The figures mean that on average, a new cancer patient was being diagnosed in the country every 7 minutes, 10 seconds in 2006, up slightly from the average of 7 minutes, 38 seconds in 2005, when 68,907 new cases were recorded, according to Chao Kun-yu, deputy chief of the DOH’s Bureau of Health Promotion.

The report showed that for the first time, colorectal cancer replaced liver cancer as the most common type among new cases recorded in a single year.

Compared with 2005, the number of new colorectal cancer cases rose by 644 to 10,248 in 2006, and liver cancer or intrahepatic bile duct cancer was found among 10,092 people – a jump of 176 cases.

Chao attributed the increased prevalence of colorectal cancer among Taiwanese to increasingly unhealthy dietary habits, such as high consumption of red meat and fat and low fiber intake.

Although people between ages 50 and 69 are advised to have fecal occult blood tests every two years to help early diagnosis of colorectal cancer, DOH statistics indicate that only 11 percent of that age group received the tests in 2008 or 2007, he said.

The third highest number of new cases in 2006 were cancers of the lung, trachea or bronchus, totalling 8,748, followed by breast cancer among women, 6,895 cases; and cancer of the mouth, oropharynx or hypopharynx, 5,352 cases, according to the report.

Rounding out the list of top 10 most common types of cancer in 2006 were stomach cancer, with 3,794 new cases; prostate cancer, with 3,073 new cases; skin cancer, with 2,457 new cases; cervical cancer, with 1,828 new cases; and uterine cancer, with 1,159 new cases.

In terms of age-adjusted incidence rate, an average 50 per 100,000 women were diagnosed with breast cancer in 2006; 37.44 per 100,000 people were diagnosed with cancer of the liver or intrahepatic bile duct cancer; and 37.35 per 100,000 people were found to have colorectal cancer.

The report revealed that in Taiwan, the risk of cancer among men was 1.4 times higher than among women.

Because of an almost exclusively male habit of chewing betel nuts, the age-adjusted incidence rates of esophageal cancer and oral cancer among men were 15.6 times to 10.4 times higher than among women in 2006, the report stated.

However, women were found to develop cancer at an earlier age than men, with the median age at diagnosis being 59 among women and 65 among men.

Colorectal cancer most common:

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The so-called Million Women Study of middle-aged women in the United Kingdom found that low to moderate consumption of alcohol increased the risk of and might be responsible for 13 percent of breast, liver, rectal and certain digestive tract cancers.

Researchers determined that only one glass of wine a night might raise the risk of cancer in women.

While prior studies indicated that moderate alcohol consumption could be good for heart health, it now appears that cancer risks from consumption may outweigh the possible cardiovascular benefits.

Oncologists endorsed the findings saying that they had promoted a healthy lifestyle for some time as primary means of reducing cancer risk.

According to the Million Women Study, for every additional drink regularly consumed per day, the increase in incidence up to age 75 years per 1000 for women in developed countries is estimated to be about 15 excess cancers per 1000 women up to age 75.

Million Woman Study Links Alcohol Use to Cancer in Women

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The procedure does a good job of detecting early signs of disease on the left side of the colon, or large intestine, but is not as effective at spotting potential problems of the right side of the organ. This means a colonoscopy’s success at preventing colorectal cancer deaths seems to lie with its ability to uncover so-called “left-sided” problems.

“We did find that colonoscopies are effective — that’s the good news. It’s still one of the best screening tests for any cancer that we have,” said study author Dr. Nancy Baxter, a colorectal surgeon with St. Michael’s Hospital in Toronto.

“But it’s not perfect,” she added. “And it does not appear to be as effective in picking up growths on the right side of the colon as it is in detecting them on the left side.”

The findings are published online Dec. 16 in the Annals of Internal Medicine.

The American Cancer Society says colorectal cancer is the third most common cancer found in men and women in the United States. There will be about 108,070 new cases of colon cancer this year; combined will rectal cancer, there will be nearly 50,000 deaths.

To gauge the effectiveness of colonoscopies at reducing colorectal cancer death, the researchers analyzed Ontario provincial health records for more than 10,000 colorectal cancer patients between the ages of 52 and 90. All the patients had been diagnosed with colorectal cancer between 1996 and 2001, and all had eventually died from the disease by 2003.

Slightly more than 700 of the cancer patients — or 7 percent — had undergone a colonoscopy. This pool was compared with just over 5,000 healthy people who also had undergone a colonoscopy.

The researchers found that having a complete colonoscopy was strongly linked to a lower death rate related specifically to colon cancer on the left side of the organ. But, the screening process showed virtually no death-prevention benefit with right-sided colon cancer.

Both findings applied equally across gender and age.

In an accompanying editorial in the journal, Dr. David F. Ransohoff, a professor of cancer epidemiology at the University of North Carolina, suggested that the mortality risk reduction offered by colonoscopies is probably closer to 60 percent to 70 percent, rather than the 90 percent figure typically cited.

Baxter said there are probably several factors that contribute to the left side/right side discrepancy.

“For example, there are differences in how polyps grow,” Baxter said. “They tend to be flatter on the right side, which is harder to pick up and harder to take out when you find them.”

“But the overall quality of colonoscopies is improving,” she added. “And, meanwhile, there are some things that patients can do to improve pick up on the right side, such as complying well with their preparations. Many do already, but many kind of give up after part of the preparation is done. So, there are a lot of people who don’t get through 100 percent of the prep. And I think it’s important that they do so.”

Dr. Judith Collins, section chief of gastroenterology at the VA Medical Center in Portland, Ore., said that despite the apparent limitations highlighted in the new study, colonoscopies are still the gold standard for detection of colorectal cancer.

“This is a totally preventable cancer,” she said. “So whether screening for it results in a 60 percent reduction in death or 90 percent reduction, there’s just no other cancer that we can see this well, and colonoscopy certainly reduces mortality. And that’s the bottom line. There are a lot of variables that show that it is not a perfect test, but it’s still a very good test.”

washingtonpost.com

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The Canadian province of Ontario has one of the world’s highest rates of colorectal cancer, according to the provincial health ministry, and it’s the second deadliest cancer in the province. The disease has a 90-percent cure rate when caught during its early stages but because the cancer is often asymptomatic until it is further progressed, it can be missed.

About 40 percent of the 20,000 Ontarians diagnosed with colon cancer each year will die, said Dr. Philip Branton, scientific director of the Canadian Health Research Institute, in a release. The disease is also often lethal in the United States, where there are an estimated 150,000 new cases of colon and rectal cancer each year and 50,000 deaths, according to the National Cancer Institute.

The Ontario provincial government recently began promoting home fecal occult tests, a screening tool that tests for blood in the stool, an early but often missed symptom of colorectal cancer. A similar screening program introduced in parts of the UK halved the number of hospital admissions and deaths from colon cancer in those areas within five years, a study published in the journal Gut showed. And last week, researchers detailed in the British Medical Journal how a national Finnish colon cancer screening program involving fecal analysis caught 40 percent of colon cancers early.

The term colorectal cancer refers to both cancer of the colon and cancer of the rectum. It’s the third most common cancer in the United States. According to the Canadian Cancer Society, symptoms include changes in bowel habits, bright red or very dark blood in the stool, diarrhea or constipation, narrowed stools, abdominal discomfort, unexplained weight loss, exhaustion and vomiting.

The death rate from colorectal cancer has been dropping over the past few years, partly due to a decrease in the number of cases, according to the American Cancer Society, but also because of the growing use of screening programs that help to catch the disease early.

Fecal occult tests can be self-administered at home. It involves collecting a small stool sample on three different days and testing for the presence of blood. Blood in the stool does not usually mean that you have cancer – only about 10 percent of people with a positive fecal occult test are later found to have colorectal cancer, according to Ontario’s Ministry of Health and Long-Term Care. But it is one of the symptoms, and the fecal occult test can detect the presence of blood before it’s visible to the eye.

If the test detects blood in the stool, a follow-up test like a colonoscopy is used to check for colon polyps, or growths, or cancer. The exam is recommended biannually for those over 50, or for those with an increased risk of colon cancer, such as people with a first-degree relative who has had the disease or who have had a fecal occult test come back positive. Studies have shown that the death rate from colorectal cancer is reduced by 16 percent over a decade when colonoscopies are done every two years, according to Ontario’s provincial health ministry.

Reuters

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The finding provides part of the answer to a big question: What triggers colon cancer?

To get at this question, Boris Pasche, MD, PhD, and colleagues followed a trail of clues that implicates adiponectin, a hormone made only by fat cells.

* Colon cancer cells have more adiponectin receptors than do normal gut cells.
* People with the highest adiponectin levels have a 47% lower risk of colon cancer than do people with the lowest adiponectin levels.
* Obese people have decreased adiponectin levels.
* Obese people have an increased risk of colon cancer.

The researchers looked at five common variants of the adiponectin gene and five common variants of the gene for the adiponectin receptor.

They first analyzed adiponectin genes from about 1,100 people of Ashkenazi Jewish ancestry, including 441 colon cancer patients. This population is at particularly high risk of colon cancer. Three adiponectin gene variants, and one adiponectin receptor gene variant, affected colon cancer risk.

The researchers then analyzed the same gene variants in 199 colon cancer patients and 199 matched controls in mixed-ethnicity Chicago-area residents. Only one variant of the adiponectin gene was linked to colon cancer, but it was the same as one of the variants in the first study and reduced the risk of colon cancer by the same amount.

When the studies were combined, the gene variant cut colon cancer by 27%.

“Now, for the first time, we see a gene in these fat cells is linked to colon cancer,” Pasche says.

Evadnie Rampersaud, PhD, research assistant professor at the University of Miami’s Institute for Human Genomics, says it’s an important finding. Rampersaud was not involved in the Pasche study.

“What is unique is this is the first time anybody has identified a genetic variation, a location within the adiponectin gene, that they can link to colon cancer,” Rampersaud tells WebMD. “That is pretty amazing.”

What excites Pasche and Rampersaud isn’t the specific gene variant linked to colon cancer. What’s much more interesting is that this variant points to a specific region of the adiponectin gene that affects colon cancer — and, very likely, other types of cancer as well.

“This opens the door for more research,” Pasche says.

Fat Gene Linked to Colon Cancer

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The findings implicate CDK8, a protein that regulates gene expression in the proliferation of colorectal cancer, the researchers found.

Should the results be validated, they could lead to new therapeutic approaches for colon cancer, as well as new screening and chemopreventative strategies, said Dr. Durado Brooks, director of prostate and colorectal cancer at the American Cancer Society.

“I think it is important work,” Brooks said. “They have identified what apparently is an oncogene associated with some colorectal cancers.”

Dr. William Hahn, of the Dana-Farber Cancer Institute in Boston, and his colleagues screened human colon cancer cells for genes that met three criteria: They were required for cellular proliferation, critical to regulating the WNT/beta-catenin signaling pathway known to be involved in the bulk of colon cancer cases, and also genetically amplified in cancerous cells.

“When we did that, we found one gene that fulfilled all three criteria, and that is CDK8,” Hahn said.

The results were published in the Sept. 14 issue of Nature.

CDK8 is a member of the so-called mediator complex, which bridges distant protein complexes to activate expression of certain genes.

According to Hahn, the study has two take-home messages.

The first, he said, is the apparent prevalence of colorectal tumors with elevated CDK8. Of the 50 tumors that Hahn and his team analyzed, 31 (62 percent) displayed evidence of CDK8 gene amplification — that is, the tumors contained more than the normal two copies of the gene, which usually leads to higher levels of protein expression.

“This is surprising in the sense that it occurs in a large percentage of colon cancers, and we didn’t know about it,” he said.

The second message involves the potential pharmacologic benefits of these results. CDK8 is a type of protein known as a kinase. Kinases are enzymes that catalyze the transfer of phosphate groups from one molecule to another. That action is like flipping a molecular switch, causing the recipient protein to turn on or off. It turns out that kinases tend to play key roles in the biochemical pathways that often go haywire in cancer, so they are popular targets for drug developers.

“There’s a reasonable likelihood, though it hasn’t happened yet, that one could develop a drug that targets this protein in colon cancer,” he said, “and you could determine which colon cancer patients are likely to benefit.”

That’s because Hahn and his team showed, using a genetic technique called RNA interference, that knocking down CDK8 protein levels in cancer cells that normally contain elevated CDK8 levels, reduced cell proliferation. That effect was less pronounced in cells containing lower levels of CDK8.

So, those tumors with elevated CDK8 levels might make good candidates for novel drug therapies directed at the enzyme, Hahn said.

“This fits into an emerging concept in cancer treatment,” he explained. “Not only do we develop better therapies, but hand-in-hand, we want to find which patients will respond to therapy, rather than giving it to everyone and hoping they will respond.”

Brooks agreed that CDK8 is a potential drug target. He noted other potential benefits, too, such as possibly being able to identify those at elevated risk of developing colorectal cancer, or identifying those who should be screened earlier and more comprehensively. It may even be possible to develop chemopreventative compounds that could diminish the risk of developing cancer in the first place.

“But we are at the very beginning of that pathway,” Brooks added. “All they have shown is this oncogene seems to be associated with a significant number of cancer specimens…. But translating that to, number one, how broadly this occurs in the broader community of colorectal cancer, and also in the general patient population, and then next, how can we use this information, we are at the very beginning of that process.”

In another report in this week’s online issue of Nature Genetics, researchers from Iceland said that they have found a genetic variant associated with increased risk of urinary bladder cancer.

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Nearly one third of all colon cancers diagnosed over an 18-year period were attributed to a BMI greater than 22.5, Dr. Lau Caspar Thygesen and fellow researchers report in the International Journal of Cancer for September.

Although overweight and obesity are consistently identified as risk factors for colon cancer, findings with regard to weight change in later life have been contradictory, the researchers note. They assume that, because of its “purely prospective weight information,” long follow-up, repeated assessments, and adjustment for confounders, the current analysis is less subject to misclassification.

The cohort included 46,349 men aged 40-75 years without cancer or ulcerative colitis at enrollment in 1986. Information on medical history, lifestyle factors, weight, and diet was updated every 2-4 years until 2004.

“Cumulative mean BMI above 22.5 was associated with significantly increased risk of colon cancer compared to BMI of 20-22.5,” Dr. Thygesen, at Denmark’s National Institute of Public Health in Copenhagen, and his associates report.

Compared with this reference, the risk was more than doubled among those with a BMI greater than 30 (multivariate adjusted hazard ratio 2.29).

To minimize bias caused by weight loss due to undiagnosed cancer, the authors examined latency time between updated weight change and colon cancer risk by lagging the follow-up by 2-4 years.

Thus, they estimate that for every 10 pounds gained in the prior 2-4 years, the risk increased by 14% (p = 0.04 for overall trend). Similarly, for every 10 pounds of weight gained per 10 years since age 21, the risk increased by 33% (p = 0.001).

By contrast, weight at age 21 was not associated with risk.

These findings, the investigators conclude, “support public health interventions to avoid weight gain for prevention of colon cancer.”

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"The risk of second cancer after irradiation, although probably small, needs nevertheless to be carefully monitored," the study team advises.

Dr. Christine Bouchardy from the University of Geneva, Switzerland and colleagues analyzed data on 1,134 men diagnosed with prostate cancer between 1980 and 1998 who survived for at least 5 years after diagnosis. Of these, 264 were treated with external radiation.

During follow-up through the end of 2003, 19 men out of the total group developed colorectal cancer.

The risk of colorectal cancer among the men who did not have radiation therapy was not increased compared to the general population, but it was 3.4-times higher than normal among the men who did have radiation, the team reports in the International Journal of Cancer.

On further analysis, the risk was significantly increased for colon cancer specifically but not for rectal cancer.

The risk of colon cancer was mainly elevated in the 5- to 9-year period after diagnosis, according to Bouchardy and colleagues.

They say "this serious long-term side effect should be discussed" with patients in weighing the pros and cons of radiation therapy for treating prostate cancer.

SOURCE: International Journal of Cancer, September 1, 2008.

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