Researchers found that cancer survivors who got exercise equaling about 150 minutes per week of moderate to vigorous walking had a 28% lower risk of death from any cause than those who did less than 60 minutes per week of walking.

And no matter their job, people who spent 6 or more hours a day of their leisure time sitting (reading, watching TV, computer-anything) had 36% higher risk of death from any cause, than people who sat 3 hours or less per day during leisure time.

Perhaps most striking, those who reported leisure-time sitting of more than 6 hours after they were diagnosed with colorectal cancer had a 62% higher risk of dying from colorectal cancer.

This was the first-ever study of the association between leisure-time sitting and death rates, but also one of the first-ever prospective, long-term studies of exercise and survival “that was beautifully designed and analyzed” according to University of Oxford professor Dr. David Kerr.

Using a national study of 184,000 people who filled out questionnaires at the beginning of a 16-year study, researchers focused on 2293 people who developed either localized or regional—but not metastatic—colon or rectal cancer during that time. (The average time of survival after their diagnosis was almost 7 years.) They compared the participants’ reported exercise and sitting times both before and after diagnosis with death from colorectal cancer or any other cause.

The study authors wrote, “Our results add to mounting evidence that physicians should consider counseling colorectal cancer survivors to adopt a physically active lifestyle …150 minutes per week of moderate intensity activity, such as walking, and to avoid prolonged sitting.”

So shut down your computer, and go out for a walk!

SOURCES: “Associations of Recreational Physical Activity and Leisure Time Spent Sitting With Colorectal Cancer Survival,” March 1 2013 Journal of Clinical Oncology (JCO 31:876-885); Medline abstract [http://Medscape.com/medline/abstract/23341510); “Get Off Your Bottom,” David Kerr, April 19 2013 Medscape .

Study shows neuropathy relief for some using antidepressant

 A well-designed clinical study has provided the first evidence that the antidepressant Cymbalta® (duloxetine) can provide some patients with significant relief from peripheral neuropathy caused by chemotherapy.

From 20 to 40 percent of cancer patients given neurotoxic chemotherapy–taxanes, platinum-based including Eloxatin® (oxaliplatin), vinca alkaloids, bortezomib–will develop painful peripheral neuropathy (numbness, tingling, burning in hands or feet). If the pain is severe, colorectal cancer patients often have to reduce the dose or stop taking Eloxatin. Even then, this painful condition can persist for months, even years, after chemotherapy is stopped.

Previous studies have found that Cymbalta eases the neuropathy pain caused by diabetes, but this is the first comprehensive trial testing whether Cymbalta could ease neuropathy from chemotherapy. As reported in the April 3, 2013 JAMA (Journal of the American Medical Association), the trial enrolled 220 patients at 8 different cancer centers across the U.S. who still had significant neuropathy (at least 4 on a pain scale of 10) at least 3 months after chemotherapy. (Over half, 129 patients, had taken Eloxatin, mostly for colorectal cancer.) In this randomized, double-blind (neither patients nor clinicians know who’s getting the test drug), crossover trial, one-half the group received Cymbalta for 5 weeks while the others took a placebo, and then the groups switched treatments.

Of those taking Cymbalta, 59% reported at least moderately decreased pain (minimum 1 point on the 10-point scale)—usually within the first week. Among those taking a placebo first, 38% reported decreased relief. Interestingly, Cymbalta-associated pain relief was significant only in feet, not hand, symptoms. Also, 11% of people taking Cymbalta had to stop due to side effects—mostly severe fatigue.

Experts theorize that the antidepressant might help because it reduces the neurotransmitters serotonin and noradrenaline, which deliver pain messages to the brain. The study authors pointed out limitations in this first study: relatively small numbers, the effects measured by patient self-report, and the study only followed patients for 5 weeks on Cymbalta.

However, “This is not just about improving quality of life by decreasing pain, but potentially it’s helping patients live longer because they can get their full chemotherapy treatment,” noted lead author Ellen M. Lavoie Smith, Ph.D., APRN, AOCN, of the University of Michigan Comprehensive Cancer Center.

Another expert not connected to the study, Marie Bakitas, D.NSc., at the University of Alabama at Birmingham School of Nursing, noted that the trial results weren’t surprising, because duloxetine is already being used in clinics. But, she also told Medscape, other treatments such as physical therapy, acupuncture and massage “are often neglected but can be very useful.”

Sources: “Effect of Duloxetine on Pain, Function, and Quality of Life Among Patients With Chemotherapy-Induced Painful Peripheral Neuropathy,” April 3 JAMA Network; “Drug for Depression Mutes Chemo Nerve Pain,”April 2 Medscape; “Antidepressant helps relieve pain from chemotherapy, study finds,” April 2 Univ. of Michigan Health Systems press release.

Searching for genes that could predict peripheral neuropathy

 Mayo Clinic researchers have reported that they’ve found that patients with mutations in  three specific genes were more likely to suffer peripheral neuropathy from chemotherapy.

Currently, doctors have no way to predict who will have the side effect, how severe it will get, nor how long it will last.

At the recent meeting of worldwide cancer researchers (AACR, or American Association of Cancer Researchers), scientists described how they studied more than 20,000 specific genes in 119 patients—over half of whom had developed peripheral neuropathy during chemotherapy. They pinpointed three genes, in which mutations were clearly associated with developing neuropathy. Their next step will be to expand their study of the entire genome in as many as 1000 patients. The ultimate goal would be to use these types of genetic clues to potentially predict which patients might suffer side effects from specific drugs.

Fight Colorectal Cancer’s Board Chair Nancy Roach noted that these first findings are a long way from proving cause-and-effect, creating a test, and actually being able to get a reliable test to doctors and patients.

Source: “Gene Variations Predict Chemotherapy Side Effects,”April 9 2013 Science News.

Disclosure: Fight Colorectal Cancer has accepted funding from Sanofi, manufacturer of Eloxatin, in support of its programs. Fight Colorectal Cancer has ultimate authority over website content.

The U.S. Supreme Court heard arguments Monday in a case that both sides consider absolutely vital to the future of medical research.

The case: Can a company take out a patent on a human gene? Or, as the company Myriad Genetics told the Court, not actually a patent on a gene, but a patent on isolated sections of DNA molecules that they synthetically re-create in the lab to make a test for the gene.

Patents were created 150 years ago in the Constitution as temporary protection of new inventions, thus giving economic incentive for inventors. But there is a clear rule that you cannot patent “a product of nature.”

During oral arguments on Monday, justices batted back and forth discussions of making everything from baseball bats to chocolate chip cookies, as they probed lawyers’ arguments about whether the patent was for a human gene (a product of nature)—or for “a new chemical entity,” as company argued in its legal brief, created through a complicated isolation process into a synthetic section of DNA to be used as a gene test.

Thirty years ago, scientists at the Utah biotech company Myriad painstakingly unraveled the 20,000 human genes that exist in a “6-foot-long molecule that’s coiled and compacted, and stuffed into each cell”. They beat other researchers in the race to isolate two genes, known as BRCA1 and BRCA2. Mutations in those genes greatly raise the risk of breast and ovarian cancer, and that risk that can be passed on to the next generation.

Myriad holds the patent and thus sells all tests for BRAC1 and BRAC2—at least for two more years until its patent expires. Myriad and others in the biotech industry argue that invalidating gene patents would threaten billions of dollars they’ve invested in creating genetic tests, drugs, vaccines, even genetically modified crops.

Opponents from the scientific and patient advocacy community argued that no company should hold rights to what is part of a human body, because it could hinder research and in fact has hindered patient access to lifesaving information turned up in clinical trials.

The Supreme Court justices today “seemed skeptical…that human genes can be patented,” reported National Public Radio’s long-time court reporter Nina Totenberg. She cited Justice Sonia Sotomayor’s remark that it seemed ‘the isolation [of the gene] itself is not valuable,’ but rather what’s done with the isolated gene. The government’s Solicitor General Donald Verrilli agreed that a gene cannot be patented, but he noted that the cDNA—the synthetic substance derived from DNA–could be patented, leaving the gene available for general research.

That’s when they got into making cookies, and baseball bats out of trees. Justice Stephen Breyer noted, “The patient law is filled with uneasy compromises.” If you develop a new process to extract sap from a plant that can cure cancer, he said, you could patent the process, but ‘what you can’t patent is the sap itself.”

Has the horse already left the barn….or is the barn burning

Myriad’s patents at issue will expire over the next two years, and according to an April 14^thNew York Times article. ”Experts say a relatively small number of other diagnostic tests or drugs are protected by patents on single genes….It will soon be possible to sequence a person’s entire genome for less than the $4000 that Myriad charges to analyze just two genes,” and most experts believe that whole-genome sequencing might not infringe on single-gene patents.

However, two researchers reported a study in the March 25 journal Genome Medicine that there are more than 40,000 patents on DNA molecules, essentially covering the whole human genome.

Credit: XnY hateZ/Fotolia

“If these patients are enforced, our genomic liberty is lost,” lead author Dr. Christopher Mason of Weill Cornell Medical College told Science Daily on March 25^th, referring to the upcoming Supreme Court case. “Just as we enter the era of personalized medicine, we are ironically living in the most restrictive age of genomics.”The research team studied two types of DNA sequence patents—for long and short fragments. They found that 41 percent of the human genome is covered by longer DNA patents often covering whole genes. But the short-fragment patents covered DNA sequences that are found in many genes, and even outside of genes, covering virtually the whole human genome. The study examined a Myriad-patented small sequence within BRCA1, which they found in at least 689 other genes; and found the company’s patents technically cover 19 other cancers plus brain development.

Dr. Mason said he undertook the study because he knew that, in his own research into brain and cancer disorders, he was studying genes or sequences actually covered under patents. “I’m extremely pro-patent,” he said, “…but I believe individuals have an innate right to their own genome…Failure to resolve these ambiguities perpetuates a direct threat to genomic liberty.”

Who owns you, and your genes? The court case is just the opening measure in this song.

  Sources:

• “Supreme Court Asks: Can Human Genes Be Patented?”, a 7-minute NPR story explaining court case, April 15, Morning Edition  
• “Justices Appear Skeptical of Patenting Human Genes,” NPR summary of court session April 15  All Things Considered,   
• “You Don’t ‘Own’ Your Own Genes: Researchers Raise Alarm About Loss of Individual ‘Genomic Liberty’ Due to Gene Patents,” Mar. 25 2013 Science Daily,  
• “Justices Consider Whether Patents on Genes Are Valid,” April 14 New York Times  
• “Are Human Genes Patentable?” April 12 ScienceDaily

Disclosure: Fight Colorectal Cancer has accepted funding from Myriad Genetics in support of its patient education program. Fight Colorectal Cancer has ultimate authority over website content.

Carlea Bauman, President of Fight Colorectal Cancer

I am deeply disappointed that President Obama’s fiscal year (FY) 2014 budget would strip nearly $4 million from the Centers for Disease Control and Prevention’s (CDC) Colorectal Cancer Control Program. The CDC estimates that the loss of funding will mean at least five fewer programs (out of the current 29) working to prevent colorectal cancer.

The president’s budget assumes that less federal funding is needed for direct screenings, such as colorectal, breast, and cervical screenings, because most health plans are required to cover these screenings without co-pays or deductibles, and because, starting in 2014, the Affordable Care Act ensures that no one can be denied health insurance because of a pre-existing condition.

However, a number of barriers contribute to low colorectal cancer screening rates, such as lack of awareness and misinformation about screening – not just lack of health coverage. A well-funded colorectal cancer control program is needed to support important awareness and education initiatives across the country.

The hopeful news is that Congress does not have to accept the President’s budget. I urge colorectal cancer patients, survivors, caregivers, and physicians to let their members of Congress know that a cut to the colorectal cancer control programs at the CDC is unacceptable.

On a positive note, the President’s budget would increase research funding to the National Institutes of Health (NIH) by $471 million (a 1.5 percent increase) over FY 2012 amounts. The NIH estimates this will result in 351 more research project grants in FY 2014.

I recognize that the President and Congress are budgeting in a difficult economic environment, but our country needs dynamic thinking from our policymakers when it comes to budget decisions. Preventing colorectal cancer and targeted treatment reduce downstream costs to our health care system and to our federal government. That makes good budget sense to me.

Dr. Pia Morelli with Fight Colorectal Cancer Board Chair Nancy Roach

Fight Colorectal Cancer and its generous Lisa Fund donors struck a blow against late stage colorectal cancer Tuesday, April 9th at the 2013 annual meeting of the American Association for Cancer Research (AACR) in Washington D.C.

Top cancer researchers from around the nation applauded as we, along with the AACR, awarded a $50,000 research grant to Pia Morelli, M.D., Ph.D., a post-doctoral Fellow at the University of Texas MD Anderson Cancer Center in Houston.

With this grant, Dr. Morelli will use highly specific DNA tests on blood samples to identify those patients most likely to respond to drugs that target the Epidermal Growth Factor Receptor (EGFR), and also to detect even more specific KRAS and EGFR mutations that develop over time, which perhaps cause patients to eventually become resistant to anti-EGFR drugs such as Erbitux (cetuximab) and Vectibix (panitumumab).

Currently, tumors of late-stage colorectal cancer patients are tested to detect a KRAS genetic mutation. If they have the mutation, they do not receive Erbitux or Vectibix. However, even those who have wild-type (non-mutated) KRAS and initially respond to anti-EGFR treatments can develop resistance and no longer benefit from these powerful drugs.

Researchers now understand that cancer is usually a “cascade” of events–often involving more than one genetic mutation and/or abnormal cell functions.–and that over time, patients may develop new mutations, even in different sections of one tumor. However, tumors are always leaking DNA into the blood stream. In her research, Dr. Morelli will analyze blood samples of colorectal cancer patients using a highly specialized new technique of DNA analysis that can detect these less frequent mutations that can occur in both the KRAS gene  and in EGFR cell-wall mutations over time, and that might cause chemotheraphy resistance. The ultimate hope would be to eventually use blood DNA analysis instead of repeated tumor biopsies to monitor cancer cell changes during disease progression and treatment.

Working at MD Anderson, she will be able to test large numbers of blood samples to see if the highly sensitive DNA analysis can better predict both initial response and/or developing resistance to the anti-EGFR targeted drugs.

Dr. Morelli graduated summa cum laude in medicine and started her medical oncology fellowship at the Second University at Naples School of Medicine, where she had the rare chance to do “translational research”—doing both patient care and  laboratory research on the EGFR (epidermal growth factor receptor) and VEGF (vascular endothelial growth factor receptor) that stimulate tumor growth. Recruited to the University of Colorado Cancer Center, she completed her medical oncology fellowship and a Ph.D. with world-renowned Dr. Gail Eckhardt, continuing her laboratory research into targeted drugs plus running Phase I clinical trials. She then worked two years at the Spanish National Cancer Research Center, and in 2012 came to the MD Anderson Cancer Center.

According to her supervising mentor, Scott Kopetz, M.D., Ph.D, at the MD Anderson Cancer Center, Dr. Morelli has “a unique insight into questions of particular clinical relevance….She is able to maximize the information derived from patient-based studies [combined with]…her unique molecular biology background.”

Her research, he said, is “anticipated to have profound impact on clinical outcomes.”

An AACR expert committee selected Dr. Morelli as winner of the 2013 Fight Colorectal Cancer-AACR Fellowship, given annually in memory of the late Lisa Dubow.

One of just a few AACR fellowships–and the only one focused on late-stage colorectal cancer–it is funded 100% by donations to the Lisa Fund at Fight Colorectal Cancer.

Lisa Dubow, one of the founding members of Fight Colorectal Cancer, directly credited researchers for giving her extra years of survival with stage IV colorectal cancer. Before her death, she launched what became known as the Lisa Fund to support young scientists who chose advanced (metastatic) colorectal cancer as their research focus.

) photo by ThinkProgress

The annual scientific meeting of the American Association for Cancer Research took a little lunch break on Monday, April 8th in Washington, D.C., while the attendees streamed outside to join a crowd of several thousand gathered across the street for a loud street rally.

“When [Congress] sees a grassroots movement rising up from doctors, from scientists, from advocates, and patients, you become impossible to ignore,” cancer survivor Rep. Rosa DeLauro (D-CT) told the cheering crowd. (Watch video of the speakers here.)

Fight Colorectal Cancer was one of 200-plus organizations who gathered and supported the  Rally for Medical Research, aimed at the politicians who have made, and are making,  decisions about budget cuts. The sequester alone will cut about $1.5 billion from the National Institutes of Health, and with overall budget cuts, NIH will lose about $12.5 billion over the year.

Penny-wise, pound-foolish: Research cuts mean lost jobs

Speaker Marc Tessier-Lavigne, Ph.D., president of Rockefeller University, pointed out that NIH total spending comes to about $100 per person in the U.S. each year, compared with that person’s yearly health costs totaling around $8000.

The main scientific organizations, including AACR (the American Association for Cancer Research) at its current annual meeting, point out that those NIH cuts alone will likely result in the loss of a half-million jobs, and an estimated $860 billion in economic growth over the next nine years. In fact,, federal investment in the largest-ever scientific collaboration, the Human Genome Project, paid off wildly: the economy gained $140 for every $1 in federal support over 5 years–not to mention the warp-speed increase in genetic knowledge about every major disease.

Scientists Honor Katie Couric

The AACR also took time to award colorectal cancer activist and journalist Katie Couric with its 2013 AACR Award for Distinguished Public Service, for all her work fundraising for research and drawing the public’s attention to cancer screening and treatment. She told the crowded hall, that “with 18,000 scientists gathered here, there are enough synapses firing in this room alone to power a nuclear reactor….To stand here in front of all of you is truly humbling….I consider myself the unofficial but highly enthusiastic cheerleader for the people who do research in cancer.”

Five years ago, she said, ” We could not tolerate the fact the NCI could only fund 1 in 10 of grant proposals,” so a dozen “truly Type A women” founded Stand Up To Cancer, emphasizing teamwork, tight time frames, and true collaboration with five “dream teams” (now grown to 10) taking on out-of-the-box ideas to beat cancer. (See the video about Katie Couric, followed by her speech, here.

Stay tuned…more to come

Fight Colorectal Cancer is well represented at AACR: stay tuned.

Sources: The Rally for Medical Research, reported on by The Hill, by HealthWatch , and “Thousands Rally for Medical Research in Washington, DC”, Apr. 8 Medscape Oncology News; news from AACR Annual Meeting, Tuesday Daily Alert. 

The Andrew Giusti Memorial Award was posthumously awarded to the late Kate Murphy for her tireless activism on behalf of colorectal cancer patients and for focusing, like Andrew Giusti did, on pushing for great science that will translate to patient benefits as quickly as possible.

Kate was a founding staff member of Fight Colorectal Cancer and our Director of Research Communications. She was the first patient advocate to ever sit on the National Comprehensive Cancer Network’s Colon/Rectal/Anal panel, which develops treatment guidelines for oncologists. She also served on nearly a dozen other scientific committees, always staying true to the needs of the colorectal cancer patient and challenging researchers to do better on their behalf.

Kate passed away from Lynch syndrome-related colorectal cancer in October 2012. Her husband Tom received the award at Call-on Congress.

Andrew Giusti was a former Board member, scientist and colorectal cancer patient. This memorial award honors advocates who work in the research environment. Andy was a superb research advocate. He was working on a vaccine against colorectal cancer when he was diagnosed in 2005 with stage IV colorectal cancer at the age of 40. He passed away in 2010.

The Advocate of the Year Award went to husband and wife team Eric and Rose Hausmann of New Jersey.

Through the years, they have raised over $30,000 for Fight Colorectal Cancer through local events, attended Call-on Congress for five years in a row, served as mentors to new advocates, represented Fight Colorectal Cancer at countless speaking events, filmed this amazing screening awareness PSA and were instrumental in getting their two senators from New Jersey to introduce a resolution proclaiming March 2013 Colorectal Cancer Awareness Month.

Individually, they are amazing people with the strength to get through Rose’s stage IV colorectal cancer while still fighting to advance the cause. Together, they are a force to be reckoned with.

Rep. McGovern with Massachusetts advocates Amy Robert (left) and Caitlin Gambee

The Congressional Champion Award was presented to The Honorable Jim McGovern (MA-2).

Rep. McGovern has strongly supported colorectal cancer legislation for many years.

He cosponsored HR 4120 in the 112th Congress that would remove barriers to screening colonoscopy for Medicare patients, co-authored a Dear Colleague letter in 2012 urging his fellow members of Congress to wear blue on the day of Fight Colorectal Cancer’s Call-on Congress visits to Capitol Hill, led a 2012 sign-on letter to House appropriators in support for funding for the the colorectal cancer program at the Centers for Disease Control and Prevention, led introduction in 2009 with Rep. Kay Granger (a past recipient of the Congressional Champion Award) of the Colorectal Cancer Prevention, Early Detection and Treatment Act, and spoke at 2011 press conference in support of colorectal cancer screening.

You think we’ve made a lot of noise during this Colorectal Cancer Awareness month?

We’re only going to get louder. On Monday morning, Fight Colorectal Cancer survivors and advocates will ring the opening bell on NASDAQ—representing 1.2 million colorectal cancer survivors in the U.S. who are only going to get louder as our numbers grow.

Good news or bad news? Both, really. As Boomers age, more Americans will get cancer—and with better treatment and earlier diagnosis, there will be more cancer survivors.

In just 10 years, the number of cancer survivors in the U.S. will increase by nearly a third—to almost 18 million survivors of all types of cancer in 2022. That population explosion and other eye-opening facts are reported in “Cancer Treatment & Survivorship Facts & figures 2012-2013,” a 35-page report just released by the American Cancer Society.

Some facts about colorectal cancer:

• Colorectal cancer is the second most common in the nation’s current 13.7 million cancer survivors. (Among men, 43% are prostate cancer survivors, with colorectal cancer second at 9%. Among women, 41% are breast cancer survivors, with colorectal and uterine cancer second at 8% each.)
• Almost half (45%) of all cancer survivors are 70-plus years old. For colorectal cancer, the median age for diagnosis is 70.

Survivor care needs to catch up

Survivors cover a wide spectrum—from those who’ll never have another trace of the cancer to those who live with continuous therapy to keep the cancer controlled.

Yet “many survivors, even among those who are cancer free, must cope with the long-term effects of treatment….As more people survive cancer, it is vital that healthcare providers are aware of the special needs of cancer patients and caregivers,” the study’s senior author Elizabeth R. Ward, Ph.D., told Reuters Health News Service .

But a 2012 study presented at last summer’s (June 2012) ASCO annual meeting found that only 22% of 1000 primary care providers correctly identified peripheral neuropathy—which can persist for months, years, or permanently–as a late effect of the commonly used chemotherapy Eloxitan (oxaliplatin).

“Most long-term survivors of colorectal cancer report a very good quality of life,” the American Cancer Society report noted,  but some survivors will have bowel problems, and as many as 40% of those treated for local or locally advanced colorectal cancer (which has invaded nearby organs) will have a recurrence.

Delayed diagnosis: so much more to do

Of the 10 most common cancers, only lung and non-Hodgkin lymphoma had a higher percentage of new cancer cases diagnosed at the regional or metastasized stages, according to the new report.

During the 2001-2007 time period, only 39% of colorectal cancers were diagnosed when it was still localized, when the 5-year survival rate is 90%. A full 20% (and 24% among African Americans) were diagnosed when the disease had already spread (metastasized), when the average 5-year survival rate hovers at 12%.

Take-away for colorectal cancer survivors

• Whether you’re discharged as “free of cancer” or still under active treatment, be sure your oncologist sends complete information to your primary care provider.
• Develop and understand your own “survivorship plan.” (Read here for specifics.)
• Help us improve those statistics–real people–diagnosed late instead of early when this cancer is curable: All year long, educate your family, friends, neighbors, political representatives about the need to get screened for colorectal cancer.

Sources: “Cancer Treatment & Survivorship Facts & figures 2012-2013,” American Cancer Society, March 2013;  “Number of US Cancer Survivors to Increase by a Third by 2022,” March 20 2013 Reuters, and “Better Information Needed for Primary Care Providers Who Treat Cancer Survivors,” June 15 2012 ASCO Post.

Al B. Benson III, MD, FACP FASCO is Professor of Medicine, Feinberg School of Medicine,  and Associate Director for Clinical Investigations, Robert H. Lurie Comprehensive Cancer Center, Northwestern University

One of the nation’s most respected experts in colorectal cancer, Dr. Benson has supported and worked with Fight Colorectal Cancer for years as an active member of our Medical Advisory Board.

Written by Dr. Al Benson, March 18 2013, Chicago, Illinois

Although March is Colorectal Cancer Awareness Month, this disease is so frequent yet in most cases preventable that we should be striving every month of the year to make even more people aware of the importance of colorectal cancer and colorectal cancer screening. The good news is that we are seeing a trend that showing more people are getting screened and more people are surviving this disease. Even so, we have much more work to do to prevent and treat colorectal cancer.

Important information to know – from screening to diagnosis for colorectal cancer:

1) Know your family history. In some cases, colorectal cancer risk is inherited and the genetic risk can be passed on to generations within a family. For those with a risk for inherited colorectal cancer, genetic counseling and testing is strongly recommended. Also if you have an immediate family member who has had colorectal cancer, your risk for developing the disease is greater. Let your doctor know about the details of your family history. If you are unsure of your family history, discuss it with your relatives to be as complete as possible.

2) If you are of African-American descent, you are potentially at higher risk for developing colorectal cancer and screening should begin earlier, at age 45.

3) There is growing recognition that obesity, diabetes and lack of exercise are contributing factors to the risk of developing colorectal cancer and these risks should also be discussed with your doctor.

4) Talk with your doctor if you experience bleeding from the rectum. Many people assume bleeding is “just hemorrhoids,” which might be true, but it also could be a sign of colorectal polyps and/or cancer. Discuss any bleeding with your doctor as well as other symptoms including change in bowel habits (e.g., recent but persistent diarrhea and or constipation), persistent abdominal pain, weight loss or loss of appetite, or increasing fatigue.

5) If you are diagnosed with colorectal cancer, make sure you ask which members of the medical team will be important for your care. A gastroenterologist, surgeon, medical oncologist, radiation oncologist (for rectal cancer), nurse, nutritionist, psychologist, social worker, financial counselor, genetic counselor are some examples of team members who you may really need to help with your diagnosis and treatment.

6) Ask if you are a potential candidate to participate in a clinical trial. All of our current therapies and advancements in the treatment of colorectal cancer have come about because people through the years participated in a clinical trial. Oncologists consider clinical trials to be one component of the standard of care. Further advances in colorectal cancer treatment will require many people willing to enroll in our clinical trials.

7) There are resources available for you. Fight Colorectal Cancer has great information available for you. The National Comprehensive Cancer Network (NCCN) has created guidelines for treatment used around the world by health care professionals. There is a patient version of colorectal cancer guidelines  that you can obtain on the internet and bring to your doctor.

I hope some of these tips will offer you and your family some additional guidance as we continue our efforts to control this common cancer.

In a retrospective population study, University of Texas researchers looked at billings for 100 percent of colonoscopies performed in Medicare beneficiaries in Texas who were aged 70 years and older who had a colonoscopy in 2008 or 2009. They also examined a nationwide sample of 5% of Medicare claims. Colonscopies were classified as “screening” if records (including claims from 2000 to 2009) did not indicate a diagnosis, or any visits for related symptoms in the previous 3 months.

Colonoscopies were labeled “potentially inappropriate” based on patient age over 75, or because the procedure was done less than 10 years after a previously negative colonoscopy. (The study population did not include anyone with a history of colon cancer, inflammatory bowel disease, colon resection, or whose procedure was performed during a hospital admission or emergency room visit.)

Among Texas residents, overall percentages of potentially unnecessary colonoscopies were:

• Age 70-75: 9.9 % of procedures done
• Ages 76-85: 38.8%
• Aged 86-plus: 24.9%.

There was wide variation in geographic areas of Texas, plus among individual doctors doing the screening procedures. The researchers did note that reasons for doing a colonoscopy in an individual patient cannot be assumed from billing information alone. (In fact only 15% of the claims included a screening code, although experts believe about two-thirds of colonoscopies are for routine screening.) The authors noted that there might be poor communication between a primary care doctor and the gastroenterologist; there could be financial incentives to do the procedure, or doctors might disagree with the national guidelines.

What are the guidelines?

In fact, there are different sets of guidelines. The U.S. Preventive Services Task Force (and recently, the American College of Physicians) specify age limits. The USPSTF says “For adults aged 76 to 85 years, there is moderate certainty that the net benefits of screening are small….and [for] adults older than age 85 years, there is moderate certainty that the benefits of screening do not outweigh the harms.”

However, joint guidelines developed by the American Cancer Society, the U.S. Multi-Society Task force on Colorectal Cancer, and the American College of Radiology do not include age limits. Part of the problem is lack of evidence: experts note that far too few population studies and clinical trials include those over age 75, even though about 30% of colorectal cancers are diagnosed in those 75 or older.

Increased risks might outweigh benefits for colonoscopy in those over age 75

Although the USPSTF urges caution in any screening over age 75, colonoscopy itself carries higher risks to elderly patients. Both this study’s authors and guideline developers urge extra caution—especially in unnecessary procedures—in the elderly who face higher risks from the preparation (fluid imbalance, start of a diarrhea/constipation cycle, dizziness or a rush to bathroom causing falls) plus effects of anesthesia in elderly patients.

Some over 75 will benefit

A caveat common among the experts: Among those who have never been screened, a screening colonoscopy might be indicated—especially if the older person is healthy, active, has few other diseases, and has an expected lifespan of more than 7 years.

Another study in the March 5 2013 Annals of Internal Medicine showed that in four HMOs, screening among people aged 55 to 85 did reduced the risk of advanced colorectal cancer by 70% in average-risk adults. However, the study showed that annual stool samples in this population (particularly when reminders and stool-sample kits were mailed to people’s homes) were as effective as colonoscopy.

What to do?

Probably the Centers of Disease Control & Prevention says it best: “The decision to be screened after age 75 should be made on an individual basis. If you are older than 75, ask your doctor if you should be screened.”

Patient Take-Away

• All guidelines recommend a colonoscopy only every 10 years, unless you have symptoms, family history, or a previous removal of polyps or an adenoma. (In those cases, plan your “surveillance colonoscopy” with your doctor.)
• People aged 75 or older should pause to consider the need for a routine screening colonoscopy, especially if it’s less than 10 years since a previous negative colonoscopy. You can also consider other screening methods, such as a yearly stool sampling that is very effective at finding early cancer.
• Discussions about cancer (and other) preventive screening probably are best with your primary-care doctor, who knows all of your other health conditions, your general fitness level, etc.
• If you do have a colonoscopy, it’s best to get your own written record of the results, including number and type of any polyps. A common cause of getting too-frequent colonoscopies could be that a different doctor doesn’t know the results of your previous test(s).

As always, stay tuned for updates on both screening and colorectal cancer treatment in the elderly: As boomers age in, and hopefully more seniors are included in clinical and prevention studies, the science will get clearer.

For More information:

* CDC brief summary of guidelines

* Choosing Wisely: on colonoscopies

* Who is the USPSTF? “A Conversation with Dr. Virginia Moyer, Chair, U.S. Preventive Services Task Force, Nov. 27 2012 NCI Cancer Bulletin.

Sources:

“Potentially Inappropriate Screening Colonoscopy in Medicare Patients,” Kristin M. Sheffield, Ph.D. et al,  JAMA Internal Medicine, published online March 11, 2013

Other coverage of this study includes: “Seniors Getting Unnecessary Colonoscopies: Study,” Monday, Mar. 11 HealthDay News; and “Many Colonoscopies for Seniors May be Inappropriate,” Christian Nordqvist, 12 Mar. 2013 Medical News Today.

See previous Research News blogs, including the Feb. 14 2013 “Colorectal Cancer is (or Could Be) the Poster Child for Cancer Prevention” and
the May 16 2011 “Fight CRC Site Update: Some People Getting Colonoscopy Screening Too Often.”

Other recent articles about screening: “CRC Screening Tools—The Data and the Guidelines,” Linda Rabeneck, M.D., M.P.H., at January 2013 ASCO GI-Symposium; and  “Screening Colonoscopy and Risk for Incident Late-Stage Colorectal Cancer Diagnosis in Average-Risk Adults,” March 5 Annals of Internal Medicine .