Digest This - Special Edition 2008 - (Page 14)

cleveland clinic colorectal cancer prevention: an update Colorectal cancer, while preventable, remains the second leading cause of cancer deaths in American men and women in 2008. The lifestyle factors of tobaccoism and obesity are significantly associated with an increased risk of colorectal neoplasia, including adenomas and cancer, and are modifiable. Other factors, such race and family history, cannot be changed. The risk significantly heightens with the strength of the family history of colorectal Dr. Carol Burke CURREnT CLInICAL InVESTIGATIonS Carol Burke, MD, Department of Gastroenterology and Hepatology, is working with a variety of co-investigators and sponsors to determine the effectiveness and safety of chemopreventive agents for colorectal adenoma prevention. While many of the studies are being done in individuals with familial adenomatous polyposis (FAP), which is a rare disorder, it often is the perfect model to get a suggestion of an agent that would be feasible for a trial in the sporadic population. The genetic pathway in FAP and sporadic colorectal carcinogenesis is similar, but it is accelerated in FAP Therefore, what takes approximately . three years to show an effect in the sporadic population may be proven in six months in a FAP population. In conjunction with the national Cancer Institute (nCI) and MD Anderson, Dr. Burke is studying the effect of the combination of celecoxib (Celebrex®), a CoX-2 selective non-steroidal anti-inflammatory drug, and difluoromethylornithine (DFMo) in a six-month study. Celecoxib is one of the first FDA-approved chemopreventive drugs for the adjunctive use for colorectal polyps in adults with FAP . Following completion of a phase I/II, nCI-sponsored trial of celecoxib in children between ages 10 and 14 with FAP Dr. Burke is one of the lead investigators on a Phase , III international trial sponsored by Pfizer, assessing the effectiveness of celecoxib on colorectal polyp burden in children between 10 and 17 years old. Another study involves nutriceuticals, which are of widening interest to the public. In conjunction with ohio State University and the United States Department of Agriculture, Dr. Burke is studying the application of lyophilized black raspberries (slurry and suppository) in colorectal polyp regression in adults with FAP We also . are part of a multi-center, national trial investigating the effect of vitamin D and calcium on the prevention of recurrent adenomas in individuals with sporadic adenomas who have undergone polypectomy. To refer patients with rare inherited colon cancer syndromes for Dr. Burke’s studies, please contact Hennie Hasson, Rn, at 216.444.6975. neoplasia (adenomas and cancer), especially when present in numerous first-degree relatives, successive generations, and when there is an early onset of disease (< 50 years old). It is well established, but unclear why, Black men and women have the highest prevalence of colorectal cancer and death therefrom, adjusted for stage, than any other racial group. national data still remind us that the uptake of colorectal cancer screening in Americans is underutilized with less than 50 percent of the eligible population reporting undergoing fecal occult blood testing, flexible sigmoidoscopy or colonoscopy according to the interval recommended by the Multi-Society Task Force on Colorectal Cancer. CoMMUnITy oUTREACH EFFoRTS In order to increase awareness of colorectal cancer, in particular the risk associated with a family history of the disease and in Blacks, the departments of Colorectal Surgery, and Gastroenterology and Hepatology offer a yearly free risk assessment during Cleveland Clinic’s Minority Men’s Health Fair and throughout March, which is Colorectal Cancer Awareness Month. For each event, eligible men and women receive a free flexible sigmoidoscopy, but all individuals are given the Multi-Society Task Force Recommendations for Screening or Surveillance, based upon the risk assessment. In addition, the departments of Anatomic Pathology, Colorectal Surgery, and Gastroenterology and Hepatology, and the Genomic Medicine Institute have worked together to develop an algorithm to ensure that clinicians caring for individuals diagnosed with microsatellite unstable colorectal cancers, a potential sign of Lynch syndrome or hereditary nonpolyposis colorectal cancer, get appropriate information regarding genetic counseling and testing options. For more information, email digestthis@ccf.org {14} Digest This Special Edition | 2008

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Digest This - Special Edition 2008 Table of Contents Investigations Institute Overview Innovations Staff Research

Digest This - Special Edition 2008

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