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OCR Page 1 of 62TO:
The First Lady
FROM:
Neera Tanden
DATE:
April 9, 1998
RE:
Colorectal Cancer
Colorectal cancer is the second leading cause of cancer-related death in the United States.
Approximately 130,000 new cases of colorectal cancer are diagnosed each year, with roughly
55,000 ending in death. For both men and women, it is the third most common cancer in
frequency.
Survival of colorectal cancer depends heavily on early detection. When diagnosed at the localized
(early) stage, only 8% of those patients will die within 5 years. However, only 37% of all
colorectal cancer cases are diagnosed at this stage. When the disease is diagnosed at an advanced
stage the death rate is a staggering 93% within 5 years.
The risk of developing colorectal cancer increases greatly after the age of 40. Men are more
likely than women to develop the disease, as are African Americans over other racial groups.
Major risk factors include having inflammatory bowel disease, a family history of colorectal
cancer, and certain hereditary syndromes. A growing number of studies suggest that diet is also a
major risk factor in the development of colorectal cancer: high fat and low fiber diets seems to
promote a high rate of polyps and cancer.
The statistics mentioned above indicate how critical early detection is to survival, yet the nature of
the cancer makes it especially difficult to detect. Most colorectal cancers are "silent" tumors; they
grow slowly and often do not produce any noticeable symptoms until they reach a large size. The
earliest sign of colon cancer is usually bleeding. Fortunately, two currently available tests have
been shown to be beneficial in screening for colorectal cancer. First, fecal occult blood testing
(FOBT) is a chemical test for blood in the stool sample. A positive test can indicate bleeding
from a precancerous growth or from colorectal cancer. Studies have found that colorectal cancer
screening by FOBT is effective, reducing colorectal cancer mortality by 33% in those who
underwent annual screening by FOBT in one study. The other popular screening method is
flexible sigmoidoscopy, which uses a hollow, lighted tube to visually inspect the wall of the
rectum and lower sections of the colon. The 60-centimeter flexible scope can detect about 65%-
75% of polyps and 40-65% of colorectal cancers. Recent studies show that removing polyps can
reduce a person's risk of colon cancer by as much as 90%. The CDC recommends an increase in
screening for colorectal cancers, especially for those individuals over the age of 50.
Under the 1997 Balanced Budget Act the President signed, Medicare covers Fecal Occult Blood
Tests, flexible sigmoidoscopy and screening colonoscopy for high-risk individuals. The Secretary
of HHS was also given authority to allow Medicare coverage of other screening tests/procedures,
or modifications thereof as they become available. Nevertheless, screening for colorectal cancer
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