A future where no Australian dies of colorectal cancer

So how do we get there?

As colorectal neoplasia progresses from polyps (stage 0), to early (stage I & II), and then advanced CRC (stage III & IV), our patients require increasing levels of care and have a poorer survival (Fig 1)¹.

There are three steps to reduce the number of Australians dying of CRC.

Step 1: Reduce colorectal neoplasia from developing

Modifiable ‘lifestyle’ factors, have a significant impact on bowel cancer risk. About 50% of patients with CRC have a preventable risk factor.^2-4

There is strong evidence that the following will reduce the development of CRC^3,4:

• increasing physical activity, dietary fibre, wholegrains, dairy and calcium
• reducing processed meat, alcohol, body mass index, red meat and smoking.

At Colonoscopy Clinic, we have dietetics support should you or your patients be interested in reducing the risk of CRC through diet and lifestyle. Aspirin also prevents the development of CRC and is clinically valuable particularly for patients with a high risk of CRC or in those with other indications for aspirin⁴.

Several studies suggest that coffee consumption also reduces the risk of developing, or dying from, CRC^5,6. Phew!

Step 2: Find CRC as early as possible

GPs have a major role in advocating for their patients that are 50 years and older to participate in the National Bowel Cancer Screening Program (NBCSP)⁷. The NBCSP saves lives and saves money⁸. But, screening should actually start privately with biennial iFOBT screening from 45 years of age⁴. Patients with a family history of CRC, or past polyps, or symptoms all need attention and possibly a colonoscopy⁴.

At Colonoscopy Clinic we ensure that all patients receive a Convenient, Affordable (bulk billed), Reliable and Excellent service. As proof, please review our recent articles in the Medical Journal of Australia that highlight Colonoscopy Clinic’s committment to patient C.A.R.E^9,10.

Step 3: Improve survival in advanced disease

When we diagnose patients with colorectal neoplasia, we usually find polyps or early stage CRC that can be cured. But, more than 4000 Australians die of CRC every year¹.

Whenever, we diagnose more advanced disease we support our patients through their journey. We carefully coordinate any necessary investigations, surgical management and refer to any other necessary specialists, in liaison with the patient’s GP.

There is, however, also a need for better ways to treat advanced colorectal cancer. Our team is involved in ground breaking research to improve survival in patients with metastatic CRC^11,12. CRC research and continuous improvement is integral to our practice and our practitioners.

Please contact us if we can ever be of service.

References (our doctors are highlighted)

1. Australian Institute of Health and Welfare 2021. Cancer data in Australia. Cat. no. CAN 122. Canberra: AIHW. Viewed 26 August 2021, https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia
2. Whiteman DC, et al. Cancers in Australia in 2010 attributable to modifiable factors: summary and conclusions. Aust N Z J Public Health 2015;39(5):477-84
3. World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Report: Diet, Nutrition, Physical Activity and Colorectal Cancer. WCRF/ACIR; 2018 Available from: https://www.wcrf.org/sites/default/files/Colorectal-cancer-report.pdf. Available at dietandcancerreport.org
4. Cancer Council Australia Colorectal Cancer Guidelines Working Party. Clinical practice guidelines for the prevention, early detection and management of colorectal cancer. Sydney: Cancer Council Australia. [Version URL: https://wiki.cancer.org.au/australiawiki/index.php?oldid=213460, cited 2021 Aug 26]. Available from: https://wiki.cancer.org.au/australia/Guidelines:Colorectal_cancer
5. Grosso G, et al. Coffee, Caffeine, and Health Outcomes: An Umbrella Review. Annu Rev Nutr. 2017;37:131-156.
6. Hu Y, et al. Association Between Coffee Intake After Diagnosis of Colorectal Cancer and Reduced Mortality. Gastroenterology. 2018;154(4):916-926.
7. Cole S, et al. Participation in screening for colorectal cancer based on a faecal occult blood test is improved by endorsement by the primary care practitioner. J Med Screen. 2002;9:147–52.
8. Worthington J, … Worthley DL, Miller C, Canfell K. Improving Australian National Bowel Cancer Screening Program outcomes through increased participation and cost-effective investment. PLoS One. 2020;15(2):e0227899.
9. Lee See M, Lee A, Roberts R, Friedman RA, Hewett DG, Worthley DL. The clinical value of “exception item” colonoscopy (MBS item 32228). Med J Aust In press.
10. Bampton P, Sammour T, Brown GJ, Hewett DG, Worthley DL. The three A’s of colonoscopy referral. Med J Aust. 2018 Nov 19;209(10):461-462.
11. Kobayashi H, …, Worthley DL*, Woods SL*. The Balance of Stromal BMP Signaling Mediated by GREM1 and ISLR Drives Colorectal Carcinogenesis. Gastroenterology. 2021 Mar;160(4):1224-1239.
12. Narasimhan V, … Worthley DL*, Ramsay RG*, Woods SL*. Medium-throughput Drug Screening of Patient-derived Organoids from Colorectal Peritoneal Metastases to Direct Personalized Therapy. Clin Cancer Res. 2020;26(14):3662-3670.