Reading Room

Colorectal Cancer Research Briefs:
Written by Kate Murphy.


Briefly
· Hormone replacement therapy reduces risk of colon cancer.
· Smoking before age 30 increases chances that colon cancer will recur.
· Low CEA levels improve both survival and disease-free survival for stage II colon cancer.
· Most patients want videos of their colonoscopies and are willing to pay for them.


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Use of hormone replacement therapy reduces colon cancer
Women in a study of California teachers who were taking hormone replacement therapy (HRT) after menopause had a 36 percent reduced risk of colon cancer over ten years than women who weren’t on HRT at the beginning of the study. Risk reduction was even greater for women with a first-degree relative who had colon cancer. Their risk fell 55 percent.
Over 57,000 women were part of the study, about 60 percent of them on HRT at the study start. Over the next ten years, 444 got colon cancer.
Despite the reduction in colon cancer in the study, doctors caution women about using HRT because of raised risks for breast cancer, heart attack, stroke, and blood clots. Advice is to use the lowest dose for the shortest time to offset severe menopausal symptoms.
Katherine DeLellis Henderson, PhD, reports the study results in the February 15, 2010 issue of the American Journal of Epidemiology.
Early smoking history reduces disease-free survival after colon cancer
Patients with stage III colon cancer who had a smoking history of 12 or more pack years before they were 30 had almost a 40 percent increased risk of having their cancer return within three years compared to patients who had never smoked.
Among the 1,045 study participants, 46 percent had never smoked, 44 percent were past smokers, and 10 percent were currently smoking.
Disease-free survival three years after treatment was about 18 percent greater for people who had never smoked than for past smokers.
The results, based on questionnaires filled out by patients in the CALGB 80893 adjuvant chemotherapy trial, were published by Nadine Jackson McCleary, MD, MPH,and her colleagues in Cancer, February 15, 2010. They wrote,
Total tobacco usage early in life may be an important, independent prognostic factor of cancer recurrences and mortality in patients with stage III colon cancer.
CEA levels before surgery important for stage II prognosis
Patients whose CEA (carcinoembryonic antigen) blood levels before surgery were low — below 5 ng/ml — had significantly better overall and disease free survival than those whose CEA’s were 5 or higher. For those with low CEA, overall survival at five years was 81.7 percent compared to 69.9 percent for high CEA. Disease-free survival was 82.4 percent for low CEA and 70.6 percent for CEA that was 5 ng/ml or higher.
However, CEA levels only made a difference in stage II patients. There was no significance for stage I or III.
Writing in the Journal of Surgical Oncology, Korean surgeon Jung Wook Huh, MD and colleagues concluded,
Preoperative serum CEA is a reliable predictor of recurrence and survival after curative surgery in patients with colon cancer, particularly in those classified as having stage II disease.
Patients want videos of their colonoscopies
Eight out of ten patients having colonoscopies said that they would like to have a video recording of their colonoscopy, and more than 6 of 10 (63 percent) were willing to pay for it. After reading a brief paragraph explaining missed lesions during colonoscopy, over half (54 percent) were more interested in a video and none were less interested.
Meghana Raghavendra surveyed 248 outpatients at the Indiana University School of Medicine and reported the results in the World Journal of Gastroenterology, in an early online article January 28, 2010.