Evidence-based Counseling
for GI Malignancy Risk
Reduction
Mark Y. Liu, DO, FAAFP
Tripler Army Medical Center
Honolulu, Hawaii
The views expressed in this presentation are those of the author and do not reflect the official
policy or position of the Department of the Army, Department of Defense, or the US
Government.
Aloha!
6 Million cans of Spam/year
Highest Life Expectancy in the U.S = 80
Case Study
 Ashley, a 48 year-old woman, just learned
that her 70 year-old father has inoperable
gastric cancer. She wants to know if she is at
risk of developing gastric cancer because she
grew up eating the same smoked meats her
father ate. Ashley also asks what she can do
to lower her risk of developing this cancer.
She has heard that calcium supplements
might help prevent gastrointestinal cancers
and ask whether she should begin taking a
calcium supplement.
Background
140,000 + develop GI cancers each
year
49,000 die
9% of all cancer mortalities
Screening and avoidance of risk
factors
I. Lifestyle Risk Factors
Lifestyle factors
2 Major longitudinal studies
 Participants with 4 healthful lifestyle
factors, had 1/3 the risk of developing
cancer
Obesity, smoking, poor diet,
physical inactivity
1. Obesity
65% overweight, 30% obese
Increases CRC, pancreatic and
esophageal CAs
Etiology of 20% of all cancers
Weight reduction leads to 60% less
cancer mortality
2. Smoking
Implicated in 30% of all cancerrelated mortalities
Oral cavity, esophagus, pancreas,
liver, stomach and colon
All forms of tobacco
Conversely, smoking cessation
reduces risk
3. Diet
Red Meat
•Colon
Charred Meat
Fried
BBQ
•Colon
•Pancreas
High Fat
•Esophageal
•Gastric
•Pancreas
•Colon
High-salt content Fruits & Veggies
Hot drinks
Preserved foods
Dairy products
Coffee
Processed foods Calcium & Fiber
•Gastric
•Decreases all GI •Inconclusive
cancer risks
4. Physical Inactivity
Physical Activity
GI CA risks
 3.5 hours/week of moderate exercise = 24% reduction
of CRC risk
 Theories:
Hormones;
Immune function;
Growth Factors
Prostaglandin
Extra: Alcohol Consumption
1 Drink (10g) increases risk of
cancers of:
 Oropharynx
 Esophagus
 Rectum
Poorly understood
Solvent properties?
II. Heredity
Heredity vs. diet/lifestyle
Cancer Type
Hereditary
Syndrome
Lifetime Risk
Esophageal
None proven
NA
Gastric
Hereditary diffuse
gastric cancer
40% to 67% in men
Up to 83% in
women
Pancreatic
Hereditary
pancreatitis
44% to 75%
Colorectal
FAP
HNCC (Lynch)
20% to 40%
III. Infections
Helicobacter pylori – Gastric CA
Epstein-Barr virus – Gastric CA
Human papillomavirus –
Esophageal CA
JC polymavirus – Colon CA
Chemoprevention
Aspirin
 Anti-inflammatory properties
 2007 USPSTF Recommendation
 2011 meta-analysis of 8 trials
 Reduces risks for esophageal, gastric,
pancreatic and colorectal cancers
 50% reduction of CRC mortalities after 5 years
 No dosage difference
Chemoprevention
Vitamin and Mineral
Supplementation
 Vitamin D, calcium & magnesium
 Strongest evidence for calcium –
lowers CRC
 ACG recommends 3 g/day
Recommendations
Lifestyle counseling
Inquire family history
Rule out infections
Discuss role of chemoprevention
Case Revisited
 You inform Ashley that there is association
between gastric cancer and diet
 You obtain a detailed family history to exclude
hereditary syndromes
 You order a test for H. pylori infection
 You recommend regular use of low-dose ASA
 You recommend calcium supplementation for
chemoprevention and bone health
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