Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ COLORECTAL CANCER (CRC) +++ Population ++ – Adults. +++ Recommendations +++ AAFP 2018, NCCN 2020 ++ – Modifiable Risk Factors Diet: Advise patients to increase consumption of fruits, non-starchy vegetables, and whole grains. Preferentially optimize nutrition from natural food sources rather than dietary supplements. Cholesterol: 2-fold increased risk of CRC with increased intake. Fat: 25% increased risk of serrated polyps with increased fat intake. Dairy: 15% reduced risk of CRC with >8 oz of cow’s milk daily. Fiber: No reduced risk of CRC or adenomatous polyps with increased fiber intake. Red and processed meat: 22% increased risk of CRC with increased red and processed meat intake. Lifestyle: Alcohol: 8% increased risk of CRC and 24% increased risk of serrated polyps. Reducing alcohol intake does not clearly lower risk for CRC or polyps. Cigarettes: 114% increased risk of high-risk adenomatous polyps and CRC in current smokers. Obesity: Bariatric surgery associated with 27% reduced risk of CRC in obese individuals. Increased BMI is associated with increased mortality from CRC. Occupational physical activity: 25% decreased risk of colon cancer and 12% decreased risk of rectal cancer. Recreational physical activity: 20% decreased risk of colon cancer and 13% decreased risk of rectal cancer. Medications: Statins: Weak evidence that statin use ≥5 y is associated with decreased risk of advanced adenomatous polyps. Calcium: 26% reduced risk of adenomatous polyps; 22% reduced risk of CRC in individuals taking 1400 mg daily calcium compared to 600 mg. – Polyp Removal Based on fair evidence, removal of adenomatous polyps reduces the risk of CRC, especially polyps >1 cm. (Ann Intern Med. 2011;154:22) (Gastrointest Endosc. 2014;80:471) Based on fair evidence, complications of polyp removal include perforation of the colon and bleeding estimated at 7–9 events per 1000 procedures. – Interventions Without Benefit Vitamin D. Folic acid. Antioxidants. +++ USPSTF 2016 ++ – Aspirin: Associated with 40% decreased CRC incidence after 5–10 y of use. Initiate low-dose aspirin for primary prevention of cardiovascular disease and CRC in persons aged 50–59 y with a 10-y cardiovascular event risk of ≥10%, no increased risk for bleeding, life expectancy of ≥10 y, and who are willing to take low-dose aspirin daily for 10 y. (USPSTF. Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer. 2016.) Individualize decision to initiate low-dose aspirin for persons 60–69 y of age with similar risk profile, as there is increased risk for bleeding and decreased CRC prevention benefit. Insufficient evidence to initiate aspirin in persons <50 or ≥70 y of age. +++ Sources ++ – Am Fam Physician. 2018;97(10):658-665. – NCCN. Colorectal Cancer Screening. 2020:1-61. – USPSTF. Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer. 2016. +++ Population ++ – Average-risk adults who have undergone baseline screening colonoscopy. ++... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth