Colorectal cancer: an overview
Each year, approximately 35,000 new cases of colorectal cancer (CRC) are diagnosed in the UK, with a prevalence rate of 57.1 for men and 37.5 for women per 100,000. Incidence increases with age, from 25 per 100,000 in the 45–55 year age group to over 300 per 100,000 in those aged 75 years and over. The most common age range at diagnosis is 60–65 years. In the UK, about 16,000 people die of CRC each year and it is the second most common cause of cancer death. Five-year relative survival rates have, however, increased steadily over the past 30 years and now stand at about 50 per cent.
There is evidence that both environmental and genetic factors play a role in the development of CRC. Four clinical or hereditary conditions that predispose people to CRC are described in Panel 1. Outside these four conditions, 15–20 per cent of patients with CRC report a family history. The association of diets low in fibre and high in red meat and saturated fat with an increased incidence of CRC have long been recognised. Epidemiological evidence suggests that obesity and smoking also increase the risk of developing the disease.
Symptoms and screening
Patients may describe a number of different symptoms, including a change in bowel habit that may be accompanied by abdominal pain, rectal bleeding or blood in the stool, weight loss or symptoms of anaemia. Symptoms can be non-specific and this can delay diagnosis. In addition, many of the symptoms have a number of possible causes.
There is evidence that early detection leads to better outcomes. Screening can lead to early detection and removal of CRCs and precancerous adenomatous polyps. A national bowel cancer screening programme for England is planned to begin in April. Men and women aged 60–69 years will be invited to take part in screening every two years. They will be sent a test kit to use at home. A sample is then sent to a laboratory, which will look for faecal occult blood. In conjunction with this, large scale pilots of flexible sigmoidoscopy will be undertaken, involving people in their 50s.
The screening programme is expected to cost £37.5m in the first two years and is one of the first of its kind in Europe.
Prevention and health promotion
Pharmacists have several roles to play in preventing CRC. Primary prevention can include:
- Promoting a diet low in red meat, low in saturated fat, low in alcohol and high in fruit and vegetables
- Encouraging patients to undertake physical activity
- Providing smoking cessation support
- Encouraging obese patients to lose weight
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Citation: The Pharmaceutical Journal URI: 10997398