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CEA

Comment about: "Prognosis

Survival is directly related to detection and the type of cancer involved. Survival rates for early stage detection is about 5 times that of late stage cancers. CEA level is also directly related to the prognosis of disease, since its level correlates with the bulk of tumor tissue."

Whether CEA is truly of clinical use is still controversial, as far as I know.

Evidence based screening

According to the National Guideline Clearinghouse™ (NGC), a public resource for evidence-based clinical practice guidelines.

at

http://www.guideline.gov/summary/summary.aspx?doc_id=14345

Colorectal cancer screening clinical practice guideline

MAJOR RECOMMENDATIONS

Definitions of the levels of evidence (evidence-based A-D, I and consensus-based) are provided at the end of the "Major Recommendations" field.

Recommendation 1*: Factors Associated with an Increased Risk of Colorectal Cancer in the General Population

1. A significant family history is associated with an increased risk of colorectal cancer. (See Recommendation #5, below, for screening recommendations and specific definition of family history.) (Evidence-based: A) 2. Advancing age is associated with an increased risk of colorectal cancer.** (Evidence-based: B) 3. There is fair evidence that blacks are at increased risk for colorectal cancer compared with whites. (Evidence-based: C) 4. There is fair evidence that a family history of advanced adenomas (i.e., >10 mm, with villous features or high-grade dysplasia) presenting before age 60 is associated with an increased risk of colorectal cancer. (Evidence-based: C) 5. There is insufficient evidence for or against the association of gender with an increased risk of colorectal cancer. (Evidence-based: I)

  • The Guideline Development Team (GDT) adopted a hazard ratio >2.0 as the cut-point to declare a risk factor as sufficient to warrant a screening recommendation different from that for people at average risk.
    • Indirect evidence from analyses using cancer registry, Medicare, and other surveillance data indicates that the risk of cancer and advanced colonic neoplasms increases with age.

Recommendation 2: Effectiveness of Colorectal Cancer Screening Tests

1. Colorectal cancer screening is strongly recommended for all asymptomatic, average-risk adults. (Evidence-based: A) 2. Any of the following tests are acceptable for colorectal cancer screening in asymptomatic, average-risk adults:*

  • High-sensitivity fecal occult blood test (FOBT) (Consensus-based)
  • Immunochemical fecal occult blood test (iFOBT/FIT)** (Consensus-based)
  • Flexible sigmoidoscopy (Evidence-based: B)
  • Colonoscopy** (Consensus-based)
  • A combination of high-sensitivity guaiac FOBT test and flexible sigmoidoscopy (Consensus-based)

3. The following additional screening tests are either less-preferred options or not recommended for screening. However, an adult who has had one of these tests is considered screened. Follow-up screening using a preferred option is recommended.

  • An annual standard guaiac FOBT is a less-preferred option.*** (Consensus-based)
  • Air contrast barium enema is not recommended as a screening strategy for average-risk adults. (Evidence-based: I)
  • Virtual colonoscopy is not recommended as a screening strategy for average-risk adults.* (Consensus-based)
  • Fecal DNA is not recommended as a screening strategy for average-risk adults.****(Consensus-based)

Note: For fecal blood tests, inform patients of the potential risks associated with false-positive test and false-negative test results, as well as the need for prompt follow-up of a positive test result. For flexible sigmoidoscopy, inform patients that the test has a small risk of complications and is not a complete examination of the entire colon.

  • There is insufficient evidence to choose one screening test over another.
    • If a patient has had a normal colonoscopy within the last 10 years, there is insufficient evidence that supplemental FOBT adds any incremental benefit.
      • Even though there is sufficient evidence in support of this screening modality, it is not a preferred option due to its low sensitivity and low compliance rates.
        • Please note that fecal DNA testing and virtual colonoscopy are not listed as "appropriate screening tests" in 2008 HEDIS (Health Plan Employer Data and Information Set) specifications for colorectal cancer screening, and therefore regions may choose to screen members with other appropriate tests.

Recommendation 3: Frequency of Colorectal Cancer Screening

1. The following intervals for colorectal cancer screening in asymptomatic, average-risk adults are recommended*:

  • Flexible sigmoidoscopy: at least every 10 years (Consensus-based)
  • High-sensitivity guaiac or immunochemical FOBT (iFOBT/FIT): every 1-2 years (Consensus-based)
  • Colonoscopy: every 10 years (Consensus-based)
  • Combined FOBT and flexible sigmoidoscopy: every 1-2 years for FOBT, at least every 10 years for flexible sigmoidoscopy (Consensus-based)

2. The following additional screening tests are either less-preferred options or not recommended for screening. However, if these tests are performed, then the recommended intervals are as indicated below. Follow-up screening using a preferred option is recommended.

  • Standard guaiac FOBT: every 1-2 years (Consensus-based)
  • Air contrast barium enema:** every 5 years (Consensus-based)
  • Virtual colonoscopy:** every 10 years (Consensus-based)
  • Fecal DNA:** every 5 years (Consensus-based)
  • The GDT recognizes that these screening intervals differ from current HEDIS measures. Some regions may choose to offer screening at more frequent intervals. HEDIS intervals are as follows: FOBT (annual), flexible sigmoidoscopy (every 5 years), air contrast barium enema (every 5 years), colonoscopy (every 10 years).
    • These modalities are not recommended for screening average-risk adults (see Recommendation #2 above).

Recommendation 4: Age to Begin and End Colorectal Cancer Screening

In the absence of sufficient evidence, the following ages at which to begin and end colorectal cancer screening in asymptomatic average-risk adults are recommended:

1. Initiation of screening is recommended at age 50. (Consensus-based) 2. Discontinuation of screening is generally recommended at age 75, provided that there is a history of routine screening. For those with no history of routine screening, discontinuation is recommended at age 80. The decision to discontinue screening should be based on physician judgment, patient preference, the increased risk of complications in older adults, and existing comorbidities. (Consensus-based)

Moved here

We need evidence that these cases were notable not just that the people were notable.

Doc James (talk · contribs · email) 15:22, 10 January 2018 (UTC)

References

  2. "Pope John Paul II". ABC News Online. Archived from the original on December 18, 2009. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  3. "Reagan turns 90". BBC News: Americas. February 6, 2001. Archived from the original on March 3, 2016. {{cite news}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  4. Goodman, Geoffrey (July 1, 2005). "Harold Wilson | Politics". The Guardian. London. Archived from the original on December 4, 2013. Retrieved April 10, 2014. {{cite news}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  5. Klein, Sarah (April 23, 2012). "12 Famous Faces Touched By Colorectal Cancer". Huffington Post. Archived from the original on April 25, 2012. {{cite news}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  6. "Humayun Ahmed dies". Bdnews24.com. July 19, 2012. Archived from the original on July 21, 2012. Retrieved July 19, 2012. {{cite news}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  7. Krishna Dronamraju (May 2010). "J.B.S. Haldane's Last Years: His Life and Work in India ". Genetics. 185 (1): 5–10. doi:10.1534/genetics.110.116632. PMC 2870975. PMID 20516291.
  8. "Cancer fundraiser Stephen Sutton dies aged 19". BBC News. Archived from the original on May 14, 2014. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)

Edit Request

It is requested that an edit be made to the semi-protected article at P. (edit · history · last · links · protection log)

This template must be followed by a complete and specific description of the request, that is, specify what text should be removed and a verbatim copy of the text that should replace it. "Please change X" is not acceptable and will be rejected; the request must be of the form "please change X to Y".

The edit may be made by any autoconfirmed user. Remember to change the |answered=no parameter to "yes" when the request has been accepted, rejected or on hold awaiting user input. This is so that inactive or completed requests don't needlessly fill up the edit requests category. You may also wish to use the {{ESp}} template in the response. To request that a page be protected or unprotected, make a protection request.

NOTE: I am proposing this edit for FleishmanHillard on behalf of Exact_Sciences_(company). I am a paid editor and am aware of the COI guidelines. I am submitting this edit request in hopes of making the information in the article about screening and testing more thorough. Below, I have detailed where proposed additions should be included, recommended copy and related sources. Thanks for your consideration.

  1. Screening
    1. In the Screening section (under “Prevention), we propose adding the following information to the beginning of the second paragraph to provide more information about the variety of screening tests available (and reinforce the importance of screening, regardless of method): “The United States Preventive Services Task Force ranks seven different existing screening methods in equal standing, stating the best screening test is the one that gets done. ”
    1. In the Screening section (under “Prevention), we propose adding the following information to the end of the third paragraph to provide insight into different testing options: “Stool DNA testing has a higher sensitivity than fecal immunochemical tests and is recommended every three years by the American Cancer Society. ”

References

  1. Final Recommendation Statement Colorectal Cancer: Screening (Report). United States Preventive Services Task Force. November 15, 2017. Retrieved June 2018. {{cite report}}: Check date values in: |accessdate= (help)
  2. "Multitarget stool DNA testing for colorectal-cancer screening". National Center for Biotechnology Information. April 3, 2014. {{cite journal}}: Cite journal requires |journal= (help)
  3. Brian C. Weiner, MD, MS, FACP, AGAF (June 15, 2018). "Stool tests for colorectal cancer screening". DynaMed. Retrieved June 20, 2018. {{cite journal}}: Cite journal requires |journal= (help)CS1 maint: multiple names: authors list (link)

Jon Gray (talk) 22:06, 26 June 2018 (UTC) Thank you for considering these edits.

Reply 08-JUL-2018

 This COI edit request has not received any comments over the past two weeks. ClockC – The request is  Stale. You may consider addressing unresolved issues through any of the WikiProject's who govern the article, listed at the top of this page, or through making a new edit request directly to the conflict of interest noticeboard.

Regards,  spintendo  06:03, 8 July 2018 (UTC)


  • Comment This "Specificity is lower than for FIT, resulting in more false-positive results, more diagnostic colonoscopies, and more associated adverse events per screening test" is a better summary which I will add. Also added some of the other bits suggested. Doc James (talk · contribs · email) 07:24, 2 August 2018 (UTC)

@Doc James: Thanks for your additions and revisions to make the article more clear and thorough. For our knowledge moving forward, what were your thoughts on the request we submitted? Is there any feedback we should keep in mind? Jon Gray (talk) 22:24, 29 August 2018 (UTC)

Queen's University Student Editing Initiative

Hello, we are a group of medical students from Queen's University. We are working to improve this article over the next month and will post our planned changes on this talk page. We look forward to working with the existing Misplaced Pages medical editing community to improve this article and share evidence. We welcome feedback and suggestions as we learn to edit. Thank you.

13wak (talk) 03:06, 2 October 2018 (UTC)

Lifestyle

Fruits

Not sure why this text was removed "The evidence for a protective significant effect conferred by fruits and vegetables is unclear as of 2014"

Doc James (talk · contribs · email) 20:44, 25 October 2018 (UTC)

The World Cancer Report 2014, page 126, under the Fruits section:
"A large protective role for total intake of fruits and vegetables against overall cancer risk now appears unlikely, but specific phytochemical or botanical subgroups may reduce risks of some cancers."
Just because there is not "a large protective role" does not mean there would not be a clear small role (i.e., "may reduce risks of some cancers"). The "unclear" statement is incorrect.
On page 126, in the subsequent sentence: "Promising leads include . . . folate-rich fruits and vegetables and colon cancer." No one would describe something "promising" as "unclear".
Further down in , "fruit fibre (n=9) was 0.93".


The World Cancer Research Fund International noted in the latest 2017 update (https://www.wcrf.org/dietandcancer/colorectal-cancer):
- There is strong evidence that consuming foods containing dietary fibre (which links to "Wholegrains, vegetables & fruit") DECREASES the risk of colorectal cancer.
- There is some evidence that low consumption of fruit might increase the risk of colorectal cancer.
There is nothing "unclear" about the benefits of fruits and fiber. But for some reason you did not like WCRF International and instead cited the WHO (which does not support your "unclear" statement either). — Preceding unsigned comment added by 24.8.207.91 (talk • contribs) 03:09, 26 October 2018 (UTC)
The World Cancer Report is a better source. A charity is not the best source for medical content.
Yes "promising" does not mean "good evidence". In fact the source says a significant effect is unlikely. Doc James (talk · contribs · email) 17:57, 26 October 2018 (UTC)
The 2019 WCR is out soon. Doc James (talk · contribs · email) 19:08, 26 October 2018 (UTC)


The World Cancer Report, which you deleted (and then added World Cancer Research Fund, despite the above), has been restored.
The reference did not say "unclear" nor "not ... benefit". We should try to be impartial, and try not to make up our own words, which in this example have clear negative connotation.
Also, you failed to include: ", but specific phytochemical or botanical subgroups may reduce risks of some cancers".
You also failed to include "Promising leads include . . . folate-rich fruits and vegetables and colon cancer."
It is very important that we edit impartially. We must at least look at the entire sentence, or the entire paragraph, so a reference is not misconstrued. — Preceding unsigned comment added by 24.8.207.91 (talk • contribs) 03:12, 27 October 2018 (UTC)
It says "A large protective role for total intake of fruits and vegetables against overall cancer risk now appears unlikely" which is even strongly than unclear. Doc James (talk · contribs · email) 04:31, 27 October 2018 (UTC)
I simply don't understand how "large . . . appears unlikely" can become "unclear".
Again, we must look at the entire sentence or the entire paragraph. What happened to ", but specific phytochemical or botanical subgroups may reduce risks of some cancers"? What happened to "Promising leads include . . . folate-rich fruits and vegetables and colon cancer"? — Preceding unsigned comment added by 24.8.207.91 (talk • contribs) 17:54, 27 October 2018 (UTC)
In science the term "may" can always be substituted with "may not". "Promising" means should be researched further but unclear. Doc James (talk · contribs · email) 18:33, 27 October 2018 (UTC)
In English, "unlikely" denotes probability. How does it have anything to do with "unclear"?
The first part of WHO's sentence is: "A large protective role for total intake of fruits and vegetables against overall cancer risk now appears unlikely".
Suppose, just suppose, fruits confer a 10% reduction, and legumes confer a 30% reduction. The protective role of fruits is certainly not as large as legumes. But a 10% reduction is significant, and the significant effect is clear. There is nothing unclear about its significant effect.
Don't you see the problem? You failed to look at the entire paragraph, you even failed to look at the entire sentence. And when you take only the first part of the sentence, you misconstrued it by making up your own words for no good reason (it's highly unlikely we will have copyright issues due to "fair use"). Your "unclear" sentence is plain wrong.

Fiber

The World Cancer Report 2014, page 127, under the Dietary fibre section:

"Several large prospective cohort studies of dietary fibre and colon cancer risk have not supported an association , although an inverse relation was seen in the large European Prospective Investigation into Cancer and Nutrition (EPIC) study and a recent meta-analysis ."

is from 2005, and concluded with "In this large pooled analysis, dietary fiber intake was inversely associated with risk of colorectal cancer in age-adjusted analyses. However, after accounting for other dietary risk factors, high dietary fiber intake was not associated with a reduced risk of colorectal cancer."

is from 2012, and concluded with "Our results strengthen the evidence for the role of high dietary fibre intake in colorectal cancer prevention."

It is not reasonable to cite the above to conclude the Lifestyle section with "Although some studies do not support a benefit from fiber", when the WHO concluded with , which is also more recent.

Also, actually DID find an inverse association, but it was only removed after "accounting for other dietary risk factors".

In https://en.wikipedia.org/search/?title=Colorectal_cancer&oldid=865717987#Lifestyle, which Doc James deleted, there is a similar pattern of an earlier, smaller, study that failed to show association, but a later report did show association (as also shown in the 2018 study Doc James cited). — Preceding unsigned comment added by 24.8.207.91 (talk • contribs) 03:09, 26 October 2018 (UTC)

Yah the 2018 meta analysis I added shows potential benefit from fiber. Doc James (talk · contribs · email) 17:59, 26 October 2018 (UTC)
But than we have the NCI from March 2018 that states "There is no reliable evidence that a diet started in adulthood that is low in fat and meat and high in fiber, fruits, and vegetables reduces the risk of CRC by a clinically important degree."
Our job is to summarize major positions.Doc James (talk · contribs · email) 19:21, 26 October 2018 (UTC)
agree w/ Doc James comments above--Ozzie10aaaa (talk) 20:38, 26 October 2018 (UTC)
NCI is seriously outdated. Instead of relying on "Overview", need to go to the "Description of Evidence" section to find out how old their references are. Also, the year 2000 study they cited is about recurrence, not in general (e.g., new incidence). This very very old and limited reference certainly should not conclude the paragraph.
There is a repeated pattern in which earlier studies showed no association, but later studies did. It is very important that people stop merely citing the first part of a sentence, or merely the first sentence of a paragraph. Must look at the entire sentence, or entire paragraph, so a reference is not misconstrued.
Yes, the World Cancer Report, which Doc James deleted despite the above, has been restored. — Preceding unsigned comment added by 24.8.207.91 (talk • contribs) 03:12, 27 October 2018 (UTC)
It is getting a little old. But sure we can update in 2019. Doc James (talk · contribs · email) 22:33, 27 October 2018 (UTC)

Shorten paragraph on fruits, fiber, etc

I don't know if it's time to say enough is enough. There are now 4 sentences conveying essentially the exact same message as in:

https://en.wikipedia.org/search/?title=Colorectal_cancer&oldid=865715475

before Doc James started to add and change references.

The message remains simple: "although older studies did not supported an association, more recent studies found a lower risk associated with higher fiber intake".

One can choose to cite the WCRF as before or the WHO, but the message remains the same.


It is also noted that one can pretty much find anything on the web, including from websites like PubMed or Sci-Hub. (And if one cites something not easily accessible, the presumption should be that the person is trying to hide something).

Our job is not to cite a bunch of sources, and we definitely should not cite sources partially to support a biased view. Rather, our job is to look carefully and present the best, most recent, information impartially and simply. — Preceding unsigned comment added by 24.8.207.91 (talk • contribs) 18:15, 27 October 2018 (UTC)

We have the NCI in 2018 who states "There is no reliable evidence that a diet started in adulthood that is low in fat and meat and high in fiber, fruits, and vegetables reduces the risk of CRC by a clinically important degree."
And the WCR from 2014 that says "A large protective role for total intake of fruits and vegetables against overall cancer risk now appears unlikely"
So no all the sources do not say "older studies do not support an association while newer ones do". What we have is some organization saying sure one can try a high fiber diet and a bunch of other organizations saying the evidence is poor and against a probable benefit. Doc James (talk · contribs · email) 18:31, 27 October 2018 (UTC)
Yes, the NCI in 2018 said that by citing a study from year 2000. Is that really a good reference? If anything, it agrees with WHO's first part of the sentence from the fiber section: "Several large prospective cohort studies of dietary fibre and colon cancer risk have not supported an association", citing a reference from 2005 (which is at least newer than 2000).
I was willing to forget about your clear error of misconstruing WHO's sentence from the fruits section. Yet you are bring it up again? This is getting old.
The WHO concluded the sentence about fiber by then stating: "although an inverse relation was seen in the large European Prospective Investigation into Cancer and Nutrition (EPIC) study and a recent meta-analysis", citing a study from 2012.
Similarly, Song and Chan also started by saying that it's inconsistent, but then concluded by saying "Nonetheless, based on existing evidence, the most recent expert report from the World Cancer Research Fund and American Institute for Cancer Research in 2017 concludes that that there is probable evidence."
Thanks for shortening the paragraph.

Simplify paragraph on dietary factors

I was able to identify things like 1970, meat consumption, fruits and vegetables, from the cited section. So I kept the first sentence.

However, I have read the pages a few times, but I am still not able to identify the next two sentences. The prospective studies were suggested by animal studies, and the recommendation was not based on animal studies. I simply could not find "retrospective observational studies" being discussed.

I also could not find where the WHO said the studies "have failed to demonstrate a significant protective effect". The WHO did discuss challenges faced by the studies, but then discussed conclusions (starting with "Despite the challenges").

Moreover, I couldn't find where the WHO said "it is uncertain whether any specific dietary interventions (outside of eating a healthy diet) will be proven to have significant protective effects".

Rather, the WHO specifically said: "Consumption of red meat, particularly processed red meat, is related to modestly higher risks, and of fruits and vegetables to modestly lower risks of some forms of cancer."

If you could please show us how the now deleted text came about, we can try to work it in. Thank you.

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