Prognostic Tests – to use or not use . . .  or rather  … To treat or not to treat?

New studies for stage II colon cancer patients contemplating chemotherapy .

by: Nancy Roach

Nancy Roach, Chair of the Board

One of the toughest decisions for patients with stage II colon cancer is whether or not to receive chemotherapy after surgery.

In a perfect world, there would be a test that could predict whether or not the cancer will reoccur and research to predict which treatment will help each patient at risk. For now, each patient’s decision is based on a wide variety of factors.

Tests to determine if the cancer has spread

Fight Colorectal Cancer hosted a webinar in 2010 with Dr. John Marshall from Lombardi Cancer Center and the late Kate Murphy from Fight Colorectal Cancer. The webinar laid out a decision-making roadmap, including a discussion of OncoType DX®, a test that may help predict risk of recurrence. Another webinar in 2011 featured Dr. Edith Mitchell from Kimmel Cancer Center and discussed research results from two similar tests, Previstage^TM  and Coloprint®.

At this year’s ASCO® meeting, a poster (abstract 3639) presented by Dr. Daniel Sargent from Mayo Clinic provided an update on research around Previstage^TM . GCC is a gene present on the surface of colon cells, but not on the surface of normal lymph node cells. The Previstage^TM  test looks for GCC genes in lymph node cells.

The theory is that if the GCC gene is present in lymph nodes, cells from the colon traveled outside of the colon. This type of cellular activity happens in cancer cells – not normal cells.  Check out this video to learn more (note:  the video was created by DiagnoCure, the company that owns Previstage^TM ).

Testing for GCC genes

Dr. Sargent’s team looked at GCC test results from lymph nodes collected between 1999 and 2008 from 463 patients with stage II colon cancer. The patients were classified as “High Risk” or “Low Risk” based on the ratio of lymph nodes with positive GCC results to lymph nodes with negative results.

Their prediction was that patients classified as “High Risk” would be much more likely to have recurrences.

The first analysis of the data did not provide the insight researchers hoped for:  The GCC results classified 195 patients as “High Risk,” but only 22 of those patients had recurrences.

The team looked back to see if they could understand why their prediction was so far off and found that:

• One research site had collected lymph nodes in a way that meant the Previstage^TM  test wouldn’t work correctly
• A different “risk scale” of High, Medium and Low might be more helpful

When they re-ran the data leaving out the un-analyzable nodes and the High, Medium and Low risk scale, the test results were more meaningful:

The results of the second test look more promising; however, they need to be validated with a pre-specified hypothesis.

In addition, 23 patients with Medium or Low Risk tumors also had a recurrence, which means that while GCC may be important, it is not the only factor involved with recurrence.

While Previstage^TM  can’t predict whether chemotherapy will reduce the chance that cancer will come back, it may help patients and their doctors decide whether or not to undergo chemotherapy in combination with other factors.

Patient take-away:

If you are diagnosed with stage II colon cancer, there is no single test that will tell you how likely you are to have a recurrence. You and your doctor need to discuss a variety of risk factors such as:

• Micro-satellite instability status
• Depth of tumor penetration into your colon wall
• How far the tumor has penetrated your colon wall
• Risks of chemotherapy

The National Comprehensive Cancer Network patient guidelines have a thorough overview of risk factors starting on page 47.  A 2^nd opinion at a major cancer center may also be appropriate.

Disclosure: Fight Colorectal Cancer has accepted funding for projects and educational programs from Genomic Health in the form of unrestricted educational grants. Fight Colorectal Cancer has ultimate authority over website content.

Want to be “in the know?”

Then make sure to join our FREE June webinar, What’s New & What’s on the Horizon. In partnership with Colon Cancer Alliance (CCA), we will present some of the latest information regarding colorectal cancer.

Representatives from both CCA and Fight Colorectal Cancer attended the 2013 Gastrointestinal Cancers Symposium co-sponsored by the American Society of Clinical Oncology®. Our teams will report on the latest news in cancer research and care.

Our webinar will touch on:

• the key 2013 colorectal cancer findings
• updates on FDA-approved drugs for colorectal cancer
• information about what’s next for colorectal cancer patients
• news about research

The webinar will be presented by Dr. John Marshall, Director of the Otto J Ruesch Center for the Cure of Gastrointestinal Cancers, Chief of the Division of Hematology and Oncology at Georgetown University Hospital and Associate Director for Clinical Research for Lombardi Comprehensive Cancer Center. Read his biography here.

Key Info…

Date:  Wednesday, June 19, 2013

Time:  8-9:30pm ET / 7-8:30pm CT / 6-7:30pm MT/ 5-6:30pm PT

Cost:  FREE

To Register:  Click here! 

Help spread the word:  Distribute this flyer

Find more topics from our Webinar Series library. See what 11K + have learned from our material.

But this week, experts at the 2013 ASCO meeting (American Society of Clinical Oncology), announced strong evidence that the calcium/magnesium does no good in either preventing or decreasing neuropathy—and it should no longer be part of routine treatment.

Neuropathy affects cancer treatment

Oxaliplatin-based chemotherapy (e.g. FOLFOX, with Eloxatin®) is one of the most commonly used drugs for people having high-risk stage II, or stages III or IV colorectal cancer. But far too often after patients have had many doses of FOLFOX over months, they have to stop this effective treatment because of increasing neuropathy—burning or numbness especially in hands and feet that becomes chronic, even permanent.

Based on two earlier preliminary studies (and biological reasoning), many oncologists began giving calcium and magnesium intravenously a half-hour before and/or after the chemotherapy, in an effort to prevent the nerve damage.

But in results from the first large, randomized trial announced at this week’s ASCO meeting, researchers found absolutely no effect from the calcium/magnesium.

Trial shows no benefit

A multisite trial randomly assigned 350 colon cancer patients receiving FOLFOX into three groups—one receiving the calcium/magnesium before and after chemo; a second receiving a look-alike placebo; and the third group getting calcium/magnesium before chemo and a placebo afterwards.

The symptoms of nerve damage—measured in multiple ways—were no different in any of the three groups of patients.

Also, there were no differences in the average number of days until symptoms became significant, or in the number of patients who had to stop the chemotherapy.

“This study did not demonstrate any activity of IV CaMg [calcium magnesium]…” said lead author Charles Loprinzi from the Mayo Clinic. He noted that when he has asked medical meeting audiences how many use intravenous Ca/Mg, more than half the clinicians present say they do.

“This practice should now be stopped,” he told Medscape Medical News in an interview.

Practice-changing results; lesson learned

The study was called “practice changing,” by Dr. Richard Wilson from Queen’s University Belfast in Northern Ireland, speaking at a “Highlights of the Day” ASCO session.

The lesson learned, Dr. Wilson said, was that the original 2004 French study was not randomized and too small for definitive proof, but raised doctors’ hopes. Another 2011 study by Mayo Clinic’s Dr. Axel Grothey (a Medical Advisory Board member for Fight Colorectal Cancer) also showed promising early results. But Grothey’s study had to be stopped early before it could get enough participants because of concerns (later disproven) from a different ongoing study. Studies have shown that the calcium/magnesium infusion does not cause harm, and does not interfere with other chemotherapy drugs’ effectiveness.

Patient take-away

If you are currently getting chemotherapy based on oxaliplatin (e.g. FOLFOX, CapeOx), ask if you are also getting a calcium/magnesium intravenous infusion. If you are, take some time to discuss your particular case with your doctor—because another lesson we’ve learned is that every individual situation is different.

This is also an excellent example of why you see recommendations for treatment, tests, and diet change over time. Science—and our understanding of cancer—builds step by step, as evidence and lessons are learned from many tests done over time.

For more information: You can ask further questions by email in advance, or live by phone, in the upcoming webinar reviewing ASCO called “What’s New and What’s On the Horizon” on Wed., June 19, at 8-9:30 pm. ET. Click here for more information or to register.

Sources:

• “Phase III randomized, placebo-controlled, double-blind study of intravenous calcium/magnesium…” 2013 ASCO meeting and Journal of Clinical Oncology 31, 2013 (suppl; abstract 3501)
• ‘Stop Using Calcium and Magnesium With Oxaliplatin,” June 3 2013 Medscape News
• Intravenous Calcium and Magnesium…”, Grothey, Feb. 1 2011 Journal of Clinical Oncology

Disclosure: Fight Colorectal Cancer has accepted funding for projects and educational programs from sanofi-aventis in the form of unrestricted educational grants. Fight Colorectal Cancer has ultimate authority over website content. See the Fight Colorectal Cancer Funding Policy and Disclosure.

Fight Colorectal Cancer applauds the New York Times for shedding light on how revenue is generated by medical practices. Importantly however, the crux of the issue is not the use or overuse of colonoscopies and the variance in pricing. Rather, the main problem to be fixed in the United States is a broken fee-reimbursement structure that puts pressure on local practices and hospitals to inflate the price of reliable and needed services, like colonoscopies, to compensate for under-reimbursement for other medical services.

It is unfortunate that colorectal cancer screening is used in this article as a primary example of failure of the medical fee-for-service structure. One relevant fact that is not highlighted in this article is that colonoscopies and other screening modalities for colorectal cancer have demonstrated a reduction in the incidence of colorectal cancer and death from the disease.

Taking a step back and looking at the bigger treatment picture, with the increase in chemotherapy costs for advanced colorectal cancer, reveals that most colorectal cancer screening strategies have actually delivered long run cost savings. Screening not only reduces colorectal cancer incidence and mortality but also controls the costs of colorectal cancer treatment.

The article does highlight another important point: we need transparency in addressing the cost of care and reducing the burden for patients seeking lifesaving services like colorectal cancer screening. Fight Colorectal Cancer has worked with a coalition of government and non-profit partners who support the introduction of H.R. 1070, Eliminating Cost Sharing for Colorectal Cancer Screening Colonoscopy.

Under current law, Medicare beneficiaries must pay a coinsurance fee when their colorectal cancer screening colonoscopy also involves the removal of polyps or other tissue. This policy is confusing to Medicare beneficiaries and serves as a financial deterrent to this highly effective method of colorectal cancer prevention. Additionally, while current law also requires most private payers to cover colorectal cancer screenings without cost sharing (copays/coinsurance/deductible), until recently, regulations resulted in private payers applying the cost sharing requirements differently. Some private payers waived cost sharing when a screening involved the removal of polyps or other tissue, others did not (the Obama Administration issued a regulation change on this issue in February 2013).

To the point that was made in the article regarding a lack of comparative studies between screening colonoscopies versus less invasive and cheaper screening methods, we say:

Support increased funding for prevention research to find these answers.

Fight Colorectal Cancer has advocated for full funding for the Centers for Disease Control and Prevention’s (CDC) Colorectal Cancer Control Program (CRCCP) so that every state in the nation may have such a program (currently only 25 states and 5 territories do). Since the program’s inception in 2009, the CRCCP has provided screening to nearly 20,000 people, finding 2,917 cases of precancerous adenomatous polyps and 50 cancers. The CRCCP program has opened the door for researchers to develop needed modeling studies. The current research pipeline includes studies by Memorial Sloan-Kettering (led by Dr. Ann Zauber) looking at colonoscopy versus fecal immunochemical testing (FIT).

The bottom line is: the best screening test is the screening test someone gets. As an organization we do not recommend one screening test over the other.

The current screening tests and intervals (2) are—

• High-sensitivity fecal occult blood test (FOBT), which checks for hidden blood in three consecutive stool samples, should be done every year.
• Flexible sigmoidoscopy, where physicians use a flexible, lighted tube (sigmoidoscope) to look at the interior walls of the rectum and part of the colon, should be done every five years with FOBT every three years.
• Colonoscopy, where physicians use a flexible, lighted tube (colonoscope) to look at the interior walls of the rectum and the entire colon, should be done every 10 years. During this procedure, samples of tissue may be collected for closer examination, or polyps may be removed. Colonoscopies can be used as screening tests or as follow-up diagnostic tools when the results of another screening test are positive.
• Colonoscopy also is used as a diagnostic test when a person has symptoms, and it can be used as a follow-up test when the results of another colorectal cancer screening test are unclear or abnormal.

We want to save lives, don’t you?

Carlea Bauman
President, Fight Colorectal Cancer

References:

1 U.S. Preventive Services Task Force. Screening for Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement. AHRQ Publication 08-05124-EF-3, October 2008. Agency for Healthcare Research and Quality, Rockville, MD.
2 U.S. Preventive Services Task Force. Guide to Clinical Preventive Services, 2008: Recommendations of the U.S. Preventive Services Task Force. AHRQ Publication No. 08-05122, September 2008. Agency for Healthcare Research and Quality, Rockville, MD.

One of the biggest puzzles for colorectal cancer is how to best treat the elderly, especially those with stages II or III (non-metastatic) cancer. It’s a huge question: today, 40 percent of colorectal cancer patients are elderly, and by the year 2030, more than 70 percent of non-inherited colorectal cancer will be among those 65 or older.

Currently, 70 years old is the median age at diagnosis, with fully 40 percent of diagnoses made in people over age 75. Yet when oncologists must consider, and explain, the risks versus benefits for treating colorectal cancer—especial stages II or III—in the elderly, there’s not enough research evidence to back informed decisions in that age group.

Lack of evidence, but elderly get chemo less often

Colorectal cancer clinical trials only enroll a minority of over-65s—and with the way current trials are designed, those probably  are the healthiest of seniors, wrote Dr. Richard Goldberg, a member of Fight Colorectal Cancer’s Medical Advisory Board, and his colleague Dr. Christina Wu also from Ohio State University, in a careful review of existing evidence. Their article, “Managing Choices for Older Patient with Colon Cancer,” one of just 133 articles among the hundreds selected for the 2013 ASCO Educational Book.

We do know that elderly patients get chemotherapy significantly less often than younger patients, according population-wide studies of patients in community practices, the authors wrote. One study found that only 58% of older-65s received chemo, compared to 84% of patients under 65.

But “it’s a disservice to classify patients based on their ..age alone,” Drs. Wu and Goldberg wrote. Doctors and patients must consider physiologic differences that can affect tolerance for chemo (e.g. body fat vs. muscle body composition; heart, liver and kidney function). Common medications (e.g. blood-thinners) can interact with chemo. Seniors who have neuropathy (i.e., numbness in feet) from diabetes or spinal stenosis perhaps shouldn’t try Eloxitin® (oxaliplatin) in the FOLFOX chemo regimen.

Life quality–and length

For elderly patients, other facts affecting treatment choices include social support—such as whether a person lives alone, and can drive or get a ride to treatments—and especially the individual’s desires for quality versus length of life.

Another paper presented at 2013 ASCO notes considerations of life-expectancy—how long the patient might expect to live—might challenge some stereotypes among both doctors and patients. In 65-year-old people (a common age for diagnosis), women have an average 18 more years of life, and men have about 14 more years. And an individual’s level of basic fitness makes a huge difference, the authors note: A healthy, fit 75-year-old man has a life expectancy of more than 14 years compared to barely 5 years for a frail 75-year-old man.

In their summary, Drs. Wu and Goldberg concluded:

“Analyses of available data in older patients…show that, as a group, they may not benefit from adjuvant chemotherapy regimens containing [Eloxitin] oxaliplatin, or at least benefit as much as younger patients. Although older patients do appear to benefit from adjuvant FOLFOX in stage III disease…the benefit is less than that observed in younger patients….It is likely that some of the fit elderly will gain value from oxaliplatin-based regimens. In advising patients, clinicians should remember that the incremental benefit from 5FU-based adjuvant therapy overshadows the incremental benefit from adding oxaliplatin to those regimens, while avoiding long-term issues with peripheral neuropathy.”

 Dr. Goldberg told Fight Colorectal Cancer, “It is particularly important for older patients to maintain very close communication with their medical team with regard to goals and priorities, as well as treatment-related side effects so that prompt and effective management of side effects can be instituted to avert modest effects from transforming into potentially serious and treatment-limiting issues. Enrollment in clinical trials is needed to help us understand management issues in older patients better. ”

Patient take-away

If you are a senior, or have a parent diagnosed with colorectal cancer, know that especially for stage II and some stage III cancers, you should take time with your oncologist to balance risks and benefits, based on your personal level of fitness irrespective of age, plus other conditions, medicines, and especially personal goals.

Sources:

• “Managing Choices for Older Patient with Colon Cancer: Adjuvant Therapy,” ASCO 2013 Educational Book ;
• ‘Approach to the Older Patient with Stage II/III Colorectal Cancer: Who Should Get Curative-Intent Therapy?” by Drs. Ramsdale, Sanoff, Muss in ASCO 2013 Educational Book
• “Future of Cancer Incidence in the U.S.,” Dec. 2008 Journal of Clinical Oncology

 Disclosure: Fight Colorectal Cancer has accepted funding for projects and educational programs from sanofi-aventis in the form of unrestricted educational grants. Fight Colorectal Cancer has ultimate authority over website content. See the Fight Colorectal Cancer Funding Policy and Disclosure.

This is by far the world’s largest organization of cancer specialists in one place at any time during the year. They are gathered to listen to scientific researchers present their latest findings, clinical specialists (oncologists, surgeons, radiologists, nurses) discuss how the new science can be applied to their patients and share what is happening and what is left to do in their respective fields of expertise.

Attending for the first time Program Coordinator Emily White had an opportunity to see TED speaker and Internet Social Media Theorist Clay Shirky. FightCRC Board member Sally Church had blogged about Clay a few years back at a similar conference, his eloquent and thoughtful style hasn’t changed and left our team brimming with ideas.

In addition to hob knobbing with celebrity and industry leader types our team also ran into GAC & Call-on Congress advocates proving that “Building Bridges to Conquer Cancer” takes an army. 30,000 is a good start!

ASCO13 – Pam and Emily

 
 
 
 
 
FightCRC MAB Adjunct Speaking Materials: Colorectal Cancer Topics

Our MAB Speakers

• Managing Choices for Older Patients with Colon Cancer:
  Adjuvant Therapy Christina Wu, MD, and Richard M. Goldberg, MD
• Hispanic race and outcome of metastatic (MET) colorectal cancer (CRC): Biology or health care (HC) setting? : Heinz-Joseph Lenz, MD, FACP
• Validation of DPYD variants DPYD*2A, I560S, and D949V as predictors of 5-fluorouracil (5-FU)-related toxicity in stage III colon cancer (CC) patients from adjuvant trial NCCTG N0147 : Daniel J. Sargent, PhD

Wednesday, June 19, 2013
8-9:30pm ET / 7-8:30pm CT / 6-7:30pm MT/ 5-6:30pm PT

For a recap of the American Society of Clinical Oncology® conference join the Colon Cancer Alliance / Fight Colorectal Cancer webinar presented by Dr. John Marshall, where we will highlight the key colorectal cancer findings from the 2013 meeting and what these advances mean for you.

“This should be seen as a step forward for the U.S. oncology community,” wrote Dr. Y-Ning Wong in the ASCO Daily News from the American Society of Clinical Oncology’s meeting in Chicago. “However, patients and providers must remain vigilant about the law’s implementation.”

Currently there is a patchwork of state laws; as of January  2014, the Affordable Care Act (ACA) creates a federally required minimum that all private insurers must cover at least the usual care when patients enroll in a clinical trial.

Medicare already must cover routine care–plus costs due to medical complications associated with participating in a clinical trial–under a rule issued by President Clinton in 2000.

The one group not covered under the new federal rule will be “grandfathered” insurance plans—those plans of large employers which haven’t changed substantially since 2010 (from 30 to 66% of all large-employer plans in 2013, it’s estimated).

Fully 70% of children with cancer enroll in clinical trials, compared to about 3% of adults, and a majority of NCI-funded adult cancer trials failing to get enough participants to continue, according to a 2010 NIH report.

“Although the new law will not resolve all the reasons adults patients with cancer do no enroll in clinical trials,” wrote Dr. Wong, “It should remove one important (and fixable) barrier.”

Source: May 31 ASCO Daily News

Fight Colorectal Cancer is represented at ASCO by staff, Board members, and four of its Medical Advisory Board who will be presenting their own research and papers. (Watch here for reports.)

“The average oncologist really needs to understand more molecular biology now than ever before,” noted Scientific Program Committee Chairman Dr. Douglas Yee in today’s ASCO Daily News  because increasingly, cancers will be diagnosed and treated according to how molecules and cancerous cells act abnormally, rather than whether the cancer arises in colon or liver or breast.

The view from inside cells: cancer panomics

Credit: XnY hateZ/Fotolia

Over the next 20 years, one of the major changes in how we understand cancer itself will come out of “cancer panomics”– how a complex combination of genes, proteins, molecular pathways, and unique patient characteristics (diet, exercise, intestinal microbes, inflammation) causes cancer in each individual. The new focus on “personalized medicine” will demand a whole new way of organizing clinical trials—hopefully using smaller numbers of better-suited patients to decrease cost and speed testing of new treatment.

Medical care in doctors’ offices will change, too. “Oncologists will have to understand these pathways and the drugs that target them in order to select appropriate therapies,” said Michael P. Link, MD, immediate past president of ASCO in the May 31 ASCO Daily News.  Everything from cancer prevention advice, to diagnostic tests, to treatments will keep changing quickly, as scientists better understand what happens inside cancer cells.

The bigger perspective of cancer in the nation, and world

The ASCO meeting doesn’t just focus on the very latest understanding inside cancer cells, but also how to give better cancer care right now, to people everywhere. “I currently work with underserved communities in Washington, DC,” said ASCO President Dr. Sandra Swain, “and every day I see gaps in connecting proven treatments and preventive measures with underserved populations.” These gaps lead to more suffering and deaths in different parts of the U.S., she noted, “not just in low- and middle-income countries.”

But in fact, a majority of new cancer cases—and two-thirds of all deaths– actually occur in developing countries. Cancer kills more people in developing countries than HIV, tuberculosis, and malaria combined.

As the world of cancer researchers and caregivers meet over the next few days in Chicago, stay tuned right here for the latest medical news.

Source: May 31 ASCO Daily News

One of our most reliable sources for patient information and webinars  has been Heather Hampel, MS, CGC, a genetic counselor for 18 years, and Associate Director of the Division of Human Genetics at the Ohio State University Comprehensive Cancer Center.

We’re proud to announce that Heather Hampel is now an official member of our Medical Advisory Board. She first became aware of Fight Colorectal Cancer years ago when the late Kate Murphy, (one of our founders and Research Communications Director, who survived 30 years with Lynch syndrome) “introduced me to this group that was doing awesome work.”

Hampel is a nationally known and respected researcher in colorectal cancer genetics as first author of articles in both the New England Journal of Medicine and Cancer Research; she has served on editorial boards of many genetics journals; she is former President of the American Board of Genetic Counselors; and serves on panel overseeing national colorectal cancer screening guidelines for NCCN (National Comprehensive Cancer Network, an alliance of the world’s leading cancer centers).

Fittingly for our Medical Advisory Board, Hampel complements her academic research by keeping one foot firmly planted in direct patient care, spending one day a week counseling patients and families. As a genetic counselor, her role is to explain complex science and help families make informed, deeply personal decisions about genetic testing and medical treatments.

Lifelong path to be genetic counselor  

Heather Hampel decided at age 12 that she wanted to be a genetic counselor, when her pregnant mother had to decide about having an amniocentesis. As a high-school sophomore, Hampel challenged her favorite biology teacher: “In this teeny town of Ohio, let’s see them find someone for me to job-shadow who does genetics.” She was sent to a local university where a pediatrician allowed her to sit in on a genetic counseling session with a pregnant woman, husband, and the woman’s brother who had Hemophilia as they discussed whether the woman should be tested. “I was hooked,” Hampel said.

After getting a degree in molecular biology at Ohio State University, she ventured to New York City for Sarah Lawrence College’s graduate school—the nation’s first and still largest Master’s degree program in genetic counseling. With New York City as a melting pot for all nationalities, it’s the perfect place to study genetics in different populations—and it was home to Memorial Sloan Kettering Cancer Institute, one of fewer than five medical centers in the U.S. doing cancer genetics counseling in the mid-1990s. “It was an incredibly exciting time: six months before I started, they’d found the first breast cancer gene (BRAC1), and six months later, they found the second.” Hampel’s early research work was with the Ashkenazi Jewish population which had a specific inherited mutation for colon cancer.

Balancing research with patient care

From graduate school, she went directly to Memorial Sloan Kettering where she started a work-pattern that continues to this day of combined academic research and clinical practice. When she wanted to move back to Ohio to be nearer family, it happened to be the very moment that Ohio State University recruited the  world-famous genetic researcher Albert de la Chapelle (known for his Finnish work in colon cancer genetics) to start its Human Cancer Genetics Program.

Fifteen years later, Hampel will be helping to start a training program for genetic counselors at OSU. In her 18 years of genetic counseling, Hampel has seen genetic medicine change from a day when there were no tests for Lynch syndrome or tumor genetic analyses, to today’s explosion of discoveries, even ads for people to buy their own self-test kits. The need for reliable, up-to-date, useful genetic information has never been greater.

We at Fight Colorectal Cancer are privileged to have Hampel as a member of our Medical Advisory Board.

For more information about genetics, family history, Lynch Syndrome:

• Nov. 2012 webinar  “Talking Turkey about Lynch syndrome” and family histories, featuring Heather Hampel
• “All in the Family,” Summer 2012 newsletter article  with Hampel
• The National Society of Genetic Counselors
• “Does Colorectal Cancer Run in Your Family?” webinar with Dr. Henry Lynch and the late Kate Murphy.
• April 16 2013 Research News blog on the current Supreme Court case on patenting genes, “You don’t own me—but do you own part of my genes?”

Tuesday June 4^{th i} is becoming known as Cancer Survivor Beauty and Support Day. On this one day, volunteers in beauty salons, barbershops and day spas all over the U.S. donate their services to “show a little free love” to cancer survivors.

This is the 10^th year for the growing grassroots effort. Volunteers decide what services they wish to offer, post CSBSD™ signage, and cancer survivors make their own appointments for that day. Check the national online listing to see if services are offered near you. Don’t delay!

Founder Barbara Paget was volunteering to help cancer patients in her local hospital when she heard of a California spa giving a free spa day to its many cancer-surviving customers. She promptly went to a local spa owner to ask if she might consider offering a spa evening with complimentary services of her choice, to cancer survivors. The owner agreed, and there quickly was a waiting list for that first spa day. Ten years later, the idea has blossomed as national beauty shop chains and other cancer organizations have joined the effort.

No funds are raised, no solicitations allowed. If you wish to offer your services as a volunteer in Cancer Survivor Beauty and Support Day™ (CSBSD™), or if you’re a survivor having trouble finding a local site, Barbara Paget asks you to alert her personally by email at bnpcsbsd@aol.com.

Source: http://www.cancersurvivorbeautyandsupportday.org/