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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EGlobal cancer prevention experts, gastrointestinal cancer physicians, and researchers attended the International Society of Cancer Prevention consensus conference to discuss the current science of colorectal cancer (CRC) carcinogenesis, screening, and preventive intervention; to develop a consensus statement encompassing current recommendations for CRC screening, genetic assessment, and cancer prevention interventions; and to further delineate knowledge gaps that need to be addressed in future CRC prevention research. This article presents the highlights from the CRC prevention consensus meeting.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EGastrointestinal Cancers\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EGastrointestinal Cancers\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EGlobal cancer prevention experts, gastrointestinal cancer physicians, and researchers attended the International Society of Cancer Prevention (ISCaP) consensus conference to discuss the current science of colorectal cancer (CRC) carcinogenesis, screening, and preventive intervention; to develop a consensus statement encompassing current recommendations for CRC screening, genetic assessment, and cancer prevention interventions; and to further delineate knowledge gaps that need to be addressed in future CRC prevention research. Powel H. Brown, MD, PhD, University of Texas MD Anderson Cancer Center, Houston, Texas, USA, presented the highlights from the CRC prevention consensus meeting.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAll participating countries recommend screening for CRC, but the methods used vary by country. \u201cIt was striking how different these colorectal screening recommendations were,\u201d commented Dr Brown. While colonoscopy is widely used in the United States, other countries use the fecal occult blood test (FOBT), the fecal immunochemical test (FIT), or sigmoidoscopy. Even though the screening methodologies differ, all experts agreed that the current screening compliance level of 40% to 60% is far too low. Of all types of cancer screening, CRC screening may have the highest impact to prevent disease and affect mortality. The panel therefore believes that some type of CRC screening should be strongly recommended, usually after age 50 years, and that the promotion of screening compliance should be a priority.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe largest variables in colonoscopies are patient and operator dependent, as bowel preparation and the experience of the endoscopist influence the success of the procedure. Novel colonoscopy techniques are in development and may help reduce this variability and increase patient compliance: Water exchange colonoscopy provides better visualization of the colon and may require little or no sedation. Capsule colonoscopy is still in development but is a promising technique that may lead to better screening acceptance.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe next generation of fecal and blood tests are also being developed. The Cologuard test is a multitarget DNA test with an FIT based on exfoliated DNA in the feces. This noninvasive method requires no bowel preparation and no diet or medication restrictions; it can be performed at home and mailed; it is affordable; and it provides results quickly. The DeeP-C trial [Imperiale TF et al. \u003Cem\u003EN Engl J Med.\u003C\/em\u003E 2014] was a prospective study of \u223c 10,000 asymptomatic patients aged 50 to 84 years. Samples were tested by both Cologuard and an FIT alone. Cologuard had better sensitivity and specificity when compared with the FIT. Blood-based tests for cancer-specific DNA (Epi ProColon) and microRNA assays also appear promising. Despite these advances, for now, the FOBT, the FIT, colonoscopy, and sigmoidoscopy remain the standard recommendations for CRC screening.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe panel also agreed that the prevention interventions of diet, healthy weight, and exercise continue to be effective prevention strategies. The current recommendation from the American Heart Association and other organizations is 30 to 45 minutes of vigorous exercise 3 to 5 times per week, and there is strong evidence that supports this recommendation. \u201cIt is also important to point out that less aggressive exercise, as much as just 15 minutes several days a week, [shows] a detectable improvement in cancer incidence,\u201d noted Dr Brown. While epidemiologic evidence indicates that diet affects risk, this has not been confirmed in randomized clinical trials testing different dietary strategies. Despite this, a diet lower in red meat and higher in fruits, vegetables, and fiber is recommended. New e-health techniques, such as fitness-tracking wristbands and smartphone apps that measure physical activity, may complement behavioral interventions.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThe conference also reviewed chemoprevention strategies for CRC. There is strong evidence suggesting that aspirin lowers cancer incidence and cancer-related mortality [Rothwell PM et al. \u003Cem\u003ELancet.\u003C\/em\u003E 2012; 2011; 2010]. The effect of aspirin on the incidence of CRC appears to be delayed and is typically seen 5 years after aspirin therapy is started [Cook NR et al. \u003Cem\u003EAnn Int Med.\u003C\/em\u003E 2013; Rothwell PM et al. \u003Cem\u003ELancet.\u003C\/em\u003E 2011]. The reason for this is unknown, but it is possible that precancerous cells are destroyed before developing into a detectable cancer. The CAPP2 study [Burn J et al. \u003Cem\u003EN Engl J Med.\u003C\/em\u003E 2008] was conducted in patients with Lynch syndrome, an inherited type of colon cancer. The original publication from this study reported no effect of aspirin (600 mg\/d) out to 4 years. However, extended data from the CAPP2 study presented at the ISCaP meeting showed that a treatment effect is evident with \u0026gt; 5 years of aspirin therapy (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/22\/4\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022CAPP2 Per-Protocol Analysis: All Lynch Syndrome Cancers\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1853270082\u0022 data-figure-caption=\u0022CAPP2 Per-Protocol Analysis: All Lynch Syndrome Cancers\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/22\/4\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/22\/4\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/22\/4\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14866\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003ECAPP2 Per-Protocol Analysis: All Lynch Syndrome Cancers\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EAP=aspirin placebo.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EBurn et al. Long-term effect of aspirin on cancer risk in carriers of hereditary colorectal cancer: an analysis from the CAPP2 randomised controlled trial. \u003Cem\u003ELancet\u003C\/em\u003E. 2011;9809:2081\u20132087. Republished with permission from Lancet Publishing Group; permission conveyed through Copyright Clearance Center, Inc.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EResearchers have not yet determined the optimal dose of aspirin, but the available data suggest a benefit at doses \u2264 100 mg\/d. The risk of gastrointestinal bleed is age dependent and is slight in patients aged 50 to 65 years. The use of aspirin is therefore recommended for CRC prevention, particularly in patients with a family history of CRC. Daily doses of 81 to 100 mg are considered safe and effective, but it is possible that higher doses may be even more effective. The CAPP3 study is being designed to test this hypothesis. In this study, patients with Lynch syndrome will be randomized to blinded doses of aspirin (100, 300, or 600 mg\/d) for several years and then switched to open-label aspirin (100 mg\/d).\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EOther agents are being investigated as potential chemopreventive agents in CRC. The use of cyclooxygenase-2 inhibitors is limited by their cardiac side effects, but investigations are ongoing into other ways to target the same inflammatory pathway. These include the use of EP antagonists, CXCR2 antagonists, and downstream pathways such as peroxisome proliferator-activated receptors. Difluoromethylornithine and sulindac may help young patients with familial adenomatous polyposis before having colectomy. In addition, preclinical data suggest that peptide vaccines may be effective in the treatment of patients with mismatch DNA-repair defects.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EIn his concluding remarks, Dr Brown reemphasized the importance of CRC screening. \u201cIncreased uptake of screening was considered the most important aspect of colon cancer prevention by the entire panel and the most cost effective.\u201d\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/22\/4.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzoxde\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzoxde\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}