The student nurse is participating in a colorectal cancer screening program. Which patient has the fewest risk factors for colon cancer?
A. Janice, a 45 y.o. with a 25-year history of ulcerative colitis.
B. George, a 50 y.o. whose father died of colon cancer.
C. Herman, a 60 y.o. who follows a low-fat, high-fiber diet.
D. Sissy, a 72 y.o. with a history of breast cancer.
Correct Answer: C. Herman, a 60 y.o. who follows a low-fat, high-fiber diet.
Large population studies with variable strength evidence have found CRC protective factors such as physical activity, diet (fruits and vegetables, fiber, resistant starch, fish), vitamin supplements (folate, folic acid, pyridoxine B6, calcium, vitamin D, magnesium), garlic and coffee, and drugs [aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), hormonal replacement therapy in postmenopausal, statins, bisphosphonate and angiotensin inhibitors].
Option A: Inflammatory bowel disease (IBD), mainly ulcerative colitis, has a well-known association with Cca, with an estimated incidence 0.5% per year between 10 and 20 years after the time of IBD diagnosis and 1% per year after that reaching a 30% risk probability by the fourth decade of patients with pancolitis.
Option B: Personal or family history of CRC, adenomatous polyps, and polyps with villous or tubulovillous dysplasia indicate a high risk for synchronous and metachronous CRC primary cancer up to 3% to 5% at 5 years or even longer after resection requiring a closer screening interval.
Option D: Colon cancer (Cca) could present as sporadic (70%), familial clustering (20%), and inherited syndromes (10%). Sporadic Cca average age diagnosis is older than 50 years and mostly linked to environmental factors, different from a minority of patients with a true inherited pattern that carries a higher risk at a younger age (younger than 50 years), and the remaining 20% are familial clustering in the absence of identifiable inherited syndrome.
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