text:
9.2 Channel Networked Class D3 AV Receiver with HDMI 2.0
- Dolby Atmos® Upgradeable
- Class D3 Amplification
- AIR Studios® Monitor Certifications
- HDBaseT™ Zone Out
- MCACC® Pro Room Calibration with Precision Distance
Listen and Be Transformed.
When it comes to creating the very best in home entertainment, the Elite® SC-89 AV Receiver is at the head of the class. Combining the enhanced realism of Dolby Atmos® with the immense power of Class D3 amplification, the SC-89 delivers unmatched sound, effortless connectivity, sophisticated room correction and advanced multi-zone features. Perfectionists, get ready to be transformed by the ultimate audiophile surround-sound experience.
Elite Dolby Atmos® Upgradable Receivers Change the Surround Landscape Forever.*
Talk about opening up a new world of sound! The new Elite SC-89 receiver upgradable for Dolby Atmos, along with our new Dolby Atmos-enabled speakers, is the best way to experience Dolby Atmos. Dolby Atmos is one of the most significant home entertainment introductions since the launch of surround sound. How does Dolby Atmos work? It adds height to the sonic landscape, creating a true 3D, multi-dimensional space that puts listeners inside the experience. Played through Atmos-enabled speakers like the new Elite Home Theater Speaker System or dedicated ceiling-mounted speakers, theatrical releases created in Dolby Atmos simply come alive. Dolby Atmos brings new life to traditional soundtracks, putting sounds into motion and delivering the full impact of the artist's work like never before. Dolby Atmos upgradable Elite AV receivers continue the Pioneer tradition of bringing state-of-the-art home theater technology into your home before others even know it's there.
*SC-89 AV Receiver are upgradable for Dolby Atmos via firmware available now. To enjoy Dolby Atmos, users must have Blu-ray Disc content encoded for Dolby Atmos, Dolby Atmos-enabled receiver, and new Dolby Atmos-enabled speakers, add-on modules, or at least two overhead speakers. Certain ceiling dimensions needed for Atmos-enabled speakers; please visit www.pioneerelectronics.com/elitespeakers
HDMI 2.0 for 4K.
The Elite SC-89 features HDMI® 2.0, the newest version of the HDMI standard, which offers increased bandwidth, resolution and frame-rate capability, supporting 4K resolution at 60 frames per second. With 7 HDMI inputs and 2 outputs, you've got plenty of connectivity options for the growing number of high-definition sources available.
Heavyweight Power Meets Efficiency with Class D3 Amplification.
Designed for hard-core audiophiles who settle for nothing but the best, the Elite SC-89 is rated at 140 Watts x 9 channels (8 Ohms, 1kHz, 0.08% THD 2 Ch) and delivers a total of 850 Watts multi-channel simultaneous drive. While lesser amplifiers' output diminishes as channels are added, the SC-89's Class D3 amps have the power to drive multiple channels simultaneously with no significant drop in per-channel output, recreating the full impact and dynamic range of high-resolution multi-channel audio. With a direct signal path and no EMI filters, feedback loops or current limiting, these amps are true engineering art, and unlike traditional designs, Pioneer Class D3 amps have the durability to handle multiple low-impedance speaker loads where other receivers lose power dramatically. Efficient Class D3 means the Elite SC-89 runs cool and draws just a fraction of the power consumed by conventional amplifier designs. And because it consumes so little power, its cool operation enhances component life and reliability too.
Certified by AIR Studios. A Serious Stamp of Approval.
The Elite SC-89 has been certified at London's legendary AIR Studios, whose work is respected worldwide for award-winning motion picture soundtracks and peerless digital CD recordings. AIR Studios understands the artist's craft, and like Pioneer, believes that faithfully reproducing what the artist originally created in the studio is the critical objective of the finest home theater system.
Pro Sound with MCACC Pro.
Now, MCACC® (Multi-Channel Acoustic Calibration) is taken to a new level of performance with MCACC Pro. Designed by Pioneer for the Atmos-enabled Elite system, MCACC Pro calibrates sound output using a microphone to monitor the sound environment and an equalizer to optimize and precision-tune each speaker to the room. How advanced is MCACC Pro? So advanced that Pioneer engineers have included dual independent subwoofer outputs, each with individual EQ. Tailoring left- and right-channel low frequency response curves lets you achieve optimum subwoofer performance based on specific room placement, creating powerful bass response and seamless integration with your main speaker system. With the push of a button, it's like having a professional acoustical engineer fine-tune your home theater system.
Precision Playback in Multiple Formats.
Supporting high-resolution digital file formats such as AIFF, WAV, FLAC and Apple Lossless lets audiophiles hear their favorite music as it was originally intended. Apple Lossless decodes compressed data with no discernible loss in audio quality. MP3, AAC, WMA, WAV and FLAC music files can be streamed from a compatible PC, laptop, tablet or smartphone. The Elite SC-89 features 192kHz/32-bit asynchronous USB-DAC for ultra-high quality music playback from a USB connected PC or Mac. Gapless Playback eliminates gaps between consecutive tracks intended to be played continuously, such as classical music or live recordings.
Multi-Zone Command with HDBaseTTM.
The new standard for multi-zone HD connectivity, HDBaseT makes watching high-definition content easy, streaming uncompressed full 4K UltraHD digital audio and video without an HDMI® cable — using just one standard LAN cable as long as 100 meters without any drop in quality! The Elite SC-89 adds ultimate flexibility to the multi-room experience by delivering up to four different zones of content, capable of powering a 5.1 Home Theater System in the main zone, stereo audio in Zones 2 and 3, and HD video content in Zone 4 via HDMI or HDBaseT. All zones can enjoy different content at the same time. Pioneer's exclusive iControlAV5 Android/IOS application lets you control the entire experience. HDBaseT supports all standard surround sound formats.
4K Pass-Through.
4K Ultra HD Pass-through is the recognized standard of ultra-high video resolution, boasting 3,840 x 2,160 (24 Hz/25 Hz/30 Hz) pixels or 4,096 x 2,160 (24 Hz) pixels. Every Elite AV receiver can pass through 4K video signals to any compatible display, offering the highest-quality image available — a full four times the current HD standard!
Get the Big Picture with Qdeo® Video Processing
Experience an exceptional, virtually noise-free picture regardless of the source. Qdeo video processing technology by Marvell and a 4K Scaler allows you to upscale any video source for improved picture quality and compatibility with next generation TVs, and makes Blu-ray Disc and DVD content look more detailed and cinematic than ever before.
PQLS Bit-stream.
Pioneer's special jitter reduction technology makes reproduced sound more realistic by utilizing the master audio clock in the Elite SC-89 for playback instead of the video clock in a compatible Blu-ray Disc player.
ESS-DAC Sabre32 Bit for All-Channel.
All channels of the Elite SC-89 employ ESS-DAC SABRE32 technology, the world's highest performance 32-bit audio DAC solution, delivering spectacular sound with a minimum of harmonic distortion.
Spotify® Connect.
Spotify Connect lets you play and control Spotify on your devices. Choose music on one device and listen on another. At home, hit "Play" on your mobile device and hear high fidelity sound through the Elite SC-89. You can also control the music from your mobile phone.
Windows® 8 Certified.
Don't limit your media experience to your laptop speakers. Windows 8 "Play To" feature makes it easy to stream music stored on your PC to the Elite SC-89, so you can enjoy your entire media library on the biggest speakers in the house.
Flexible Freedom with AirPlay®.
In addition to being DLNA® 1.5 and Windows® 8 certified, the Elite SC-89 features AirPlay to wirelessly stream iTunes music from your PC, Mac®, iPhone®, iPad® or iPod touch® through your home theater system at the touch of a button. And because it supports network audio sources in other zones, you can even send music to another room.
ROKU Ready.
An MHL 2.0 port supports the small but mighty Roku Streaming Stick, which lets you stream more than 1,000 channels of TV, tens of thousands of movies and other programming options for a limitless streaming experience.
Internet Radio Puts the World at Your Fingertips.
Featuring vTuner®, the Elite SC-89 offers a wealth of entertainment options. Not only can you enjoy thousands of Internet radio stations around the world, you can also access Pandora® Internet Radio complete with on-screen album art and music information.
Pioneer's Ultimate Control App
Pioneer's free of charge iControlAV5 turns your iPhone, iPad, iPod touch, or select Android device into a powerful wireless remote that controls everything from volume and input selections to advanced features like EQ adjustments and Internet Radio, and even streams music stored on your phone through the Elite SC-89 using the new "Push Player" feature.
Elevate Your Sound ExperienceTM
The Elite SC-89 is the ultimate AV receiver and designed to be the heart of today's most capable multi-channel system. The SC-89, combined with the new Elite Home Theater Speakers, elevates home theater to a new level of performance. Listen once and be forever transformed.
A Perfect Solution for Your Home Theater.
The Elite SC-89 is built to last and offers versatile custom-installation solutions for home entertainment, with Multi-Zone capability that lets you set up three great systems. And because Pioneer is dedicated to custom installation, our relationships with custom-control providers like AMX®, Control4®, Crestron® and other leading brands makes the SC-89 the perfect centerpiece for whole-house systems.
Dolby Atmos System Requirements
Room Requirements
Using the Pioneer Elite Dolby Atmos Enabled Speakers you will need the following in order to use the Dolby Atmos-enabled capability of these speakers, the listening room ceiling should have horizontal flat hard surface (for audio reflection) and a height of 8' to 14'.
Equipment Requirements
In addition to a Dolby Atmos compatible speaker set up, you must have a Dolby Atmos compatible receiver/processor and Dolby Atmos encoded content.
To learn more, please visit here
- Class D3 (Direct Energy HD)
- 9.2
- VSX Model Power Rating Only
- VSX Model Power Rating Only
- 140 Watts
- 255 Watts
- 850 Watts
- Yes
- 370 W/0.1 W (standby)
- -
Handheld and Internet
- Yes
- Yes
- Yes
- iControlAV5
- Yes
- Yes
- Yes
- MP3, WMA, AAC, Apple Lossless, WAV, FLAC, AIFF, DSD
- Apple Lossless, WAV, FLAC, AIFF, DSD
Decoders & Formats
- Texas Instruments Aureus
- AIR Studios Monitor Certification
- Yes
- ESS SABRE32 Ultra
 192K/32Bit
- 1.4
- Yes
 (Firmware update may be required)
- Yes
- Yes
- Yes
- Multi- Channel
Soundfield Calibration
- Pro
- 6
- Auto / Plus
- Yes
- 9-Band (Advanced)
- Yes
- 1/2 Inch
- Yes
- Yes
- Yes
Listening Modes
- Yes
- Multi-Channel
- Yes
- Direct / Pure Direct
- 11+ 1
- Yes
- Yes (Focus/Wide)
- Yes
Audio Features
- 192kHz/32-bit
- 2 Ch (5.6MHz/2.8MHz)
- Hi-bit32
- Yes
- Multi-Channel / Auto with ARC
- Yes
- Yes
- Multi
- Yes (800 ms)
- Yes
- Front, Center, Surr, SP-B
Video Processing
- Yes
- Yes
- Yes
- Yes
- Yes
- Yes
- Yes
- Marvell Qdeo
- Yes
- Yes
- -
- YNR, CNR, BNR, MNR, Detail, Brightness, Contrast, Hue, Chroma, Black Level
- 8 in/4 out (2 for MAIN, 2 for MAIN/HDZONE)
- 1 (Rear)
- -
- -
- 2 In (Assignable)
- Front USB
- Yes
- 2 In / 1 Out
- 1 In
- Yes
- 4 In / 1 Out
- Preout 9.2 ch (11.2 ch terminals)
- Yes
- 63
- Graphical User Interface (GUI) with Album Artwork (HDMI only)
- HDZONE Audio & Video (HDMI and Powered) / Powered ZONE 2 Audio / Powered ZONE 3 Audio
- All Audio Sources
- All Audio Sources
- Eco Mode 1/Eco Mode 2
- Yes
- 2
- Yes
- 2 In / 1 Out
- Yes
- Yes
- Surround Back/ Front Height/ Front Wide/ Front Bi-Amp/ Zone 2/ B-Speaker/ Powered HD Zone
- Yes
- Yes
- Learning Remote Control (Luminous)
- Yes
- Yes
- Brushed
- Yes
- Yes
- 11 Large
- Yes
- Yes
- 3 Years Parts & Labor
- -
- 17-1/8 x 7-5/16 x 17-3/8
- 38 lbs. 13 oz.
The CES Innovation Awards are based upon descriptive materials submitted to the judges. CEA did not verify the accuracy of any submission or of any claims made and did not test the item to which the award was given
Specifications and design subject to modification without notice.
Pioneer, MCACC, Elite and MCACC logos, and Advanced Sound Retriever, and the corresponding logos are registered trademarks of Pioneer Corporation and are used by Pioneer & Onkyo U.S.A. Corporation under license.
The impedances indicated are actual values that speakers can present to an amplifier while playing back music. They do not necessarily refer to the nominal rated impedances of speakers you use.
Phase Control is a trademark placed on a product with Pioneer's Phase Control Technology concept. The technology enables high-grade sound reproduction environment by improving the phase matching for each of the components.
HDMI connection may not allow transmission of copyright protected material, depending on the capability of the signal source.
The terms HDMI and HDMI High-Definition Multimedia Interface, and the HDMI Logo are trademarks or registered trademarks of HDMI Licensing LLC in the United States and other countries.
AIR STUDIOS and the AIR STUDIOS logo are registered trademarks of Air Studios, Inc.
Dolby, Atmos, Pro Logic, Dolby Digital, and the double-D symbol are registered trademarks of Dolby Laboratories.
DTS, DTS-HD, DTS Neo:X, and the DTS logo and Symbol are registered trademarks of DTS, Inc.
Blu-ray Disc is a registered trademark of the Blu-ray Disc Association.
Windows and the Windows logo are trademarks of the Microsoft group of companies.
AirPlay works with iPhone, iPad, and iPod touch with iOS 4.3.3 or later, Mac with OS X Mountain Lion, and Mac and PC with iTunes 10.2.2 or later.
"Made for iPod" and "Made for iPhone" mean that an electronic accessory has been designed to connect specifically to iPod or iPhone respectively, and has been certified by the developer to meet Apple performance standards. Apple is not responsible for the operation of this device or its compliance with safety and regulatory standards. Please note that the use of this accessory with iPod or iPhone may affect wireless performance. Apple, AirPlay, iPad, iPhone, iPod, iPod nano, iPod touch, iTunes and Mac are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc. The AirPlay logo is a trademark of Apple Inc.
iOS is a trademark on which Cisco holds the trademark right in the US and certain other countries.
DLNA, the DLNA Logo and DLNA Certified are registered trademarks, service marks, or certification marks of the Digital Living Network Alliance.
HTC, the HTC logo, and HTC Connect are registered trademarks of HTC Corporation.
"x.v.Color" is a trademark of Sony Corporation.
"Qdeo" is a registered trademark of Marvell or its affiliates.
SABRE is a trademark of ESS Technology, Inc.
Android and Google Play are trademarks of Google Inc.
HDBaseT™ and the HDBaseT Alliance logo are trademarks of the HDBaseT Alliance
MHL, the MHL Logo, and Mobile High-Definition Link are trademarks of MHL LLC in the United States and other countries.
Aureus is a registered trademark of Texas Instruments, Inc.
Pandora, the Pandora logo, and the Pandora trade dress are trademarks or registered trademarks of Pandora Media, Inc. and are used with permission.
Spotify and the Spotify logo are trademarks of the Spotify Group, registered in the U.S. and other countries.
Roku and the Roku Ready logo are registered trademarks of Roku, Inc. in the United States and other countries.
vTuner is a registered trademark of Nothing Else Matters Software, Ltd.
Texas Instruments Aureus is a registered trademark of Texas Instruments, Inc.
For details on iPod compatibility, visit http://pioneer.jp/homeav/support/ios/na/


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From "The Eyes Have It," an interview with Orange Is the New Black actress Uzoamaka "Uzo" Aduba, who was asked whether she ever considered changing her name:
When I started as an actor? No, and I'll tell you why. I had already gone through that. My family is from Nigeria, and my full name is Uzoamaka, which means "The road is good." Quick lesson: My tribe is Igbo, and you name your kid something that tells your history and hopefully predicts your future. So anyway, in grade school, because my last name started with an A, I was the first in roll call, and nobody ever knew how to pronounce it. So I went home and asked my mother if I could be called Zoe. I remember she was cooking, and in her Nigerian accent she said, "Why?" I said, "Nobody can pronounce it." Without missing a beat, she said, "If they can learn to say Tchaikovsky and Michelangelo and Dostoyevsky, they can learn to say Uzoamaka."
(There's a Tchaikovsky in Brazil.)
From an article about a woman named Cinderella in the Irish Independent:
"I'd been living as Eva my whole life until I found out my name was Evangeline Cinderella. Of course this was the most amazing news as a seven year old girl and unfortunately I told everybody. I've paid for it ever since. People have always remembered," she said.
From the essay "The name shame of Axl, Anakin, Arya…" by Gene Weingarten (via Name News):
To consult this list [the SSA's Change in Popularity list] is to dip your toe into the fetid waters of cheesy celebrity worship. Consider this: One of the skyrocketing names is … "Anakin." Yes, people are giving their baby boys a name invented specifically to sound non-human, for a character in another galaxy far, far away, one who grows up to become Darth Vader, an evil overlord who wants to enslave the universe. (There have been plenty of Darths, too.)
(Here's more on Darth.)
From the video "Instrument: Celeste" featuring keyboardist Elizabeth Burley of the Philharmonia Orchestra of London:
I've got a celeste here today to show you how that works. As you'll see it looks a little bit like an upright piano, but it's actually a lot different. Although it's operated by a keyboard, inside, instead of strings, it's a set of…metal chime bars. They're suspended over wooden resonating boxes, and when I press a key, a hammer hits the chime bar to make the sound, like on a piano the hammer would hit the string. The name celeste…it's a French name meaning "heavenly," and it does make a very heavenly sound, as you'll hear.
From a blog post about electronic music pioneer Delia Derbyshire at Open Culture:
With her buttoned-up style, work with the UN, and name like a plucky character in a certain English wizard series, Delia Derbyshire may not seem a likely pioneer of experimental electronic music.
From the blog post "What's in a Name?" by theology professor/social activist Rev. Dr. Miguel A. De La Torre:
Today, no one calls me Brother Mike. Nonetheless, if the first act of liberation is self naming, why do I still insist on spelling my surname the way those who had power over me taught me? I have no doubt the reader is probably wondering what's the big deal? Just spell my name correctly. What they fail to recognize is the power of the colonizing process, and the difficulty to reclaim identity. So as I tag my name to my liberationist works I am reminded with each upper case letter how far I still need to go to claim my own liberation. The struggle, la lucha, continues, even in the letters of my name.
From the article "What Your Conference Room Names Say About Your Company Culture" by Ekaterina Walter:
At Sprinklr, our conference rooms are named after the company's values. Honesty, Passion, Perseverance, Humility, Character, Courage, and Integrity are just some of the names you will encounter. My personal favorites are Awesomeness and 1+1=3. When I asked our founder, Ragy Thomas, why the leadership team chose to name conference rooms in this way, he said: "It would be kind of hard to be arrogant in a room named Humility, wouldn't it? Or give up in a room named Perseverance, don't you think?"
From the New York Times article "Jens and Vita, but Molli? Danes Favor Common Names" (2004) about Denmark's Law on Personal Names, which was "initially designed to bring order to surnames":
Then in the 1960's, a furor erupted over the first name Tessa, which resembled tisse, which means to urinate in Danish. Distressed over the lack of direction in the law, the Danish government expanded the statute to grapple with first names. Now the law is as long as an average-size book.
Among the baby names rejected in Denmark: Anus, Pluto, and Monkey. Among those accepted: Leica, Benji, Jiminico, and Fee.
Want more quotes? Here's the name quotes category.

subset: commoncrawl


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Simplicity redefined.
Multifunction printers that simplify your work.
ConnectKey is software that connects multifunction printers to the way work gets done.
With ConnectKey, you can do much more than just print, scan, fax and copy. You can print from just about anywhere through mobile print capabilities. Also, documents can be scanned directly to cloud services like Google Drive, Evernote and Microsoft Office 365 for storage and collaboration.
You can develop simple applications and embed them on the multifunction printer with easy-to-use tools. For example, a health insurance company can add a feature to its device that allows scanning of reimbursement claims directly into their payment system with just one touch.
IT professionals can manage ConnectKey multifunction printers easily, and make applications more accessible to your workforce right from the device's touch screen. Plus, ConnectKey provides a common user interface across multiple devices making them easy to use.
And, with ConnectKey multifunction printers, your data is secured and protected from malware with security from McAfee.
ConnectKey multifunction printers adapt to the way you work on the go, virtually and through the cloud allowing you to focus on what matters: your real business.


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Posts Tagged 'victoria'
Did You Think?
Posted August 16, 2012on:
Did you think that there was something wrong with yourself as a person? Are you who you want to be? There is not one reason that you should be unhappy with yourself because you are one of a kind. Let your light shine and think about all the things in your life that you are happy with. Those things that you are happy with are the things the reflect who you are and who you will eventually be. Since we are always changing it means that you are constantly getting to know yourself. In this life, it's all about you. Don't let someone else take that free will away from you. Feel free to express yourself and like what you want. Don't hold back too much or your life will just pass you by.


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Tuesday, May 3
Celebrate Cinco de Mayo with Bacon Guacamole!
May 5th is Cinco de Mayo, the day when Mexicans commemorate their victory over the French in the Battle at Puebla of 1862. In the Mexican town of Puebla, schoolchildren will study history, artists will sing and dance and chefs will cook traditional foods, all to honor their brave ancestors.
And in cities throughout America, Americans will get drunk. Somehow, this day of national pride for Mexicans has become another excuse for Americans to get sloshed. Think I'm exaggerating? According to Time magazine Cinco de Mayo is the 4th drunkest holiday of the year.
How about this year you get drunk on bacon guacamole instead?
If you think traditional guacamole is irresistible, then be prepared to get punch drunk in love with this porky version: Classic creamy guacamole is studded with nibs of salty, smoky, crisp bacon. And in case you're wondering, yes, bacon guacamole does taste better if you eat it while wearing a sombrero and shaking some maracas.
Like this recipe? There are over 60 more like it in my book, Recipes Every Man Should Know, co-authored with Brett Cohen. It's a little, sleek black book that fits neatly into every man's back pocket.
Bacon Guacamole
This recipe is from my book, Recipes Every Man Should Know
Makes 6-8 servings
Printable recipe.
6 slices bacon
Flesh of 2 ripe avocados
1 medium tomato, chopped
4 scallions (white parts only), finely chopped
Juice of 1 lime
A couple of pinches of salt
A couple of dashes of hot sauce
Small handful fresh cilantro leaves, finely chopped
1. Place bacon in a skillet over medium-high heat and cook until crisp. Drain on a paper-towel-lined plate. Let cool and chop into small pieces.
2. Combine remaining ingredients in a blender or food processor and pulse until chunky.
Here are more guacamole recipes you might enjoy:
Grilled Guacamole recipe from The Kitchn
Grapefruit Guacamole recipe from No Recipes
Edamame Guacamole recipe from Two Peas and Their Pod
Roasted Garlic, Poblano, and Red Pepper Guacamole recipe from Ezra Pound Cake
Photo credit by Sala Kannan of www.veggiebelly.com.
20 comments:
- sheila @ Elements said...
Sounds totally amazing! I would have never thought about adding bacon to it, but it's a wonderful idea! Can't wait to try it! :)
- May 3, 2011 at 7:16 PM
If you're a fan of bleu cheese, throw some in your guacamole (to taste). I saw this on Food Network and gave it a try and LOVED it.
- May 3, 2011 at 7:54 PM
- Valerie Harrison (bellini) said...
Every man, woman and child should get to know this guacamole with bacon Susan.
- May 3, 2011 at 8:13 PM
- Deborah Dowd said...
I love guacamole and add some bacon? Well we all know that everything is better with bacon!
- May 4, 2011 at 6:12 AM
- MrsJenB said...
I think that my husband would actually eat guacamole if I made this! (he's afraid of avocado or something)
- May 4, 2011 at 7:02 AM
- Susan from Food Blogga said...
sheila-It's a revelation. Trust me.
anonymous-Oh, my husband would LOVE that idea. Thanks for sharing.
val-Ha! I think so too.
deborah-A girl after my own heart.
mrsjenb-Maybe he needs to spend some time in San Diego getting to know them. :)
- May 4, 2011 at 9:22 AM
- Joanne said...
I will absolutely for sure NOT be getting drunk...actually I don't think I've EVER gotten drunk on cinco de mayo. Well, maybe on guac. If that's your definition of drunk. This sounds delicious!
- May 4, 2011 at 9:41 AM
- Food Glorious Food! said...
Just found your blog and love all your recipes! Following you now and would like you to check out my blog too.... I am new to blogging...
- May 4, 2011 at 10:54 AM
- The Short (dis)Order Cook said...
Oh wow. I love guac and it's hard to improve upon a good thing, but if there is one way to improve on it, then it would defintiely be ADD BACON. Two great tastes that taste great together for sure!
- May 4, 2011 at 11:48 AM
- Sippity Sup said...
This man knows that recipes like this are loved by women too. Cinco is a good time to try it out. But I'd also recommend making it on a Tuesday or Saturday or a Monday or well, any day. Because bacon and avocado make a powerful team. Kinda like you and Cheryl. Loved your presentation at Camp. Do you like how I weaved those two things together? GREG
- May 4, 2011 at 5:55 PM
- Pille said...
That bacon-addition sounds like a very good idea indeed. Do I understand it correctly that you blitz some of the bacon with rest of the ingredients and use some as a crispy garnish?
- May 5, 2011 at 3:29 AM
- Susan from Food Blogga said...
joanne-Getting drunk on guac is definitely the way to go.
fgf-Thanks! Welcome!
greg-A sign of genius, man, a sign of genius. ;)
pille-That's it, my dear!
- May 6, 2011 at 6:19 AM
- kellypea said...
You'd think by now I would have figured out that bacon goes in guacamole considering I LOVE smashed bacon on a good California Club. YUM!
- May 6, 2011 at 7:52 AM
- Recipe contests said...
You can put bacon on anything and I'll eat it - but guacamole? YUM! Thanks for sharing. I only wish I had seen this before Cinco de Mayo :)
Take care,
-- Chelseyq
- May 6, 2011 at 4:03 PM
Genius! I'm thinking why I never thought to do so.... Thanks for sharing!
- May 6, 2011 at 8:52 PM
- Kristina Vanni said...
You had me at BACON...
Thanks so much for sharing your advice and wisdom at Camp Blogaway last weekend. I didn't get a chance to chat with you, but I look forward to following your blog!
- May 6, 2011 at 11:15 PM
- Miami catering said...
Your post just give me a new recipe to be served for my family. I really its name "Cinco de Mayo with Bacon Guacamole!" very historic and as well as delicious. Thanks for sharing!
- May 7, 2011 at 11:32 PM
- GF Gidget said...
Bacon Guacamole? You have officially ousted the dog as "man's best friend"!
- May 8, 2011 at 7:06 AM
- marla said...
Really, really love bacon guacamole. On everything!
- May 9, 2011 at 9:28 PM
- Jennifer Brody said...
Ive never seen bacon look so elegant crumbled on a table. This looks like an awesome recipe. What would be better than bacon and avocado?
Domestic Divas
- May 16, 2011 at 9:39 AM


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We would really appreciate you filling out one, final form for us, so we can see how everyone has improved over the last 6 months.
It has been an epic, fantastic, exhillarating journey and we thank all of you for coming along on the ride with us.
There is also a question at the end if you would like a certificate of completion to be sent to you, so you can
brag quietly admire your accomplishment.
Kate and Abigail.


text:
Center on Chinese EducationSkip to content Skip to main navigation
Center on Chinese Education
Welcome to the Center on Chinese Education
The Center on Chinese Education, Teachers College Columbia University (CoCE) is aimed at contributing to a better understanding of education in China and to educational exchange between the United States and China. It seeks to achieve this mission through three categories of activities: research and development, education and training, as well as outreach and exchange. These activities will draw upon the historically special relationship between Chinese education and Teachers College, the interests and expertise of the faculty at Teachers College, as well as expertise and resources outside of Teachers College.
Learn More About the Center on Chinese Education
Professor Sheng Zhengfa's lecture on developing scientific research capacity in China's newly-built four-year colleges
On the afternoon of November 19th, 2012, Professor Zhengfa Sheng, currently an associate professor of Hunan Institute of Humanities, Science and Technology, and a post-doc at National Institute of Education Sciences (NIES), presented a lecture on developing scientific research capacity in China's newly-built four-year colleges
CoCE welcomes visiting scholars and students in the new semester of spring 2014
Center on Chinese Education is hosting a group of visiting scholars and students for the 2013-2014 academic year, who continue to be present in the spring 2014 semester.
Professor Zhou Huimei's presentation: the institutional analysis of changes of the mass education museum in Republic of China
On the February 3 of 2014, Zhou Huimei, a visiting scholar from Beijing Normal University's Faculty of Education, gave a presentation on the changes of mass education museum in Republic of Chin
Professor Xia Xue's presentation on quantity and quality of primary and secondary school teacher quality in China
On February 17, 2014, Xia Xue, a visiting scholar from Northeast China Normal University, gave a presentation on the quantity and quality of primary and secondary school teachers in China
Recent Research Studies
- Determinants of Academic Performance in China
- Gender Gaps in Academic Performance in Basic Education in China
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This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.
Note: Separate PDQ summaries on Colorectal Cancer Prevention; Colon Cancer Treatment; and Rectal Cancer Treatment are also available.
Based on solid evidence, screening for colorectal cancer (CRC) reduces CRC mortality, but there is little evidence that it reduces all-cause mortality, possibly because of an observed increase in other causes of death.
Colorectal cancer (CRC) is the third most common malignant neoplasm worldwide [1] and the second leading cause of cancer deaths in the United States.[2] It is estimated that there will be 143,460 new cases diagnosed in the United States in 2012 and 51,690 deaths due to this disease. From 2004 to 2008, CRC incidence declined by 2.9% per year in white men and 2.2% per year in white women. However, in adults younger than 50 years, CRC incidence rates have been increasing by 1.7% per year since 1992. From 2004 to 2008, mortality from CRC declined by 2.7% per year in men and 2.5% per year in women.[2] The incidence is higher in men than in women. It ranges from 39.9 per 100,000 per year in Hispanic men to 67.7 per 100,000 per year in African American men. In women it ranges from 28.4 per 100,000 per year in Hispanics to 51.2 per 100,000 per year in African Americans.[3] The age-adjusted mortality rates for men and women are 21.2 per 100,000 per year in men and 14.9 per 100,000 per year in women.[3] About 5% of Americans are expected to develop the disease within their lifetime and about half of those will die from it.[4] Age-specific incidence and mortality rates show that the vast majority of cases are diagnosed after age 50 years; about 7% of CRCs occur younger than age 50 years.[5,6]
Among the groups that have a high incidence of CRC are those with hereditary conditions, such as familial adenomatous polyposis and hereditary nonpolyposis CRC (inherited in an autosomal dominant manner). Combined, the two groups account for no more than 6% of CRCs. More common conditions associated with an increased risk include a personal history of CRC or adenomas; first-degree relative with CRC; a personal history of ovarian, endometrial, or breast cancer; and a personal history of long-standing chronic ulcerative colitis or Crohn colitis.[7,8,9] These high-risk groups account for about a quarter of all CRCs. Limiting screening or early cancer detection to only these high-risk groups would miss the majority of CRCs.[10]
Genetic,[11] experimental, and epidemiologic[12] studies suggest that CRC results from complex interactions between inherited susceptibility and environmental or lifestyle factors. Efforts to identify causes led to the hypothesis that adenomatous polyps (adenomas) are precursors for the vast majority of CRCs.[13] In effect, measures that reduce the incidence and prevalence of adenomas may result in a subsequent decrease in the risk of CRCs [14]; however, some CRC mortality may be caused by fast-growing lesions and even lesions that do not pass through an adenomatous phase. Overall, the details of growth rates of adenomas and cancer are unknown; most likely there is a broad spectrum of growth patterns, including formation and spontaneous regression of adenomas.[15]
Fecal Occult Blood Test (FOBT)
In FOBT testing, a person collects stool samples that are analyzed for the presence of small amounts of blood. Collection details vary somewhat for different tests, but typically involve collection of as many as three different specimens on 3 different days, with small amounts from one specimen smeared by a wooden stick on a card with two windows or otherwise placed in a specimen container.
The guaiac test identifies peroxidase-like activity that is characteristic of human and nonhuman hemoglobin. Thus, it will record blood from ingested meat, upper airway bleeding such as epistaxis, upper gastrointestinal (GI) bleeding, as well as colonic lesions.
Five controlled clinical trials have been completed or are in progress to evaluate the efficacy of screening utilizing the FOBT. The Swedish trial is a targeted study for individuals aged 60 to 64 years.[1] The English trial selects candidates from lists of family practitioners.[2] The Danish trial offers screening to a population aged 45 to 75 years randomly assigned to a control or study group.[3,4]
The Minnesota trial demonstrated that annual guaiac-based FOBT (gFOBT) testing using primarily rehydrated samples decreased mortality from colorectal cancer (CRC) by 33% [5] and that biennial testing developed a 21% relative mortality reduction.[6] Some part of the reduction may have been attributed to chance detection of cancer by colonoscopies; rehydration of guaiac test slides greatly increased positivity and consequently increased the number of colonoscopies performed.[7] Subsequent analyses by the Minnesota investigators using mathematical modeling suggested that for 75% to 84% of the patients mortality reduction was achieved because of sensitive detection of CRCs by the test; chance detection played a modest role (16%–25% of the reduction).[8] Nearly 85% of patients with a positive test underwent diagnostic procedures that included colonoscopy or double-contrast barium enema plus flexible sigmoidoscopy (FS). After 18 years of follow-up, the incidence of CRC was reduced by 20% in the annually screened arm and 17% in the biennially screened arm.[9]
The English trial allocated approximately 76,000 individuals to each arm. Those in the screened arm were offered nonrehydrated gFOBT testing every 2 years for three to six rounds from 1985 to 1995. At a median follow-up time of 7.8 years, 60% completed at least one test, and 38% completed all tests. Cumulative incidence of CRC was similar in both arms, and the trial reported a relative risk (RR) reduction of 15% in CRC mortality (odds ratio [OR] = 0.85; 95% confidence interval [CI], 0.74–0.98).[10] The serious complication rate of colonoscopy was 0.5%. There were five deaths within 30 days of surgery for screen-detected CRC or adenoma in a total of 75,253 individuals screened.[11] After a median follow-up of 11.8 years, no difference in CRC incidence between the intervention and control groups was observed. The disease-specific mortality rate ratio associated with screening was 0.87 (0.78–0.97; P = .01). The rate ratio for death from all causes was 1.00 (0.98–1.02; P = .79).[12] When the median follow-up was extended to 19.5 years, there was a 9% reduction in CRC mortality (RR = 0.91; 95% CI, 0.84–0.98) but no reduction in CRC incidence (RR = 0.97; 95% CI, 0.91–1.03), or death from all causes (RR = 1.00; 95% CI, 0.99–1.02).[13]
The Danish trial in Funen, Denmark, entered approximately 31,000 individuals into two arms, in which individuals in the screened arm were offered nonrehydrated gFOBT testing every 2 years for nine rounds over a 17-year period. Sixty-seven percent completed the first screen, and more than 90% of individuals invited to each subsequent screen underwent FOBT testing. This trial demonstrated an 18% reduction in CRC mortality at 10 years of follow-up,[14] 15% at 13 years of follow-up (RR = 0.85; 95% CI, 0.73–1.00),[15] and 11% at 17 years of follow-up (RR = 0.89; 95% CI, 0.78–1.01).[16] CRC incidence and overall mortality were virtually identical in both arms.
The Swedish trial in Goteborg enrolled all 68,308 citizens in the city born between 1918 and 1931 that were aged 60 to 64 years, and randomly assigned them to screening and control groups of nearly equal size. Participants in the control group were not contacted and were unaware they were part of the trial. Screening was offered at different frequencies to three different cohorts according to year of birth. Screening was done using the gFOBT Hemoccult-II test after dietary restriction. Nearly 92% of tests were rehydrated. Individuals with a positive test result were invited to an examination consisting of a case history, FS, and double-contrast barium enema. The range of follow-up times was from 6 years 7 months to 19 years 5 months, depending on the date of enrollment. The primary endpoint was CRC-specific mortality. The overall screening compliance rate was 70%, and 47.2% of participants completed all screenings. Of the 2,180 participants with a positive test, 1,890 (86.7%) underwent a complete diagnostic evaluation with 104 cancers and 305 adenomas of at least 10 mm detected. In total, there were 721 CRCs (152 Dukes D, 184 Dukes C) in the screening group and 754 CRCs (161 Dukes D, 221 Dukes C) in the control group, with an incidence ratio of 0.96 (95% CI, 0.86–1.06). Deaths from CRC were 252 in the screening group and 300 in the control group, with a mortality ratio of 0.84 (95% CI, 0.71–0.99). This CRC mortality difference emerged after 9 years of follow-up. Deaths from all causes were very similar in the two groups, with a mortality ratio of 1.02 (95% CI, 0.99–1.06).[1]
All trials have shown a more favorable stage distribution in the screened population compared with controls (Table 3). Data from the Danish trial indicate that while the cumulative incidence of CRC was similar in the screened and control groups, a higher percentage of CRCs and adenomas were Dukes A and B lesions in the screened group.[14] A meta-analysis of all previously reported randomized trials using biennial FOBT showed no overall mortality reduction by gFOBT screening (RR = 1.002; 95% CI, 0.989–1.085). The RR of CRC death in the gFOBT arm was 0.87 (95% CI, 0.8–0.95), and the RR of non-CRC death in the gFOBT group was 1.02 (95% CI, 1.00–1.04; P = .015).[17]
Mathematical models have been constructed to extrapolate the results of screening trials to screening programs for the general population in community health care delivery settings. These models project a reduction in CRC mortality or an increase in life expectancy using currently available screening methodology.[18,19,20,21] The anticipated success of such methodology is critically dependent on the appropriate use of the FOBT and an effective clinical management plan.[22,23]
A systematic review done through the Cochrane Collaboration examined all CRC screening randomized trials that involved gFOBT testing on more than one occasion. The combined results showed that trial participants allocated to screening had a 16% lower CRC mortality (RR = 0.84; 95% CI, 0.78–0.90). There was, however, no difference in all-cause mortality between the screened and control groups (RR = 1.00; 95% CI, 0.99–1.02). Furthermore, the trials reported a low positive predictive value (PPV) for the FOBT test, suggesting that most positive tests were false positives. From the trials with nonrehydrated slides (Funen and Nottingham), the PPV was 5.0% to 18.7%, while the PPV in the trials using rehydrated slides (Goteborg and Minnesota) was 0.9% to 6.1%. The report contains no discussion on contamination in the control arms of the trials and no information on treatment by stage.[24,25]
On initial (prevalence) examinations, from 1% to 5% of unselected persons tested with gFOBT have positive test results. Of those persons with positive test results, approximately 2% to 10% have cancer and approximately 20% to 30% have adenomas,[26,27] depending on how the test is done. Data from randomized controlled trials (RCT) are summarized in Table 3.
Newer FOBTs: Nonrandomized Controlled Trial Evidence
The immunochemical FOBT (iFOBT) was developed to detect intact human hemoglobin. The advantage of iFOBT over guaiac FOBT (gFOBT) is that it does not detect hemoglobin from nonhuman dietary sources. It also does not detect partly digested human hemoglobin that comes from the upper respiratory or GI tract. Preliminary studies of several commercially developed iFOBT tests define their sensitivity and specificity compared with concurrently performed colonoscopy. These studies also examine these outcomes for different cut points, and the benefit of multiple versus single stool samples.[29] Generally, iFOBT testing is more sensitive for cancers than for benign neoplasias. As expected, higher cut points decrease sensitivity and increase specificity.
In one study, 2,188 patients scheduled for colonoscopy because of an elevated risk due to personal or family history of colorectal neoplasm, positive gFOBT result, change in bowel habits, anemia, abdominal pain with weight loss, or anal symptoms were invited to participate in a comparative assessment of iFOBT against colonoscopy findings. After exclusions for health and cognitive reasons, 1,859 patients were offered iFOBT, 1,116 patients adhered to the protocol, and 1,000 patients completed the procedure. Sensitivity and specificity were calculated at various cut-points. At a cut-point of 100 ng/mL, sensitivity and specificity were, respectively, 88.2% and 89.7% for cancer and 61.5% and 91.4% for any clinically significant neoplasia (cancer and advanced polyps). At 150 ng/mL the respective sensitivities and specificities were 82.4% and 91.9% for cancer and 53.8% and 95% for any clinically significant neoplasia. Calculations were based on the most severe pathologic finding from colonoscopy and the highest fecal-hemoglobin concentration measured by iFOBT applied to three stool samples collected prior to the colonoscopy. Stool samples were collected by patients following iFOBT kit instructions and analyzed by the OC-MICRO analyzer (from the Eiken Chemical Company in Tokyo, Japan).[30]
In another study, 21,805 asymptomatic patients received iFOBT based on one stool sample collected by patients following the kit instructions on the day of or the day before the colonoscopy. Stool samples were analyzed using the Magstream 1,000/Hem SP automated system (from Fujirebio Incorporated, Tokyo, Japan), which is based on the HemeSelect system (from Beckman Coulter, Palo Alto, California). Sensitivity and specificity based on subsequent colonoscopy were, respectively, 65.8% and 94.6% for cancer and 27.1% and 95.1% for advanced neoplasm.[31]
Fecal immunochemical tests may vary with regard to numbers of stools tested and cut-off values for a positive result.[29,32,33]
A systematic review to evaluate the comparative diagnostic performance of gFOBT and iFOBT in the context of a decision to introduce screening for CRC in the United Kingdom, included 33 studies evaluating gFOBT and 35 studies evaluating iFOBT, including nine that evaluated both gFOBT and iFOBT. There was no clear evidence for superiority of either gFOBT or iFOBT. Sensitivities for the detection of all neoplasms ranged from 6.2% (specificity 98%) to 83.3% (specificity 98.4%) for gFOBTs and 5.4% (specificity 98.5%) to 62.6% (specificity 94.3%) for iFOBT. Increasing sensitivity entailed adjusting cut-points to decrease specificity. Sensitivities were higher for the detection of CRC and lower for adenomas.[34]
Some studies have utilized the quantitative ability of iFOBT to consider detection and specificity at various test cut-points for defining a positive test. One study [35] found that reducing the cut-point from the standard 100 ng/mL to 50 ng/mL increased the detection of advanced adenomas but had little impact on the detection of cancer. The number of colonoscopies required to detect a single advanced adenoma or cancer increased from 1.9 to 2.3; a 20% increase. Specificity declined from 97.8% to 96%.
Potential false-positive test results due to an increased risk of upper GI bleeding are of concern with FOBT testing and pretest protocols, therefore; low-dose aspirin regimens should be discontinued for a week or more prior to FOBT. The performance of iFOBT was tested in an ongoing diagnostic study (2005–2009) at 20 internal medicine GI practices in southern Germany. Nineteen hundred seventy-nine patients (233 regular low-dose aspirin users and 1,746 never users) were identified in the records for inclusion in the analysis. All patients provided one stool sample taken within a week before colonoscopy preparation, which was collected according to instructions in a container that was kept refrigerated or frozen until rendered to the clinic on the day of colonoscopy, and the patients agreed to complete a standard questionnaire regarding the use of analgesics and low-dose aspirin (for prevention of cardiovascular disease). Stool samples were thawed within a median of 4 days after arrival at the central laboratory (shipped frozen from the recipient clinics). Fecal occult blood levels were measured by two automated iFOBT tests according to the manufacturer's instructions (RIDASCREEN Haemoglobin and RIDASCREEN Haemo-/Haptoglobin Complex, r-biopharm, Bensheim, Germany) following clinical procedures and blinded to colonoscopy results. Advanced neoplasms were found in 24 aspirin users (10.3%) and in 181 nonusers (10.4%). At the cut-point recommended by the manufacturer, sensitivities for the two tests were 70.8% (95% CI, 48.9%–87.4%) for users compared with 35.9% (95% CI, 28.9%–43.4%) for nonusers and 58.3% (95% CI, 36.6%–77.9%) for users compared with 32% (95% CI, 25.3%–39.4%) for nonusers (P = .001 and P = .01, respectively). Specificities were 85.7% (95% CI, 80.2–90.1%) for users compared with 89.2% (95% CI, 87.6%–90.7%) for nonusers and 85.7% (95% CI, 80.2%–90.1%) for users compared with 91.1% (95% CI, 89.5%–92.4%) for nonusers (P = .13 and P = .01, respectively). For these iFOBTs, sensitivity for advanced neoplasms was notably higher with the use of low-dose aspirin while specificity was only slightly reduced, suggesting that there might be an advantage to aspirin use to increase sensitivity without much decrease in specificity.[36]
The flexible fiberoptic sigmoidoscope was introduced in 1969. The 60 cm flexible sigmoidoscope became available in 1976.[37] The flexible sigmoidoscope permits a more complete examination of the distal colon with more acceptable patient tolerance than the older rigid sigmoidoscope. The rigid instrument can discover 25% of polyps, and the 60 cm scope can find as many as 65%. The finding of an adenoma by FS may warrant colonoscopy to evaluate the more proximal portion of the colon.[38,39] The prevalence of advanced proximal neoplasia is increased in patients with a villous or tubulovillous adenoma distally and is also increased in those aged 65 years or older with a positive family history of CRC and with multiple distal adenomas.[40] Most of these adenomas are polypoid, flat and depressed lesions, which may be somewhat more prevalent than previously recognized.[41]
Virtually all screening studies using these types of sigmoidoscopes have demonstrated an increase in the proportion of early cases and a corresponding increase in survival compared with cases diagnosed in a nonscreening environment. Most of these studies, however, lack appropriate comparison groups, and their interpretation is unclear because of screening biases.
The first incidence and mortality results from a randomized trial of sigmoidoscopy were reported in the Norwegian Colorectal Cancer Prevention (NORCCAP) trial. This trial randomly assigned 41,913 men and women aged 55 to 64 years to a usual-care control group and 13,823 individuals to a screening group, 6,915 of whom received one-time FS and 6,908 of whom received both FS and iFOBT. Screening was conducted from January 1999 to December 2000. Follow-up was through national registries in Norway and ended December 31, 2006 for incidence and December 31, 2005 for mortality. The primary endpoint was incidence of CRC after 5, 10, and 15 years of follow-up based on an intention-to-screen analysis. The two randomly assigned groups had the same median age of 59 years and equal gender distribution. The attendance rate for screening was 65%. Mean insertion depth of the endoscope was 48.9 cm for men and 44.0 cm for women, with no severe complications. A neoplastic lesion was found in 19% of people screened, and 5% had a high-risk adenoma or invasive cancer. There were 33 prevalent CRCs, 17 in the subgroup invited for sigmoidoscopy only and 16 in the subgroup invited to both tests. Compliance for colonoscopy work-up was 97%. There was no difference in the cumulative hazard of CRC between the screened and control groups; 134.5 versus 131.9 cases per 100,000 person years, after a median follow-up of 7 years. The hazard ratio (HR) for CRC mortality was 0.73 (95% CI, 0.47–1.13) and for rectosigmoidal cancer mortality was 0.63 (95% CI, 0.34–1.18) after a median follow-up of 6 years. The HR for all-cause mortality was 1.02 (95% CI, 0.98–1.07). Additional follow-up is planned.[42]
In the Telemark Study in Norway, 400 people aged 50 to 59 years were offered FS in 1983 and, if polyps were found, a colonoscopy was available to them at that time, and again 2 years later, and also 6 years later (the intervention was more aggressive than the one-time sigmoidoscopy currently being tested in the United Kingdom). A nonrandomized control group was selected that did not have a baseline examination. In 1996, all persons were invited to have a colonoscopy. The result was that ten persons in the control group and two in the screening group developed CRC (RR = 0.2; 95% CI, 0.03–0.95). The screening group, however, had a higher overall mortality compared with the control group.[43]
A RCT of sigmoidoscopy screening in the United Kingdom suggests that the impact of endoscopic screening, at least on the left side of the colon, is substantial and prolonged. In this RCT, 170,000 persons were randomly assigned to one-time sigmoidoscopy versus usual care. At sigmoidoscopy, polyps were removed and patients with cancer were referred for treatment. Based on sigmoidoscopy findings, persons were considered to be low risk if they had normal exams or only one or two small (<1 cm) tubular adenomas; such persons were not referred for either colonoscopy workup or colonoscopic surveillance. In a follow-up of 10 years, the left-sided CRC incidence in the low-risk group (about 95% of attendees were low risk) was 0.02% to 0.04% per year—a very low risk of CRC compared with average risk. The cause of reduced risk—whether due to detection and removal of large or small polyps, or selection of individuals at lower risk—is yet unclear,[44] but may be assessed in further analysis. The natural history of large polyps is not well known, but some evidence suggests that such lesions become clinical CRC at a rate of approximately 1% per year.[45] Evidence from multiple studies has raised questions about the ability of endoscopy to reduce CRC mortality in the right colon.[46,47,48] Thus, it is unclear what the overall impact of endoscopy (e.g., colonoscopy screening) is, and whether there may be a large difference in impact on the left side of the colon compared with the right side.[46]
The SCORE RCT from Italy randomly assigned 34,272 participants aged 55 to 64 years to either one-time FS or control. About 58% of FS group participants actually had an FS. After 10.5 years of follow-up, CRC incidence was reduced in the FS group by 18% (RR, 0.82; 95% CI, 0.69–0.96), with the reduction beginning about 5 years after randomization. CRC mortality in the FS group was also lower than in the control group, but not to a statistically significant degree (RR, 0.78; 95% CI, 0.56–1.08). Overall, these results are consistent with the United Kingdom results.[49]
Sigmoidoscopy screening was also evaluated in the Prostate, Lung, Colorectal, and Ovarian Cancer (PLCO) screening randomized trial.[50] Results were very similar to those of the United Kingdom trial. In PLCO, 77,445 men and women aged 55 to 74 years were randomly assigned to receive 60 cm flexible sigmoidoscopy screening at baseline and again at 3 or 5 years from 1993 to 2001 depending on their date of entry into the trial. The 77,455 men and women randomly allocated to the control arm received usual medical care. An examination was considered positive if a polyp or mass was detected. Participants were then referred to their primary care physicians for diagnostic follow-up. A total of 86.6% of participants underwent at least one sigmoidoscopy screening and 28.5% were positive. Of these, 80.5% had a diagnostic evaluation, of which 95.6% underwent colonoscopy. Thus 21.9% of participants in the intervention arm had a colonoscopy. Colorectal cancer screening in the control arm (contamination) was assessed by a questionnaire in a small sample of participants. The rate was estimated as 46.5%. In addition, the rate of colonoscopy after the screening phase was estimated as 47.7% in the intervention arm and 48.0% in the control arm.
The primary endpoint was colorectal cancer mortality, with colorectal cancer incidence a key secondary endpoint. All cancers and deaths were ascertained primarily by means of an annual questionnaire. Median follow-up time was 11.9 years and vital status within a year of the cutoff date was known for 99.9% of participants. The incidence rate of colorectal cancer was 11.9 per 10,000 person years in the intervention arm (1,012 cases) versus 15.2 in the usual care arm (1,287 cases) yielding a statistically significant RR of 0.79 (95% CI, 0.72–0.85). The absolute colorectal cancer risk reduction was 0.35%. In the distal colon the RR was 0.71 (95% CI, 0.64–0.80) while in the proximal colon the RR was 0.86 (95% CI, 0.76–0.97). The colorectal cancer mortality rate was 2.9 deaths per 10,000 person-years in the intervention arm (252 deaths) versus 3.9 deaths in the usual care arm (341 deaths) for a statistically significant RR of 0.74 (95% CI, 0.63–0.87). The absolute reduction in risk of colorectal cancer death was 0.11%. The mortality RR for the distal colon was 0.50 (95% CI, 0.38–0.64) while that for the proximal colon was 0.97 (95% CI, 0.77–1.22). Treatment of diagnosed colorectal cancers was very similar by arm within each stage. The rate of bowel perforations was 2.8 per 100,000 sigmoidoscopies. False positive screening results were observed in 20% of men and 13% of women. The RR for deaths from all causes excluding prostate, lung, colorectal, and ovarian cancers was 0.98 (95% CI, 0.96–1.01).[50]
Two case-control studies have been reported that evaluate the efficacy of screening sigmoidoscopy in preventing CRC mortality;[51,52] one study used rigid sigmoidoscopy, and the other used rigid and FS. Both studies were conducted in prepaid health plans and suggested a significantly decreased risk (70%–90%) of fatal cancer of the distal colon or rectum among individuals with a history of one or more sigmoidoscopic examinations compared with nonscreened patients.
There are no strong direct data to determine frequency of screening tests in programs of screening.
Combination of FOBT and Flexible Sigmoidoscopy
A combination of FOBT and sigmoidoscopy might increase the detection of lesions in the left colon (compared with sigmoidoscopy alone) while also increasing the detection of lesions in the right colon. Sigmoidoscopy detects lesions in the left colon directly but detects lesions in the right colon only indirectly when a positive sigmoidoscopy (that may variously be defined as a finding of advanced adenoma, any adenoma, or any polyp) is used to trigger a colonoscopic examination of the whole colon.
In 2,885 veterans (97% male; mean age 63 years), the prevalence of advanced adenoma at colonoscopy was 10.6%. It was estimated that combined screening with one-time FOBT and sigmoidoscopy would detect 75.8% (95% CI, 71.0%–80.6%) of advanced neoplasms. Examination of the rectum and sigmoid colon during colonoscopy was defined as a surrogate for sigmoidoscopy. This represented a small but statistically insignificant increase in the rate of detection of advanced neoplasia when compared with FS alone (70.3%; 95% CI, 65.2%–75.4%). The latter result could be achieved assuming that all patients with an adenoma in the distal colon undergo complete colonoscopy. Advanced neoplasia was defined as a lesion measuring at least 10 mm in diameter, containing 25% or more villous histology, high-grade dysplasia, or invasive cancer.[53] One-time use of FOBT differs from the annual or biennial application reported in those studies summarized in Table 1.
A study of 21,794 asymptomatic persons (72% were men) who had both colonoscopy and fecal immunochemical testing (FIT) for occult blood compared the detection of right-sided cancers as triggered by different test results. FIT alone resulted in a sensitivity of 58.3% and a specificity of 94.5% for proximal cancer diagnosis. FIT plus the finding of advanced neoplasia in the rectosigmoid colon yielded a sensitivity of 62.5% and a specificity of 93%. Thus, in this trial, the addition of sigmoidoscopy to FIT did not substantially improve the detection of right-sided colon cancers, compared with FIT alone.[54]
The NORCCAP once-only screening study randomly assigned 20,780 men and women, aged 50 to 64 years, to FS only or a combination of FS and FOBT with FlexSure OBT.[55] A positive FS was defined as a finding of any neoplasia or any polyp at least 10 mm. A positive FS or FOBT qualified for colonoscopy. Attendance in this study was 65%. Forty-one cases of CRC were detected (0.3% of screened individuals). Adenomas were found in 2,208 participants (17%), and 545 (4.2%) had high-risk adenomas. There was no difference in diagnosis yield between the FS only and the FS and FOBT groups regarding CRC or high-risk adenoma. There were no serious complications after FS, but there were six perforations after therapeutic colonoscopy (1:336).
Barium Enema
As part of the National Polyp Study, colonoscopic examination and barium enema were compared in paired surveillance examinations in those who had undergone a prior colonoscopic polypectomy.[56] The proportion of examinations in which adenomatous polyps were detected by barium enema was related to the size of the adenoma (P = .009); the rate was 32% for colonoscopic examinations in which the largest adenomas detected were no larger than 5 mm, 53% for those in which the largest adenomas detected were 6 mm to 10 mm, and 48% for those in which the largest adenomas detected were larger than 10 mm. In patients who have undergone colonoscopic polypectomy, colonoscopic examination is a more sensitive method of surveillance than double-contrast barium enema.
Because there are no RCTs of colonoscopy, evidence of benefit is indirect. Most indirect evidence is about detection rate of lesions that may be clinically important (like early CRC or advanced adenomas). Some case-control results are available. One RCT of colonoscopy has been initiated.[57]
Evidence about lesion detection rate
In a colonoscopic study of 3,121 predominantly male U.S. veterans (mean age: 63 years), advanced neoplasia (defined as an adenoma that was ≥10.0 mm in diameter, a villous adenoma, an adenoma with high-grade dysplasia, or invasive cancer) was identified in 10.5% of the individuals.[58] Among patients with no adenomas distal to the splenic flexure, 2.7% had advanced proximal neoplasia. Patients with large adenomas (≥10.0 mm) or small adenomas (<10.0 mm) in the distal colon were more likely to have advanced proximal neoplasia than were patients with no distal adenomas (OR = 3.4; 90% CI, 1.8–6.5 and OR = 2.6; 90% CI, 1.7–4.1, respectively). One-half of those with advanced proximal neoplasia, however, had no distal adenomas. In a study of 1,994 adults (aged 50 years or older) who underwent colonoscopic screening as part of a program sponsored by an employer, 5.6% had advanced neoplasms.[59] Forty-six percent of those with advanced proximal neoplasms had no distal polyps (hyperplastic or adenomatous). If colonoscopic screening is performed only in patients with distal polyps, about half the cases of advanced proximal neoplasia will not be detected.
A study of colonoscopy in women compared the yield of sigmoidoscopy versus colonoscopy. Among 1,463 women, cancer was found in one woman and advanced colonic neoplasia in 72 women or 4.9% (about one-half the prevalence compared with men). The authors focused, however, on RR (i.e., RR of missing an advanced neoplasm) as the outcome, instead of absolute risk of such neoplasms, which is substantially lower in women. In addition, the natural history of advanced neoplasia is not known, so its importance as an outcome in studies of detection is not clear.[60]
Analysis of data from a colonoscopy-based screening program in Warsaw, Poland demonstrated higher rates of advanced neoplasia in men than in women. The predominant age range of participants was 50 to 66 years. Of the 43,042 participants aged 50 to 66 years, advanced neoplasia was detected in 5.9% (5.7% among women with a family history of CRC, 4.3% among women without a family history of CRC, 12.2% among men with a family history of CRC, and 8.0% among men without a family history of CRC). Clinically significant complications requiring medical intervention were rare (0.1%) consisting of five perforations, 13 episodes of bleeding, 22 cardiovascular events, and 11 other events over the entire population of 50,148 screened persons. There were no deaths; however, the author reported that collection of 30-day complications data was not systematic (therefore, the data may not be reliable).[61]
Detection rates in colonoscopy screening vary with the rate at which the endoscopist examines the colon while withdrawing the scope. Detection rates among gastroenterologists (mean number of lesions per patient screened, 0.10–1.05; range of the percentage of patients with adenomas, 9.4%–23.7%) and the times to withdraw (3.1–16.8 minutes for procedures not including polyp removal). Examiners whose mean withdrawal time was 6 minutes or more had higher detection rates than those with mean withdrawal times of less than 6 minutes (28.3% vs. 11.8%; P < .001 for any neoplasia) and (6.4% vs. 2.6%; P < .005 for advanced neoplasia).[62] Overall detection rate of adenomas and cancer may be affected by how thoroughly endoscopists search for flat adenomas and flat cancer. While the phenomenon of flat neoplasms has been appreciated for years in Japan, it has more recently been described in the United States. In a study in which endoscopists used high-resolution white-light endoscopes, flat or nonpolypoid lesions were found to account for only 11% of all superficial colon lesions, but they were about 9.8 times as likely to contain cancer (in situ neoplasia or invasive cancer) compared with polypoid lesions.[41] However, because the definition of flat or nonpolypoid was height less than one-half of the diameter, it is likely that many lesions classified as nonpolypoid in this study would be routinely found and described by U.S. endoscopists as sessile. At the same time, the existence of very flat or depressed lesions (depressed lesions are very uncommon but are highly likely to contain cancer) means that endoscopists will want to pay increasing attention to this problem.[63] Flat lesions may play a role in the phenomenon of missed cancers.[64]
Flat or difficult-to-detect lesions include "serrated polyps," which may be more common in the right colon than they are in the left. The term serrated polyp is currently used to include hyperplastic polyps, sessile serrated adenomas, traditional serrated adenomas, and mixed serrated polyps.[65,66] The clinical significance of these lesions is uncertain, because the natural history is so difficult to learn for any polypoid lesion. However, the histologic and molecular characteristics of some serrated lesions suggest possibly important malignant potential (mutations in the BRAF gene may be an early step toward carcinogenesis in serrated polyps).[66] This potential, along with the challenges of detecting flat lesions, may partially account for recent reports of a colonoscopy's lesser protective effect in the right colon compared to the left.
In 2011, authors of one study reported variability of detection rates for proximal serrated polyps. They studied 15 colonoscopists on faculty at one university and showed, during the years 2000 to 2009, a wide variation in detection rate for proximal serrated polyps, ranging (per colonoscopy) from 0.01 to 0.26, suggesting that many proximal serrated lesions may be missed on routine exam.[65] The overall proportion of polyps that are "serrated" is unknown, in part because these lesions have been unappreciated and/or difficult to identify.
Evidence about colorectal cancer mortality reduction
Although there is no RCT to assess reduction of CRC incidence or mortality by colonoscopy, some case-control evidence is available. Based on case-control data about sigmoidoscopy, noted above, it has been speculated in the past that protection for the right colon might be similar to that found for the left colon. However, a recent case-control study of colonoscopy raises questions about whether the impact of colonoscopy on right-sided lesions might be different than the impact on left-sided lesions.[47] Using a province-wide administrative data base in Ontario, investigators compared cases of persons who had received a diagnosis of CRC from 1996 to 2001 and had died by 2003. Controls were selected from persons who did not die of CRC. Billing claims were used to assess exposure to previous colonoscopy. The OR for the association between complete colonoscopy and left-sided lesions was 0.33, suggesting a substantial mortality reduction. For right-sided lesions, however, the OR of 0.99 indicated virtually no mortality reduction.
This difference, which was striking and unexpected, might be explained in several possible ways and has been discussed extensively.[67] It is possible that exams were incomplete and did not reach the cecum even though they were coded as complete. It is possible that poor prep or incomplete mucosal inspection caused important lesions to be missed. It is also possible that examination was complete but some right-sided lesions simply grow rapidly and are not detected and treated by periodic colonoscopy. In other words, it is impossible to determine the reason for the dramatically different results on the right side compared to the left side, which are either the result of physician-related and patient-related factors or are the result of the biology of cancer.
Even if it is not possible to determine which reasons may be responsible for the right side versus the left side difference, the findings beg the question, "What is the degree of mortality reduction from colonoscopy?" While a figure of 90% is sometimes cited as the degree of mortality reduction,[68] the question will not be properly answered until the European study is completed.[57] In the meantime, the results of the study mentioned above [47] question what is known about the degree of CRC mortality reduction provided by colonoscopy. Until there are more reliable results from RCTs, it may be prudent to expect an approximately 60% to 70% CRC mortality reduction, based on consideration of these studies and other data.[67]
Evidence about colorectal cancer reduction
A case-control study assessed CRC reduction (not CRC mortality reduction) in the right side versus the left side. In a population-based study from Germany, data were obtained from administrative records and medical records; 1,688 case patients (with CRC) were compared with 1,932 participants (without CRC), aged 50 years or older.[46] Data were collected about demographics, risk factors, and previous screening examinations. According to colonoscopy records, the cecum was reached 91% of the time. Colonoscopy in the previous 10 years was associated with an OR for any CRC of 0.23, for right-sided CRC of 0.44, and for left-sided CRC of 0.16. While this study does not assess CRC mortality, the results suggest that the magnitude of the right side versus the left side difference may be smaller than previously found.[47] It would be extremely useful to assess right side versus left side differences in a RCT.
Virtual Colonoscopy (Computed Tomographic [CT] Colonography)
Virtual colonoscopy (also known as CT colonography or CT pneumocolon) refers to the examination of computer-generated images of the colon constructed from data obtained from an abdominal CT examination. These images simulate the effect of a conventional colonoscopy. Patients must take laxatives to clean the colon before the procedure, and the colon is insufflated with air (sometimes carbon dioxide) by insertion of a rectal tube just prior to radiographic examination.[69]
A large, paired-design study was conducted by the American College of Radiology Imaging Network group, with 2,531 average-risk people (prevalence of polyps or cancer greater than or equal to 10 mm = 4%; mean age about 58 years) screened with both CT colonography and optical colonoscopy (OC). The gold standard was the OC, including repeat OC exams for people with lesions found by computed tomographic colonography (CTC) but not by OC. Of 109 people with at least one adenoma or cancer greater than or equal to 10 mm, 98 (90%) were detected by CTC (referring everyone with a CTC lesion of 5 mm or greater). Specificity was 86% and PPV was 23%. There are several concerns from this study, including the following:
Unknowns from the study include the following for either OC or CTC: the number of detected polyps that would have progressed to invasive cancer, and the number of people harmed by the screening process.[70]
Another study reported similar sensitivity and specificity in persons with an increased risk of CRC.[71] In this study, the sensitivity of OC could not be determined because it was done in an unblinded manner. This study suggests that virtual colonoscopy might be an acceptable screening or surveillance test for persons with a high risk of CRC, but this cross-sectional study does not address outcome or frequency of testing in high-risk persons.
Some studies have assessed how well virtual colonoscopy can detect colorectal polyps without a laxative prep. The question is of great importance for implementation because the laxative prep required by both conventional colonoscopy and virtual colonoscopy is considered a great disadvantage by patients. By tagging feces with iodinated contrast material ingested during several days prior to the procedure, investigators in one study were able to detect lesions larger than 8 mm with 95% sensitivity and 92% specificity.[72] The particular tagging material used in this study caused about 10% of patients to become nauseated; however, other materials are being assessed.
Another study [73] utilized low fiber diet, orally ingested contrast, and 'electronic cleansing', a process that subtracts tagged feces. CTC identified 91% of persons with adenomas 10 mm or larger, but detected fewer (70%) lesions greater than or equal to 8 mm. Patients who received both CTC and optical colonoscopy preferred CTC to optical colonoscopy (290 vs. 175). This study shows that CTC without a laxative prep detects small 1 cm lesions with high sensitivity and is acceptable to patients. Long-term utilization of CTC will depend on several issues including the frequency of follow-up exams that would be needed to detect smaller lesions that were undetected and may grow over time.
Extracolonic abnormalities are common in CT colonography. Fifteen percent of patients in an Australian series of 100 patients, referred for colonography because of symptoms or family history, were found to have extracolonic findings, and 11% of the patients needed further medical workups for renal, splenic, uterine, liver, and gallbladder abnormalities.[74] In another study, 59% of 111 symptomatic patients referred for clinical colonoscopy in a Swedish hospital between June 1998 and September 1999 were found to have moderate or major extracolonic conditions on CT colonography. CT colonography was performed immediately prior to colonoscopy and these findings required further evaluation. It is unstated to what extent the follow-up of these incidental findings benefited patients.[75]
Sixty-nine percent of 681 asymptomatic patients in Minnesota had extracolonic findings, of which 10% were considered to be highly important by the investigators, requiring further medical workup. Suspected abnormalities involved kidney (34), chest (22), liver (8), ovary (6), renal or splenic arteries (4), retroperitoneum (3), and pancreas (1);[76] however, the extent to which these findings will contribute to benefits or harms is uncertain. Two other studies, one large (n = 2,195) and one small (n = 136) examined the moderate or high importance of extracolonic findings from CTC. The larger study [77] found that 8.6% of patients had an extracolonic finding of at least moderate importance, while 24% of patients in the smaller study [78] required some evaluation for an extracolonic finding. The larger study found nine cancers from these evaluations, at a partial cost (they did not include all costs) of $98.56 per patient initially screened. The smaller study found no important lesions from evaluation, at a cost of $248 per person screened. Both of these estimates of cost are higher than previous studies have found. The extent to which any patients benefited from the detection of extracolonic findings is not clear. Because both of these studies were conducted in academic medical centers, the generalizability to other settings is also not clear. Neither of these studies examined the effect of extracolonic findings on patient anxiety and psychological function.
Technical improvements involving both the interpretation methodology, such as three dimensional (3-D) imaging, and bowel preparation are under study in many centers. While specificity for detection of polyps is homogeneously high in many studies, sensitivity can vary widely. These variations are attributable to a number of factors including characteristics of the CT scanner and detector, width of collimation, mode of imaging (two dimensional [2-D] vs. 3-D and/or "fly-through"), and variability in expertise of radiologists.[79]
Digital Rectal Examination
A case-control study reported that routine digital rectal examination was not associated with any statistically significant reduction in mortality from distal rectal cancer.[80]
Detection of DNA Mutations in the Stool
The molecular genetic changes that are associated with the development of colorectal adenomas and carcinoma have been well characterized.[81] Advanced techniques have been developed to detect several of these gene mutations that have been shed into the stool.[82,83,84,85] Stool DNA testing was recently assessed in a prospective study of asymptomatic persons who received colonoscopy, three-card FOBT (Hemoccult II), and stool DNA testing based on a panel of markers assessing 21 mutations. Conducted in a blinded way with prestated hypotheses and analyses, the study found that among 4,404 patients, the DNA panel had a sensitivity for CRC of 51.6% (for all stages of CRC) versus 12.9% for Hemoccult II, while the false-positive rates were 5.6% and 4.8%, respectively. On this basis, the approach looks promising but would be improved, if possible, by increased sensitivity (perhaps by increasing the number of DNA markers) and by reduced cost.[86,87]
Harms are associated with the various modalities used to screen for colorectal cancer (CRC).
Fecal Occult Blood Testing (FOBT)
A systematic review done through the Cochrane Collaboration examined all CRC screening randomized trials that involved FOBT on more than one occasion. The trials reported a low positive predictive value for the FOBT, suggesting that more than 80% of all positive tests were false-positives.[1] A positive test can lead to further diagnostic procedures that include colonoscopy or double-contrast barium enema plus flexible sigmoidoscopy.
Sigmoidoscopy can be an uncomfortable or painful procedure. Women may have more pain during the procedure, which may discourage them from returning for future screening sigmoidoscopies. Sigmoidoscopy can also cause perforation and bleeding, although this is rare.
Clinically significant complications requiring medical intervention are rare but can include the following: perforations, bleeding, cardiovascular events, and other adverse events. The rate of complications may increase among older persons.[2]
Computed Tomographic (CT) Colonography
Extracolonic abnormalities are common in CT colonography. Fifteen percent of patients in an Australian series of 100 patients, referred for colonography because of symptoms or family history, were found to have extracolonic findings, and 11% of the patients needed further medical workups for renal, splenic, uterine, liver, and gallbladder abnormalities.[3] Other areas of extracolonic findings include the chest, ovary, and pancreas. In another study, 59% of 111 symptomatic patients referred for clinical colonoscopy in a Swedish hospital between June 1998 and September 1999 were found to have moderate or major extracolonic conditions on CT colonography. CT colonography was performed immediately prior to colonoscopy, and these findings required further evaluation. It is unstated to what extent the follow-up of these incidental findings benefited patients.[4]
Sixty-nine percent of 681 asymptomatic patients in Minnesota had extracolonic findings, of which 10% were considered to be highly important by the investigators, requiring further medical workup. Suspected abnormalities involved kidney (34), chest (22), liver (8), ovary (6), renal or splenic arteries (4), retroperitoneum (3), and pancreas (1).[5]
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Evidence of Benefit
Added text to state that the guaiac test identifies peroxidase-like activity that is characteristic of human and nonhuman hemoglobin, thus recording blood from ingested meat, airway bleeding such as epistaxis, and upper gastrointestinal bleeding, as well as colonic lesions.
Revised text to state that at a median follow-up time of 7.8 years, 60% completed at least one fecal occult blood test (FOBT) and 38% completed all tests.
Added text to state that when the median follow-up was extended to 19.5 years, there was a 9% reduction in colorectal cancer mortality but no reduction in colorectal incidence, or death from all causes (cited Scholefield et al. as reference 13).
Revised Table 3 with changes made to the % Cancers Localized column, and revisions to the Sweden row.
Added text to state that the immunochemical FOBT (iFOBT) was developed to detect intact human hemoglobin, and its advantage over guaiac FOBT is that it does not detect hemoglobin from nonhuman dietary sources; preliminary studies of several commercially developed iFOBT tests show that iFOBT is generally more sensitive for cancers than for benign neoplasias.
Added text about the sigmoidoscopy screening portion of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer screening randomized trial in which 77,445 men and women aged 55 to 74 years were randomly assigned to receive either 60 cm flexible sigmoidoscopy screening at baseline and again at 3 or 5 years, or usual medical care from 1993 to 2001 (cited Schoen et al. as reference 50).
Added text to state that the primary endpoint of the sigmoidoscopy screening evaluation of the PLCO trial was colorectal cancer mortality and that the colorectal cancer mortality rate was 2.9 deaths per 10,000 persons-years in the intervention arm (252 deaths) versus 3.9 deaths in the usual care arm (341 deaths) for a statistically significant relative risk (RR) of 0.74; the RR for deaths.
Added text about a study that utilized low fiber diet, orally ingested contrast, and 'electronic cleansing', a process that subtracts tagged feces, that found that computed tomographic colonography without a laxative prep detects small 1 cm lesions with high sensitivity and is acceptable to patients (cited Zalis et al. as reference 73).
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This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about colorectal cancer screening. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the PDQ Screening and Prevention Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Board members review recently published articles each month to determine whether an article should:
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National Cancer Institute: PDQ® Colorectal Cancer Screening. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://cancer.gov/cancertopics/pdq/screening/colorectal/HealthProfessional. Accessed <MM/DD/YYYY>.
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Tag Archives: Daniel McNaughton
"Simeon Toribio (1905-1969): A World-Class High Jumper" by Joboy Quintos
May 27, 2013Posted by on
It has been eighty-years since Simeon Toribio won the high jump bronze medal from the Los Angeles Olympic Games. Ask any Filipino about Toribio and chances are, you'll be met with a blank stare. I know for a fact that athletics in the Philippines is nothing more than a fringe sport. The days of Lydia de Vega are long gone. And despite the best efforts of our national athletes, the sport is hard pressed to break into mainstream consciousness.
Perhaps a look back into our storied athletics history could bring back a sense of pride, and lift our collective desensitation from decades of being sporting minnows.
I first read about the exploits of Toribio and Miguel White back in college, through the fine book entitled "Philippine Sporting Greats." White, winner of the 400m hurdles bronze in Berlin, died during the Japanese invasion at the early stages of the Second World War. The Bohol-born Toribio, fortunately, survived that terrible episode and lived well into his sixties.
Toribio was a renaissance man in every sense of the word. In my readings of Jorge Afable's "Philippine Sports Greats", I was amazed at how he balanced a full-time job with a no non-sense athletics training regimen.[1] In his heyday, the tall Toribio reigned supreme in Asian high jumping circles. In a thirteen year period spanning from 1921 to 1934,[2] the Filipino champion won a staggering five gold medals in Far Eastern Games, the precursor to today's Asian Games.
The Filipino made his Olympic debut in Antwerp back in 1928.[3] Bob King won gold with a superior mark of 1.94m.[4] The next four jumpers, Toribio included, had identical jumps of 1.91m.[5] However, Toribio missed out on the bronze in the ensuing jump-off.[6]
He reached the pinnacle of his career in Los Angeles, where he sailed over 1.97m to win bronze. The 1932 Summer Olympics was the Philippines' most successful foray into the World's Greatest Show, with three bronze medals. Teofilo Yldefonso snared his second Olympic third place finish in as many attempts, while boxer Jose Villanueva grabbed the bronze medal in the bantamweight division.
The high jump competition in Los Angeles was a long drawn battle, taking four hours according to Afable. With the top four jumpers all tied with clearances of 1.97m, another jump-off was held to determine the placings.[7] The competitors all failed to clear 2.007m and 1.99m.[8] The gold was awarded to Canada's Daniel McNaughton, who had a first-time clearance over 1.97m, [9] while Bob Van Osdel of the United States took the silver.
Afable wrote about a peculiar competition rule from that era that required athletes to stay at the competition grounds during the entire event, and opined that had Toribio not been burdened by the "call of nature," he could have cleared 2.007m.[10] Coming into the Games, the Filipino had a personal best of 2.00m set in 1930. Perhaps because of discomfort, the then 26-year old Toribio took three attempts[11] to negotiate 1.94m and 1.97m – heights well within his capabilities.
A helpful Japanese coach lent a blanket for Toribio to cover himself in as he relieved his bladder!
The world record at that time was at 2.03m, with the Olympic record at 1.98m.
Toribio competed at the 1936 Berlin Olympics, his third Olympiad, but finished outside the medals. During the War, he narrowly escaped arrest by the Kempeitai when a Japanese officer saw one of Toribio's mementoes from an athletics competition in Japan (If my memory serves me right, it was a memento from the 1923 Far Eastern Games in Osaka. I'd have to verify this by reading "Philippine Sports Greats" again).[12] Since it was the Japanese emperor's birthday, the Kempeitai officer spared Toribio.[13]
The Filipino high jumper went on to become a congressman in his native Bohol, serving his constituents for 12 years.
Eighty-two years since Simeon Toribio set his 2.00m personal best, the Philippine high jump record has improved by a mere 17cm. Nowadays, it is a rarity to see a Filipino athlete qualify for an outright Olympics slot, much less make it to the top eight. It is sad to note that in local collegiate- and national-level track & field meetings today, a 2.00m clearance is still deemed competitive.
Curing the ills of Philippine athletics will be a hard fought struggle. Let us remember – and honor – our past heroes, and draw inspiration from their world-beating feats.
Article by Joboy Quintos
- Afable, Jorge (1972). "Philippine Sports Greats."
- "Simeon Toribio." http://en.wikipedia.org/wiki/Simeon_Toribio. Retrieved 8-19-2012.
- Afable 1972.
- "Athletics at the 1932 Los Angeles Summer Games: Men's High Jump." http://www.sports-reference.com/olympics/summer/1932/ATH/mens-high-jump.html. Retrieved 8-19-2012.
- "Simeon Toribio."
- "Athletics at the 1932 Los Angeles Summer Games: Men's High Jump."
- "Athletics at the 1932 Los Angeles Summer Games: Men's High Jump."
- "Athletics at the 1932 Los Angeles Summer Games: Men's High Jump."
- "Athletics at the 1932 Los Angeles Summer Games: Men's High Jump."
- Afable 1972.
- "Simeon Toribio." http://www.sports-reference.com/olympics/athletes/to/simeon-toribio-1.html. Retrieved 8-19-2012.
- Afable 1972.
- Afable 1972.