¨ A maioria dos cânceres colorretais se origina de pólipos adenomatosos ou serrilhados preexistentes. A incidência e a mortalidade do câncer colorretal podem ser reduzidas com o rastreamento de adultos de risco médio entre 50 e 75 anos de idade. Ensaios clínicos randomizados mostram evidências de redução da mortalidade específica por câncer colorretal com testes de sangue oculto nas fezes baseados em guaiac e sigmoidoscopia flexível ou colonoscopia. Outras opções de triagem incluem o teste imunoquímico fecal, a colonografia tomográfica computadorizada e o teste de DNA fecal multivariada combinado com o teste imunoquímico fecal. Há boas evidências de que a aspirina, os antiinflamatórios não-esteróides, os inibidores da ciclooxigenase-2 e a terapia hormonal diminuem o risco de câncer colorretal e pólipos adenomatosos, mas danos potenciais limitam sua utilidade. Há boas evidências de que a suplementação de cálcio, o consumo moderado de laticínios, o consumo reduzido de carne vermelha, o aumento da atividade física, o índice de massa corporal diminuído e o uso de estatinas diminuem o risco de câncer colorretal e pólipos adenomatosos. Embora o aumento da ingestão de álcool e o uso de tabaco estejam associados a um risco aumentado de câncer colorretal, não há evidências diretas de que a redução do consumo de álcool ou a cessação do tabagismo diminua o risco.¨
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■ Dr Paulo Fernando Leite
Cardiologia/Prevenção Cardiovascular
Estratificação de Risco Cardiovascular
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