Colorectal Cancer. Goals: Reduce colorectal cancer mortality. Reduce disparities in the incidence and mortality of colorectal cancer. Objective 1: Increase the rate of screening for colorectal cancer of those aged 50 and older by increasing the public’s knowledge of colorectal cancer risk factors, symptoms, screening recommendations, and options.
Colorectal Cancer. In the United States, colorectal cancer is the second leading cause of cancer death and the third most common type of cancer. Colon cancer comprises about three quarters of colorectal cancer and less is generally known about rectal cancer (Giovannucci, 2002). Colorectal cancer is positively associated with diet, including high fat, red meat, and alcohol consumption. High body mass index (BMI) and smoking are also risk factors for colorectal cancer (Roncucci & Xxxxxxx, 2015; Potter, 1999; Xxxx, 2008). Consumption of vegetables, physical activity, postmenopausal hormones, and regular non-steroidal anti-inflammatory drug (NSAIDs) use are inversely associated with colorectal cancer ((Danaei, 2005; Roncucci, 2015; Potter, 1999; Xxxx et al., 2008). Colorectal cancer rates are higher among men compared to women, and appear to be more common among certain ethnicities, including African-Americans, Native Americans, and certain Asian American ethnicities (Xxxx et al., 2008; USPSTF, 2008). Patients 50 years or older make up more than 80% of diagnosed colorectal cancer cases (USPSTF, 2008). Screening is an important preventative measure, particularly as the cancer progresses in a stepwise fashion and often develops from precancerous polyps. The US Preventive Services Task Force (USPSTF) recommends regular screening for colorectal cancer beginning at age 50 and continuing until 75 years old. Individuals with a family history of colorectal polyps or colorectal cancer, inflammatory bowel disease, Crohn’s disease, ulcerative colitis, or genetic syndromes like Xxxxx Syndrome, or a familial adenomatous polyposis (FAP), may need to be tested before age 50. For most individuals age 76 to 85 years, USPSTF does not recommend routine screening and for most individuals older than 85, screening is not recommended at all; individual circumstances may vary and screening should be done per a doctor’s recommendation (USPSTF, 2008). Cervical Cancer Cervical cancer is the third most common cause of cancer incidence in women worldwide. In the US alone, about 12,990 diagnosed cases and 4,120 deaths are estimated for 2016 (Arbyn et al., 2011; ACS, 2016). Cervical cancer is caused by certain types of Human Papillomavirus (HPV), with 70% of cases caused by types 16 and 18 (zur Hausen, 2000; Xxxxxxxx et al., 2005; Xxxxxx et al., 2008). HPV is a very common sexually transmitted infection, infecting mucosal and skin tissues, with low-risk types causing warts and high-risk types causing cancer. ...
Colorectal Cancer. First visit to PC* GP vs Patient (n=473) -2.4 25 20 55 0.89 (0.87,0.91 ) GP vs Patient (n=664) 2.2 18 29 53 0.95 (0.95,0.96) Diagnosis Registry vs Patient (n=664) -3.8 22 28 50 0.98 (0.98,0.98) Registry vs GP (n=664) -6.0 28 27 45 0.97 (0.96,0.97) SP vs Registry (n=451) 7.1 18 53 30 0.95 (0.94,0.96) SP vs Patient (n=451) 2.9 10 43 47 0.95 (0.94,0.96) Treatment SP vs Patient (n=451) 4.0 58 18 24 0.89 (0.87,0.91) Lung cancer First visit to PC* GP vs Patient (n=339) 1.8 19 19 62 0.91 (0.89,0.93 ) GP vs Patient (n=360) 10.9 12 21 66 0.96 (0.95,0.97) Registry vs Patient (n=306) 5.9 6 26 68 0.98 (0.97,0.98) Treatment SP vs Patient (n=232) 2.7 47 24 29 0.96 (0.95,0.97) Ovarian cancer First visit to PC* GP vs Patient (n=246) 6.4 35 18 48 0.91 (0.89,0.93) GP vs Patient (n=255) 10.0 9 27 64 0.97 (0.96,0.97) Registry vs Patient (n=255) 1.3 7 25 67 0.98 (0.97,0.98) Diagnosis Registry vs GP (n=255) -8.7 28 23 49 0.97 (0.97,0.98) SP vs Registry (n=194) 7.5 28 27 44 0.99 (0.98,0.99) SP vs Patient (n=194) 5.5 7 30 63 0.98 (0.98,0.98) Treatment SP vs Patient (n=194) 8.1 57 17 26 0.93 (0.91,0.95) All cancers First visit to PC* GP vs Patient (n=1632) -1.3 32 21 47 0.92 (0.91,0.92) GP vs Patient (n=2287) 4.3 19 31 50 0.96 (0.96,0.97) Registry vs Patient (n=2233) -2.0 18 32 50 0.98 (0.98,0.98) Diagnosis Registry vs GP (n=2233) -6.5 27 33 40 0.98 (0.97,0.98) SP vs Registry (n=1469) 6.8 18 51 31 0.97 (0.97,0.97) SP vs Patient (n=1523) 3.4 12 43 45 0.96 (0.95,0.96) Treatment SP vs Patient (n=1523) 4.6 57 18 25 0.90 (0.89,0.91) *only for symptomatic patients Abbreviations: CI: confidence interval, GP: general practitioner, PC: primary care, SP: cancer specialist disease, the agreement was still reasonable. CCC for date of first presentation ranged from 0.89 for colorectal cancer to 0.95 for breast cancer. CCC for date of treatment was about 0.88 for breast and colorectal cancers and above 0.9 for the other two diseases. CCC for date of diagnosis was homogenous across all four cancer types, ranging from 0.94 to 0.99. The mean difference ranged from 0.6 days for diagnosis date of breast cancer between SP and patient to 12 days for diagnosis date of lung cancer between SP and registry.
Colorectal Cancer. Colon and rectal cancers are the same in many ways, but they are different in treatments. Because the sits of the rectum in a tight space, barely separated from other organs and structures in the cavity of pelvis. So, there challenging at complete surgical removal of rectal cancer is highly complex (Xxxx et al., 2016).
