Colorectal Cancer Trends in Maryland: A Conversation with Dr. Ralph V. Boccia

As the third most common cancer in the United States, colorectal cancer (CRC) affects about 1 in 20 Americans. However, incidence and death rates for cancer of the colorectum have significantly decreased over the past several decades as a result of increased screening and drastic improvements in treatment. In Maryland alone, approximately 70% of adults over the age of 50 have an up-to-date colorectal cancer screening, helping contribute to the reduction in mortality rates.

Dr. Ralph V. Boccia, an oncology and hematology specialist at Regional Cancer Care Associates (RCCA) in Bethesda and Germantown, Maryland says, “The more colorectal screening we have and the earlier it gets started, the lower the stage that the cancer is typically picked up.” In turn, early detection has led to the state’s lower mortality rates over time.

The Benefits Of Increased Screening

According to Dr. Boccia, improving screening rates “affects the stage at which the cancer presents itself and [the patient’s] potential for survival.” Between 2002 and 2010, the percentage of Maryland adults with up-to-date colorectal cancer screenings increased from 64% to 71%. As a result, CRC mortality rates in Maryland decreased considerably among both men and women in that eight-year timeframe. Dr. Boccia explains, “The trend we’ve actually seen – which is that more people are being screened – has resulted in more improvements of overall survival in patients with colorectal cancer.”

However, as colon cancer rates decline in adults 50 years and older, both incidence and death rates are increasing in the under-50 population. “We’re seeing a scary trend of younger patients getting colorectal cancer,” remarks Dr. Boccia, “even down into the 20s.” However, at this point in time, there’s insufficient data to clearly identify the causation behind this trend.

Colorectal Cancer Risk Factors

According to a report from the Maryland Department of Health and Mental Hygiene, the incidence rate of colon cancer per 100,000 people in Maryland was 1,174 for men and 1,109 for women in 2012. When looking at new cases of CRC, research shows that incidence may be tied to habits and lifestyles. Among these lifestyle- associated risk factors are being overweight or obese, lack of physical activity, smoking, heavy alcohol use and certain types of diets.

As outlined by the American Cancer Society, other risk factors unrelated to lifestyle choices are personal and family histories of colorectal cancer or adenomatous polyps, having type 2 diabetes, possessing an inherited syndrome, such as Lynch Syndrome, and certain racial and ethnic backgrounds. In addition, Dr. Boccia notes that a personal history of inflammatory bowel disease may increase the risk for developing colorectal cancer. “Patients with ulcerative colitis have to be screened very frequently for colon cancer,” Dr. Boccia elucidates, “because of that high predisposition.”

Common CRC Treatments

“For early stage colorectal cancer, the treatment of choice is surgery,” says Dr. Boccia. In this stage, a group of abnormal cells, referred to as carcinoma in situ (CIS), can be removed by a polypectomy, or a part of the colon can be removed via a partial colectomy. Once the cancer has penetrated the wall of the colon and perhaps even grown into nearby tissue, patients of RCCA Maryland will typically undergo active surveillance – although other treatment options are offered to those with high-risk tumors, says Dr. Boccia.

Once the cancer has reached Stage III, patients are generally offered a form of chemotherapy for roughly six weeks. “FOLFOX is the adjuvant therapy of choice,” says Dr. Boccia, “and that we know will lower the incidence of recurrence by about 40-50%.” For Stage IV diseases, which make up about 20% of the cases that RCCA Maryland sees each year, chemotherapy, targeted therapy and even immunotherapy can be used to offer aggressive treatment. If they no longer respond to a particular drug, patients will be introduced to a new regimen.

In regards to new research and treatment options, Dr. Boccia concludes, “I have 50 to 60 clinical trials open at all times in the center, so we’re always looking actively for good, cutting-edge therapies and offering those to our patients.”