Judith M. E. Walsh

To determine the effect of raloxifene on colorectal cancer (CRC) risk. We analyzed data from the Multiple Outcomes of Raloxifene Evaluation (MORE) trial, a randomized, blinded clinical trial designed to determine the effect of raloxifene on vertebral fracture risk. In this trial, 7705 women received either raloxifene or placebo and were followed for an average of 3.4 years. CRC cases were classified as definite (pathology available), probable (imaging or colonoscopic diagnosis), or possible (self-report). Relative hazard for CRC was calculated using multivariate Cox proportional hazards models. Fifty cases of definite or probable CRC were diagnosed; 40 were definite and 10 probable. Twenty-nine cases occurred among the 5129 women in the raloxifene group, and 21 occurred among the 2576 women in the placebo group (p = 0.15). The relative hazard for CRC for women treated with raloxifene was 0.78 (95% CI 0.43, 1.43, p = 0.43). Restricting the analysis to definite CRC, the relative hazard was 0.77 (95% CI 0.39, 1.5, p = 0.45). Although the MORE trial was large, the number of CRC cases was too small to provide definitive evidence concerning the effect of raloxifene on CRC risk. There does not appear to be a substantial increased risk of CRC with raloxifene use. Studies including larger numbers of women and women at risk for CRC should further investigate the effect of raloxifene on CRC.

OBJECTIVE: To identify current colorectal cancer (CRC) screening practices and barriers to screening in the Latino, Vietnamese, and non-Latino white populations. METHODS: We conducted a telephone survey of Latino, non-Latino white, and Vietnamese individuals living in San Jose, California. We asked about demographics, CRC screening practices, intentions to be screened, and barriers and facilitators to screening. RESULTS: Seven hundred and seventy-five individuals (40% white, 29.2% Latino, and 30.8% Vietnamese) completed the survey (Response Rate 50%). Overall, 23% of respondents reported receipt of fecal occult blood test (FOBT) in the past year, 28% reported sigmoidoscopy (SIG) in the past 5 years, and 27% reported colonoscopy (COL) in the past 10 years. Screening rates were generally lower in Latinos and Vietnamese. Vietnamese were less likely than whites to have had SIG in the past 5 years (odds ratio [OR], 0.26; 95% confidence interval [CI], 0.09 to 0.72), but ethnicity was not an independent predictor of FOBT or COL. Only 22% of Vietnamese would find endoscopic tests uncomfortable compared with 79% of whites (P<.05). While 21% of Latinos would find performing an FOBT embarrassing, only 8% of whites and 3% of Vietnamese felt this way (P<.05). Vietnamese were more likely than whites to plan to have SIG in the next 5 years (OR, 2.24; 95% CI, 1.15 to 4.38), but ethnicity was not associated with planning to have FOBT or COL. CONCLUSIONS: Rates of CRC screening are lower in ethnic minority populations than in whites. Differences in attitudes and perceived barriers suggest that culturally tailored interventions to increase CRC screening will be useful in these populations

Screening for colorectal cancer reduces mortality in individuals aged 50 years or older. A number of screening tests, including fecal occult blood tests, sigmoidoscopy, double-contrast barium enema, and colonoscopy, are recommended by professional organizations for colorectal cancer screening, yet the rates of colorectal cancer screening remain low. Questions regarding the quality of evidence for each screening test, whether screening for individuals at higher risk should be modified, the availability of the tests, and cost-effectiveness are addressed. Many potential barriers to colorectal cancer screening exist for the patient and the physician. Strategies to increase compliance for colorectal cancer screening are proposed.

Review from JAMA — Colorectal Cancer Screening — Scientific Review — ContextScreening for colorectal cancer clearly reduces colorectal cancer mortality, yet many eligible adults remain unscreened. Several screening tests are available, and various professional organizations have differing recommendations on which screening test to use. Clinicians are challenged to ensure that eligible patients undergo colorectal cancer screening and to guide patients in choosing what tests to receive.ObjectiveTo critically assess the evidence for use of the available colorectal cancer screening tests, including fecal occult blood tests, sigmoidoscopy, colonoscopy, double-contrast barium enema, and newer tests, such as virtual colonoscopy and stool-based molecular screening.Data SourcesAll relevant English-language articles were identified using PubMed (January 1966-August 2002), published meta-analyses, reference lists of key articles, and expert consultation.Data ExtractionStudies that evaluated colorectal cancer screening in healthy individuals and assessed clinical outcomes were included. Evidence from randomized controlled trials was considered to be of highest quality, followed by observational evidence. Diagnostic accuracy studies were evaluated when randomized controlled trials and observational studies were not available or did not provide adequate evidence. Studies were excluded if they did not evaluate colorectal screening tests and if they did not evaluate average-risk individuals.Data SynthesisRandomized controlled trials have shown that fecal occult blood testing can reduce colorectal cancer incidence and mortality. Case-control studies have shown that sigmoidoscopy is associated with a reduction in mortality, and observational studies suggest colonoscopy is effective as well. Combining fecal occult blood testing and sigmoidoscopy may decrease mortality and can increase diagnostic yield.ConclusionThe recommendation that all men and women aged 50 years or older undergo screening for colorectal cancer is supported by a large body of direct and indirect evidence. At present, the available evidence does not currently support choosing one test over another.

Hyperlipidemia is a risk factor for coronary heart disease (CHD) in both men and women, although the association between total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and CHD risk differs in men and women. Although several clinical trials of lipid lowering for both primary and secondary prevention of CHD have been conducted, women have not always been included, have been included in small numbers, or have not had their results analyzed separately. CHD risk assessment is an important component of decision making about screening and treatment of hyperlipidemia. This article presents guidelines for screening and treatment of hyperlipidemia in women with CHD, in healthy women, and in women at risk for CHD.