People with a family history of colon cancer carry the emotional burden of knowing they have twice the risk of developing the disease themselves. But now, a new study may ease some of their anxiety. Patients with a family history of colon cancer are also more likely to survive the disease.
The surprising paradox, published in Wednesday’s Journal of the American Medical Association, may ultimately steer researchers toward new treatments and a better understanding of the disease.
An estimated 153,000 cases of colon and rectal cancer will be diagnosed in 2008, according to the American Cancer Society, and about 50,000 people will die from the disease. Studies of twins show that about 35 percent of colon cancers are inherited, and about 11 percent of patients have at least two close relatives with the disease. An individual who has a first-degree relative with colorectal cancer faces about a 1 in 10 chance of being diagnosed with colon cancer, compared to 1 in 20 for those with no family history.
The latest study, conducted by researchers at the Dana-Farber Cancer Institute in Boston, followed 1,087 patients being treated for Stage III colon cancer, which means the cancer had spread to nearby lymph nodes but not to other organs. Of those patients, 195, or about 18 percent, had a parent or sibling with the disease. Those who had at least one close family member with colon cancer were 25 percent less likely to die from the disease during the 5.6 years of patient follow-up than those with no close relatives with colon cancer.
The risk of dying was even lower for those with two or more relatives with the disease. Those patients had a 51 percent lower risk for cancer recurrence or death.
“This news may be reassuring to people with a family history, but our hope is that we can discover what underlies this effect of family history in biological terms,” said the study’s first author, Dr. Jennifer Chan, from Dana-Farber’s Center for Gastrointestinal Oncology.
Why a person has a better prognosis if they have a family history of colon cancer isn’t clear. The scientists ruled out several explanations for the difference, including the possibility that people with a family risk for colon cancer have adopted healthier lifestyles or take part in additional screening. Dr. Chan said the researchers looked at important lifestyle factors like diet, exercise and smoking and found no association with improved survival. And because all the patients had stage III cancers, more frequent screening and an earlier diagnosis also couldn’t explain the difference.
However, there is other evidence that genetic factors play an important role in colon cancer prognosis. It’s known, for example, that colon cancer that develops as a result of a rare inherited condition called Lynch syndrome — also called hereditary nonpolyposis colorectal cancer — is less aggressive than the cancers found in patients with no genetic risk.
The study was paid for with grants from the National Cancer Institute and Pharmacia & Upjohn Co., now Pfizer Oncology.
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From 1 to 25 of 34 Comments
I am not a religious person; I cannot explain my reactions.
— edna laveyI am a triple survivor. When I had lymphoma, my dr. said “80% chance of recurrence.” I said”it is never coming back.” 22 yrs. ago.
Brest cancer 4 yrs. ago. 1 yr. after my husband died in 3 months. I was in deep mourning, and did not care. Bad carcinoma. Totally gone.
I am totally disabled from spinal disorder. Cancer never caused me pain. There was no battle - the drs. did it all.
Only possible conclusion: I believe that some people are natuarlly resistent to cancer, and the
basic surgeries and post-operatvive procedures are
sufficient. Other people succumb.
Jackie O, my husband,so many others-no way to fight.
Edna,
— MikeYou go girl!
Mike
Cancer like so many diseases can be cured. My husband was treated for colon cancer in 1991. After surgery, chemotherapy and radiation, he is still living a vital life 17 years later. Cancer is simply a diagnosis not a knell. Catherine Keating.
— catherine keatingYou are so right, comment #3.
— GSGHere’s my history :
1) Bladder cancer 19 years ago. Was told “chances of recurrence are high”. Never came back.
2) Thyroid cancer 3 years ago. Upon some very recent tests I was told that that chances of recurrence are “extremely low”.
I guess I was born to survive :-)
My father died in February [on my birthday] after a 1.5 year battle with colon cancer. It was a slow and terrible death. He was only 54 years-old and had all the prescribed colon cancer screenings. During his illness a significant family history of colon caner was “discovered.” I have since been worrying and trying to find out when I need to start screenings.
I am 24 years-old and have already survived a very rare, non-malignant, congenital brain tumor. This study gives me hope.
— Emily BarrettEmily, I would advise you to start screening now with an annual colonoscopy. You can also do a genetic test which, if negative, would mean you would only need to do the colonoscopy more rarely.
— to emilyTo #3: I’m glad that your husband is doing well, but please don’t belittle cancer. When my mother was diagnosed with stage III ovarian cancer too many people told me straight faced that she would be fine. Some were just trying to cheer me up, but many falsely believed that cancer is a disease we can cure. She died 3 years and 3 months to the day from initial surgery. Treatment has come a long way, but odds are that stage III ovarian cancer will kill within 5 years. Please don’t tell me that cancer can be cured.
— JaniceMy son died almost 2 years ago from metastatic colon cancer. Yes, it had spread to his bones and liver and possibly his lungs. He was 24 and battled the disease with great vengence. His original diagnosis was familial polyposis and that caused many many polyps in his colon. One of the polyps actually got to be the size of a grapefruit and there the cancer was found. He had a colonectomy 3 years before he died. He had no signs of cancer for 1 1/2 years after that. His life was good. My husband and I have had genetic testing to see if we were carriers. We have 4 other children and wanted to have some heads up. Neither one of us are carriers. My son was a mutation of the condition. We also encourage colonoscopys when appropriate. Stay well!!
— LaurieI have had 2 melanomas in the past 3 years. I am utterly convinced that the fear, depression, and stress that came with my divorce and figuring out how to be a single mom in a very isolated part of the country with literally no financial security were the cause. I am stronger now and have changed my circumstances considerably simply by getting myself out of such high stress conditions. I feel much more confident that, if faced with another cancer, I will be in better shape to fight. Stress is deadly. It could have killed me. Maybe these colon cancer survivors with a family history were better prepared (less stressed) because they were aware of what the future might hold having seen their family member’s struggle with the disease.
— Simone“Cancer” is a vague, non-specific term. As we all know it appears in many forms. Some are quick and deadly, some are slow to develop and relatively easy to deal with (or cure). One thing is clear-it is frightening to get any diagnosis of any type of cancer.
— Timothy FranklinI was diagnosed with colon cancer 3 years ago and underwent surgery. I was lucky as it hadn’t spread to the lymph nodes but I will say the diagnosis changed me. I spend little time thinking about the future. The present is all that matters and I’m better for having learned that.
simone; - u r unfortunately dead on. My late husband died at the age of 43 with a perfect health record prior to the misdiagnosed late one of stomach cancer. He was always under tremendous stress with a growing family, 2 businesses that literally required 24/7/365, and many personal and societal obligations that were charitable. Too much for one young man on such a grand scale. Stress needs to be addressed for what it is - a killer
— delilaI am a 20-year survivor of Colon cancer (I was 35). I lucked out when the company I worked for was closing and I went for a physical before I lost my health insurance. A good doctor picked up on the abdominal tumor by touch. I had surgery and chemo for a year and responded well.
— KevinMy brother died from colon cancer 4 years ago despite the knowledge of my history and his tremendous medical plans. He and his doctor decided that a sigmoidoscopy was an OK screening method. That only covers the lower colon. Both my cancer and his originated in the cecum area, which requires a colonoscopy to examine.
While he was alive we both talked with as many relatives as possible about screening and testing. This is a discussion every family needs to have especially after the first diagnosis. I know of at least 10 relatives who have had polyps removed and will follow-up with regular tests. When I was diagnosed the genetic link was not discussed and colon cancer was not publicized. My brother who was the most detail oriented person I know took responsibility for his failed diagnosis yet I carry the burden of his death in my heart. Every family member in every family diagnosed with colon cancer needs to talk about this. I am an example of the promise of treatment but also the heartache of my failure to follow up within my family. Every family member needs to pursue the correct screening methods and be an advocate for proper testing and screening.
I believe my cancer was slow growing and I did not follow up on earlier signs of my cancer. I was in my late 20’s and rejected the idea of a colonoscopy at that time despite an abdominal problem and a doctor’s desire to test further. This cancer is not a death sentence but rather a wake up call of our own mortality and chance to get closer to our families. I have spoken to more extended family members over the years and have gotten closer to all of them. I have gotten calls and e-mails from many of them after their tests and feel good afterward that they acted. Hopefully you will never know the guilt I feel when I think about my brother.
To the person with a personal history of brain cancer and family history of colon cancer….rare genetic syndromes can cause brain and colon cancers in a family. you should speak to your oncologist about whether or not you might be one of these people and whether genetic testing and screening is appropriate for you and other family members.
— Jerome Graber, MDMy grandmother died of intestinal cancer which had probably started as colon cancer. My father developed colon cancer at 72 and survived for another 12 years. Because of this history, I began having colonoscopies when I was forty and now have them every three years. I am aggressive about my diet. No wonder I might survive. I know what my risks are and am taking preventive action.
— Julia Bradford“Colon Cancer in Family Predicts Better Survival” has given us some guidance about colon cancer which was not expected.
1) Do nothing to improve actual primary prevention by changing to a healthier life style (See references #9 and 10 in the study that found the opposite before colon cancer diagnosis)
2) Do not bother to get more diagnostic tests after the first diagnosis (Some would argue that so-called “early” or “routine” detection tests efficacy have not been supported by independent scientific research to show that they actually improve outcomes or extend lives.)
3) Hope you do not get diagnosed with colon cancer
4) Hope that if you do, your parents and siblings [the more the merrier] got it first. (Does the order of diagnosis of each family member matter?)
5) Hope that this study, partially funded by a drug company, strikes genetic gold because 153,000 Americans are diagnosed with and 50,000 American still die each year because of colon cancer.
JAMA is recognized as a quality peer reviewed professional publication. What might the researchers and reviewers missed, if anything?
A review of the actual published study (found in today’s issue of JAMA) indicates that the origional study was amended so some participants were excluded from the evaluation of life style impact and some of the (to be) participants were dropped because they died within 90 days (standard research protocol) but which might have been important as the total numbers of participants and those with family histories in this study of colon cancer seem small. All studies can be criticized so these points might not be that important.
One criticism in general is that America is spending too much for after the fact diagnostic testing and ongoing treatment (minimally estimated at $4.59 billion for the people newly diagnosed with colon cancer each year excluding research projects) and not enough on research to identify and implement primary prevention techniques.
— healthinfoEmily - by all means get a colonoscopy and genetic testing. I have the same story … my beloved Dad died at age 54 after battling colon cancer for four years. I was a teenager at the time and watched him wither away, be tortured, then die weighing 86 pounds. It has effected me all my life. Being screened won’t make the pain of loss go away, but it will give you the peace of mind knowing you don’t have to unreasonably fear the same hideous end.
— Kimberly CoryatI wonder if this is because people with a family history are more vigilant about screening. Have they studied people who don’t know their family histories? I’m adopted, and have not been able to get any family medical history. If I had a family history of colon cancer, I wouldn’t know it - would the higher level of survival carry over to someone like me?
FROM TPP — It was screening. All the people in the study were diagnosed with the same level of Stage III cancer, so it was an issue of early diagnosis as a result of screening. It appears that genetic cancers are less aggressive.
— Karenthis is good news!
— Marjorie KobrinI was diagnosed with HNPCC (a genetic colon cancer) at the age of 27 (I’m female). Because of my general good health and youth, I was misdiagnosed two times. My father had colon cancer as well, and when I went to a self-referred gastroentologist, even he doubted my condition was serious, though he did think it reasonable to perform a colonoscopy. They found a golf-ball sized tumor in my rectum. I had aggressive chemotherapy and radiation, as well as participated in a clinical trial. By the time I had my resection, my cancer was stage I.
I’m 30 now, and am scheduled to have a colonoscopy every 2 years, assuming they find no polyps. I was told that if you have a family history, you should start getting tested 10 years before the youngest person with the disease was diagnosed. That means, if I have children, they will have to be screened at 18. If you have a history, please be aware, and if you don’t, please get screened at 50. Take care of yourselves everyone!
— AmyMy husband was diagnosed with Stage IIIa colon cancer this past January. It was discovered during a routine colonoscopy for his 50th birthday. He had no symptoms and was in good health. Both his surgeon and his best friend who is also a gastroenterologist shared that this routine procedure unquestionably saved his life. He had a colectomy with resection, and just finished round 7/12 of the Folfox regimen. We are priviliged to have the best of medical insurance and care. The inequity of our health care system is unjust and everyone should be entitled to the same level of care and preventative screening as we have received. There was no known family history of colon cancer.
— StaceyMy husband was diagnosed w/stage III colon cancer at age 25 after only 3 weeks of symptoms. He had experienced no prior weight loss, bowel changes, etc. until the first onset of belly discomfort and change in bowel habits. His primary tumor nearly obstructed the ascending colon near the cecum, and the rest of the right-sided and transverse colon were “speckled” with cancerous cells “like buckshot” (in the words of the surgeon.)
He died a year after diagnosis, after receiving chemotherapy and two resections. The cancer spread widely throughout his small bowel and the lymph nodes, but interestingly, never to his liver.
It was only near the end of my husband’s life that I learned that both of his uncles had died of colon CA. I was able to send the pathology from his tumor for further testing, and found that he did indeed have HNPCC.
I would not put much weight on this study. Just get the colonoscopy early, and often. Twenty of them would be a lot less gruesome and heartbreaking than the last year of my husband’s life.
— CarolynEmily, you’re describing something that sounds very much like Turcot Syndrome. My father-in-law died of brain cancer (glioblastoma) and had AFAP, a genetic condition that causes polyps and various other issues. My brother-in-law also has FAP and is currently fighting for his life. When colon and brain cancer present themselves in the same family, it might be Turcot Syndrome, which is something you can be tested for.
— Sarahwhat means of Studies of twins ? who can tell me?
— liFROM TPP — Twin studies are useful because twins have identical genetic makeup, so it’s a way to determine what health issues are purely genetic and which have an environmental/behavior/lifestyle influence. There is a large body of research using twin pairs.
One year ago my wife had a colonoscopy and one polyp found and removed (beneign). She hust had another and one polyp was removed and a biopsy taken of another polyp that is at the spot where the small and the large intestines join. (there is a flap ? there) That tested beneign also. The doctor recommends that my wife have surgery to remove that beneign polyp and cutting off a bit of the large and a bit off the small intestines, then rejoining them. Historically, my wife’s aunt had colon cancer and dealt with it off and on for 7 years. Our big concern is that the doctors always say “Cut” and then there is the risk of problems with the intestines afterwards. Why remove something by cutting away part of the intestines if it tested beneign? This is our concern right now. My daughter just emailed me that her father-inlaw had the same procedure and where rejoined, it was weak and he has had all kinds of problems. My wife just turned 70.
FROM TPP — You need to talk to your doctor about what kind of polyp this is and why this surgery is necessary. It sounds to me like this polyp can’t be fully removed because of its location. I also wonder what kind of polyp it is. This sounds like a situation where a second or even third opinion is warranted. I would also suggested going to an academic research center where people have a lot of experience.
Even though most colon polyps are benign, they are often removed since some may turn into colon cancer over time. There are four types of polyps that commonly occur in the colon.
Inflammatory - Often found in patients with ulcerative colitis or Crohn’s disease. These are not true polyps, but a reaction to chronic inflammation of the colon wall. They are not the type that turns to cancer.
Hyperplastic - Usually small and found in the rectum; considered to be low risk for cancer.
Tubular adenoma or adenomatous polyp: Most common type of polyp (about 70%). Adenomas carry a definite cancer risk which rises as the polyp grows larger. These grow slowly and may take years to turn into cancer.
Villous adenoma or tubulovillous adenoma: About 15% of polyps removed are of this type. This is a much more serious type of polyp that has a very high cancer risk as it grows larger. Often they are larger and not on a stem making removal more difficult.
— Jay Anthonymy family has a colon cancer its heredity my father and my brother suffer from colon cancer and i was undergo to coloscopy and they laser 2cm polyp .is there a possibility that i will suffer also to colon cancer.
— estrella castroFROM TPP — Everyone has a chance of developing colon cancer, but people with close family history have about a 1 in 10 chance. However, regular screening and polyp removal if necessary will dramatically improve your odds.