UAB plays role in colon cancer testing that cuts deaths by 26% | al.com

BIRMINGHAM, Alabama -- A national study that involved UAB researchers and about 6,100 Alabama volunteers found that screening for colorectal cancer by a procedure less invasive than colonoscopy can reduce cancer incidence by 21 percent and death by 26 percent.

The study and an editorial about its significance were both published Monday in the New England Journal of Medicine.

Colorectal cancer is the second-leading cause of cancer deaths in the United States. Increasing the number of screenings for the cancer in people 55 and older could reduce those deaths.

One way to screen is a colonoscopy, which requires bowel cleansing and anesthesia for the patient, and a medical specialist who examines the entire four-foot length of the colon with an endoscope. A procedure called flexible sigmoidoscopy examines only the lower part of the colon -- the 18-inch sigmoid colon -- with an endoscope, but it can be done by a nurse practitioner or primary care doctor, and only requires the patient to have an enema.

Researchers didn't expect this less-invasive procedure -- which some have said is like doing mammography on just one breast -- to have such benefits, said Dr. Mona Fouad, who is director of the University of Alabama at Birmingham's division of preventive medicine and one of the authors in Monday's study.

"It's effective, cheaper and easier," said Fouad. "Our message is to encourage people to get screening, and any screening is better than none."

Both procedures can reduce cancer by detecting the growth of precancerous polyps.

UAB won the competition to be one of 10 sites in this massive study because of its ability to enroll blacks as participants, said Fouad, who also directs UAB's Minority Heath & Health Disparities Research Center. Half of the volunteer participants enrolled by UAB were black, and many of those were from the rural counties of Alabama's Black Belt, which is named for its soil.

The 6,100 participants from Alabama were about 4 percent of the 155,900 people from across the nation who enrolled in the study, which followed participants for nearly 15 years. But the blacks who volunteered for the UAB screenings made up about 40 percent of all the blacks in the national study. Participants ranged from 55 to 74 years old.

UAB's participation in the study has brought in nearly $19 million of funding, Fouad said. When participants were scheduled to be seen, UAB would send a van to the Black Belt and bring six or eight people at a time to the research clinic in the Medical Towers building near Five Points South. All of the flexible sigmoidoscopies at UAB were done by a nurse practitioner who was trained and supervised by a UAB gastroenterologist.

Screening crucial

Screening can find cancer before it reaches a late stage, when the risk of death is much higher. One of the goals of UAB's Comprehensive Cancer Center is increased education and awareness of cancer among minority and underserved populations.

In the national study -- which also looked at prostate, lung and ovarian cancer screening -- half of the participants had a flexible sigmoidoscopy, with a repeat screening after three or five years. The other half received their usual care. Everyone was then followed for an average of 12 years to see if they got colorectal cancer or died from it. Twenty-five researchers, including Fouad, are co-authors of Monday's report.

Besides the cost of a colonoscopy, some people avoid the procedure because of the time it takes and the unpleasant bowel cleansing procedure the day before the test.

In his editorial on Monday, Dr. John Inadomi said that "significantly fewer persons with a recommendation for a colonoscopy chose to undergo screening than did persons with a recommendation for alternative screening strategies."

Even though the flexible sigmoidoscopy does not examine all of the colon, "the best test," wrote Inadomi, "is the one that gets done."

Join the conversation by clicking to comment or email Hansen at jhansen@bhamnews.com.

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