Reducing mortality from colorectal cancer: screening versus primary prevention

SUMMARY

Screening reduces mortality from colorectal cancer but, like breast and prostate cancer screening, does not significantly prolong life expectancy. It is cost effective though, as polyp removal prevents cancer development and its associated cost and morbidity. Given the lack of impact of screening on overall life expectancy, prevention of colorectal cancer by lifestyle adjustment, particularly dietary, should still be considered as an alternative strategy. Avoidance of excessive calories and increased fiber intake would probably reduce risk not only for colorectal cancer but also for cardiovascular and cerebrovascular disease and substantially reduce all-cause mortality. We need better knowledge though of how specific dietary components impact on colon cancer risk and for this we probably need better understanding of the role of bacteria.

KEYWORDS:

• bacteria
• colonoscopy
• colorectal cancer
• contrabiotic
• diet
• flexible sigmoidoscopy
• life expectancy
• occult blood
• prebiotic
• prevention
• screening
• survival

Financial & competing interests disclosure

JM Rhodes is or has been a member of advisory boards for Atlantic, Pharmacosmos, Procter & Gamble, Vifor and Falk, has received speaking honoraria from Abbott, Falk, Ferring, GlaxoSmithKline, Merck, Procter & Gamble, Schering Plough, Shire and Wyeth, and with the University of Liverpool and Provexis UK, holds a patent for use of a soluble fiber preparation as maintenance therapy for Crohn's disease plus a patent pending for its use in antibiotic-associated diarrhea. Patent application pending with the University of Liverpool and others in relation to use of modified heparins in cancer therapy. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.