the Texas population, the authors found:
The authors describe a similar correlation identified in an Australian population, where:
This study along with multiple other studies conducted in relation to dietary factors and their contribution to cancer highlight the importance of diet—especially insufficient fiber intake and excess red or processed meat intake—on overall cancer burden.
Abigail Parker is a Colon Cancer Prevention Intern with the Colon Cancer Foundation.
Colorectal Cancer Advocates Celebrate Screening Policy Reforms
The new year brought news of two success stories in our fight to increase accessibility to colorectal cancer (CRC) screening. The first, is a change in private insurance coverage requirements for colonoscopies. The second is from Kentucky, where a pharmacy protocol was passed to allow at-home fecal tests to be taken care of like a regular prescription. More details below.
Coverage for Screening Colonoscopy Without Cost Sharing
A document jointly released by the Departments of Labor, Health and Human Services, and Treasury on January 10th 2022 categorically states that private insurance plans are required to cover a follow-up colonoscopy after a positive non-invasive stool-based test or a direct visualization screening test, without any cost-sharing with respect to the colonoscopy for the health plan beneficiary. This coverage requirement will go into effect on May 31, 2022, one year after the updated recommendation on CRC screening was issued by the US Preventive Services Task Force.
The Affordable Care Act requires health insurers to fully cover preventive screening. However, colonoscopies done after a stool-based test (such as FIT, gFOBT, or MT-sDNA/sDNA-FIT) were considered diagnostic and were not covered in the same way as decennial colonoscopies.
Medicare covers a follow-up colonoscopy after a positive stool-based screening test result. Medicaid coverage policies vary based on the state.
Kentucky: Easy Access to Stool-Based Testing
On September 28, 2021, a new pharmacy protocol passed in the state of Kentucky will allow fecal immunochemical test (FIT) or stool DNA test (sDNA-FIT) to be taken care of at the pharmacy like a flu shot or regular prescription.
With the screening age for average-risk adults lowered to 45 years, it is important to eliminate the barriers for those who actually want and need screening. As we have seen over the last couple of years though, the COVID-19 pandemic has prevented many from getting the care that they need, including preventive care services. This bill has truly come at the right time.
“Kentucky is the first state in the nation to have this type of protocol passed, and why not here?” said Dr. Whitney Jones, founder of the Colon Cancer Prevention Project, which is based out of Kentucky. “Colorectal cancer is treatable and preventable when caught early, and this new protocol will allow the general population more avenues to get screened on time.”
Gargi Patel is a Colon Cancer Prevention Intern with the Colon Cancer Foundation.
mRNA-Based Vaccine to Treat Colorectal Cancer and Prevent Relapse May Be Here Soon
Immunotherapy aids your immune system to fight off cancer. There are five types of immunotherapy: treatment vaccines, immune checkpoint inhibitors, T-cell transfer therapy, monoclonal antibodies, and immune system modulators. While there have been no treatment vaccines approved for colorectal cancer (CRC) yet, BioNTech’s mRNA-based treatment vaccine has recently reached phase 2 clinical trials for CRC. The vaccine, individualized to each patient, is being developed as a treatment for CRC as well as to prevent relapse in those who have undergone CRC surgery.
How Does Immunotherapy Work?
The immune system is built to detect and destroy abnormal/mutated cells. Tumor-infiltrating lymphocytes are often found around tumors and they are an indication that the immune system is working to eliminate the tumor. Cancer cells typically undergo genetic changes that allow them to escape the immune system—they often have proteins on their surface that inactivate immune cells, and they can even change cells surrounding them to interfere with the immune system. Therefore, a therapy that can train the immune system to identify and destroy cancer cells capable of defying the immune system is important.
Cancer Treatment Vaccines
Cancer treatment vaccines are designed for people who already have cancer, and trains their body’s immune system to find well-hidden cancer cells. These vaccines can be made in three different ways.
Matias Riihimäki et al. in their 2016 epidemiologic study published in Scientific Reports found that up to 18% of all CRC patients have recurrence and up to 25% have metastasis. A treatment vaccine would be able to help prevent recurrence and help patients with metastasis suppress small tumors that are often difficult to remove surgically.
BioNTech Chief Medical Officer and Co-founder Özlem Türeci, M.D., noted in a press release, “This trial is an important milestone in our efforts to bringing individualized immunotherapies to patients. Many cancers progress in such a way that the patient initially appears tumor-free after surgery, but after some time tumor foci that were initially invisible grow and form metastases. In this clinical trial in patients with colorectal cancer, we aim to identify high-risk patients with a blood test and investigate whether an individualized mRNA vaccine can prevent such relapses.”
Gargi Patel is a Colon Cancer Prevention Intern at the Colon Cancer Foundation.
NCCRT Annual Meeting: Experts Share Strategies to Improve CRC Screening Rates During the COVID-19 Pandemic
The COVID-19 pandemic has affected nearly every aspect of life from schools to offices and, most importantly, healthcare. While certain things may have gone back to normal, the healthcare space continues to struggle. During a discussion at the National Colorectal Cancer Roundtable (NCCRT) Annual Meeting, panelists shared how their respective organizations adapted to the pandemic to ensure continued delivery of colorectal cancer (CRC) screening.
Rachel Issaka from the Fred Hutchinson Cancer Research Center kicked off the discussion with the history of the COVID-19 pandemic in the U.S., starting with when the SARS-CoV-2 virus reached the U.S and the government declared a national emergency on March 13th, 2020, due to the rapid spread of the virus. A day later, on March 14th, the office of the U.S. Surgeon General advised hospitals to reschedule all elective procedures. Subsequently, the Gastroenterology Society released a statement that recommended all endoscopies and clinical practices be rescheduled along with other non-urgent procedures and the Centers for Disease Control & Prevention (CDC) recommended that healthcare systems prioritize urgent visits and delay elective care. The American Cancer Society (ACS) advised patients to postpone elective care, including cancer screenings, if they are at average risk for cancer and did not have any signs or symptoms.
Following these recommendations, many adults delayed or avoided medical care. A study conducted in June 2020 by the CDC found that:
Another study conducted in April 2020 found that cancer diagnoses decreased by 46% as compared to the year before, and CRC diagnoses dropped by 49%. The primary cause for this drop in diagnoses was delayed screenings for individuals who had symptoms but did not want to use the healthcare system during the pandemic. CRC screenings were down 25% between March of 2020 and March of 2021. It is estimated that these delays in screening and diagnoses will be responsible for an additional 4,500 deaths from CRC by the year 2030.
Fortunately, organizations such as the Lincoln Community Health System in Newport, Oregon, recognized this growing gap in screening and diagnosis of CRC and came up with solutions. Jaraka Carver, LPN, from Lincoln Community Health Center, who was planning on running a CRC awareness campaign in March 2020, witnessed the project being derailed by the pandemic. Instead, after seeing the growing gap in CRC diagnosis she and her team implemented a bi-annual FIT mailing program to reach out to individuals and remind them that they were overdue for a CRC screening, and then sent them an at-home FIT test. Of the kits that were sent out:
Virginia Mason Franciscan Health in the Pacific Northwest was also looking to increase CRC screenings among their constituents. Their divisional vice president, Michael Anderson, had partnered with ACS on a program to increase CRC screenings to 70%. However, once the pandemic hit, they had to change directions. With the goal of scheduling annual wellness visits during the pandemic, they specifically focused on vulnerable populations and clearly communicated Medicare’s new rule that a patient could complete a visit in person, online, or by phone.
The organization also began reaching out to patients who were overdue for an annual visit and implemented a digital tool that helped prioritize patients by their likelihood of completing a CRC screening test. The program had a 40% success rate: they scheduled 5,300 annual wellness visits, completed 1,325 cancer screenings, and saved nearly 8.16 years of life. On a population level, this program allowed 41 more men and women to spend an extra year of life with their friends and family because they were screened for CRC.
The panel concluded with a question and answer session where participants were able to ask the presenters questions regarding the effects of SARS-CoV-2 on CRC screenings. This meeting stressed the importance of annual screenings as well as the importance of adapting to different situations and needs, with a focus on ensuring that patients are able to achieve the best health outcome possible.
*Additional Information on the NCCRT annual meeting can be found at 2021 80% in Every Community Conference & NCCRT Annual Meeting – National Colorectal Cancer Roundtable
Presenters slides can be downloaded using this link https://nccrt.org/download/101349/
Abigail Parker is a Colon Cancer Prevention Intern with the Colon Cancer Foundation.
Homage, NFTs, and Colorectal Cancer Awareness: In Conversation With Will Holman
Will Holman is a writer-producer and is the founder of the post-production company Super Star Power Productions. Having lost his dad Willie Holman, and his friend, actor Chadwick Boseman, to colorectal cancer (CRC), Will was inspired to create a non-fungible token (NFT) series in their honor that will be auctioned online starting January 10th, and proceeds from the auction will be donated to charitable causes, including the Colon Cancer Foundation (CCF). “I wanted to honor Chadwick’s legacy and also give back to the community,” Will told the CCF in an interview.
At 46 years, Will is very aware of his personal risk for CRC. His father, Willie Holman, a football player—defensive lineman for the Chicago Bears—was diagnosed with and died from colon cancer in 2002 at age 57. His family, however, was unaware of his diagnosis. Consequently, Will has started screening himself early. He first got tested at 41 years—the recommendation is to start screening at age 40 or 10 years before your first-degree relative was diagnosed with CRC. The USPSTF recommends that all average-risk adults should initiate screening at 45 years. He is also very conscious of his dietary habits and the important connection between eating healthy and preventive wellness.
Willie Holman was from South Carolina. “A country boy who used to work out a lot but did not know much about health and wellness and what it was to take care of himself,” Will said describing his father’s lifestyle. Being aware of the lineage he carries, Will does not want himself or his children going down that same path. “My father’s experience has a big influence on my healthy lifestyle.”
The risk of colon cancer “is not talked about and dealt with, especially in the black community,” he said. Will is also aware of the lack of access to healthy food for those living in low-income neighborhoods. Many of these neighborhoods are identified as “food deserts”: the residents in these areas lack access to supermarkets or food vendors that sell affordable yet nutritious food such as fresh fruits and vegetables. If the residents do not have easy access to transportation, they may not be able to reach supermarkets that sell fresh food and may have to depend on their corner grocery store that sells processed foods that may not be healthy. Research has shown that survival is worse among colorectal cancer patients living in food deserts.
By paying homage to both his father and to Boseman through his digital art pieces, Will hopes to give back to the community via his charitable contribution to CCF.
The NFT collection is available on Opensea and the individual links are below:
OpenSea_1
OpenSea_2
OpenSea_3
OpenSea_4
OpenSea_5
OpenSea_6
OpenSea_7
OpenSea_8
OpenSea_9
Increased Risk of CRC in Patients with Slow-Transit Constipation
Slow-transit constipation (STC) is reported to occur in 15-30% of people in the U.S. The most widely accepted definition of STC is two or fewer bowel movements per week or straining at stool more than 25% of the time. Research continues to point to STC as a risk factor for colorectal cancer (CRC).
A study published in 2020 that looked at 2,165 patients (median age 54 years), found that the cumulative probability of CRC was 0.2% 5 years after STC diagnosis and 0.4% 10 years after STC diagnosis. This was not significantly different (p=0.575) than among those without STC diagnosis. However, this may be due to the small number of patients (5) who were diagnosed with CRC.
Although the authors of the 2020 study did not find a significant difference among those with and without STC diagnosis, it is well established that STC increases CRC risk. Gurérin et al. in their 2014 study of over 100,000 patients identified a statistically significant risk of CRC among those with STC:
Current management options for STC range from dietary counseling, pharmacological therapy, and surgery.
While the etiology of STC remains unclear, there is increasing evidence that it is caused by an imbalance in the gut microbiome. Zhang et al. in their 2021 review published in Gastroenterology Report found that gut microbiota may play a major role in modulating colonic motility, secretion, and absorption. However, there is still much research needed to understand how the gut microbiome modulates movement of fecal matter through the small intestine and colon.
Conversations about the role of the gut microbiome in CRC development were a part of the Early-Age Onset Colorectal Cancer Summit held by the Colon Cancer Foundation in May 2022.
Gargi Patel is a Colon Cancer Prevention Intern with the Colon Cancer Foundation.