An article published by WebMD on December 13, 2011 highlights a new study published by the Archives of Internal Medicine. The article highlighted some notable statistics:

• Between 1998 and 2007 colorectal cancer cases have dropped steadily in adults over 50, but they increased by more than 2% each ear in younger adults, as much as 4% for rectal cancers, and 3% for colon cancer.
• Younger adults were more likely than older adults to be diagnosed with late-stage cancers.
• People in their 30s were about 30% more likely than other age groups to be diagnosed with cancers in stage III or IV.
• When a patients in their 30s or 40s present with symptoms like bleeding, abdominal pain, or change in bowel habits doctors and patients alike are less like to suspect cancer and there fore diagnosis is delayed.

Advise to patients?

• Just because you’re under 50, doesn’t mean your not at risk
• If you have a family history, go talk to your doctor, especially if that relative got colon cancer before they were 50.

- Advise from Anthony, Starpoli, MD, a gastroenterolist at Lenox Hill Hospital in New York City, as told to WebMD.

To read the full article published on December 13, visit WebMD.com.

The study was lead by Ninez Ponce of the University of California, Los Angeles, used U.S. Preventive Services Task Force guidelines at the time to determine if participants were getting screened according to recommendations. The information from the 2005 telephone survey of more than 30,000 adults under 65 in California found…

Fifty-one percent of all adults with no family history were screened according to guidelines, versus 71 percent who had a relative with colon cancer.

Compared with average-risk whites, Latinos with no family history of colon cancer were 26 percent less likely to say they had been screened. And those with a family history were 72 percent less likely than whites with a family history to get recommended screening.

You can read the entire study here (login required).

Or summary of study here (Reuters on NIH.gov).

Get Your Rear in Gear is trying to help spread the importance of screening for colorectal cancers to the community.  As part of a grant from the Twin Cities race, Get Your Rear in Gear worked with Marco Polo Advertising in Minnesota to produce an information video for the Spanish-speaking community.

Please share this video with the Spanish-speaking people in your life.

The study’s lead author is Dr. James J. Biagi, a medical oncologist and head of the oncology department at Queens University, in Kingston, Ontario. The study was presented at the annual meeting for the American Society of Clinical Oncology, and published in the June 8, 2011 edition of the Journal of the American Medical Association. Findings indicate that patients who begin chemo therapy four weeks following surgery for colorectal cancers have higher chances for survival than those who wait just four weeks longer.

“What our research has indicated is that giving chemo early rather than later after surgery is associated with improved survival,” stated Dr. Biagi. “Giving it later appears to be detrimental. But at the same time, we also believe that it still might be worthwhile having a patient look to chemotherapy even if they wouldn’t be starting until the three-month point.”

A good summary of the study appears here.

Complete text of the study can be found in the June 8 edition of the Journal of the American Medical Association here.

“The (risk) reductions that we saw here are not inconsequential,” said Dr. Ruder. “But we are not at the point that one could make a public health recommendation,” she added.

The complete Reuters story can be found here.

The study as published in the The American Journal of Gastroenterology can be found here (login required).

Imagine you or someone close to you were diagnosed with cancer, and your doctor could tell you ahead of time what treatment would respond best based on a genetic analysis of the cancer found. That’s what researchers are working towards with a next-generation blood test technology announced last month by Massachusetts General Hospital and partner Johnson & Johnson. In trials right now with cancer patients at four medical centers in the United States, the predictive blood test may personalize cancer treatment, improve quality of life, and eliminate biopsies. GYRIG previously discussed the impact on treatment with a version of this test currently available to patients with advanced colon cancer.

“If doctors can use circulating tumor cells (CTCs) found in the blood to tell patients that a drug is not going to work ahead of time, then you’ve spared the patients toxicity and allowed them to move on to something else,” said Dr. Howard Scher of Memorial Sloan-Kettering Cancer Center at a National Cancer Institute conference.

Scientists will study the genetics of circulating tumor cells which, its hoped, will enable doctors and patients to monitor treatment effectiveness during early phases of therapy. Development of this next-generation CellSearch Circulating Tumor Cell (CTC) microchip technology received $30 million dollars from Johnson & Johnson in January, and a $15 million dollar grant from money raised by the Stand Up to Cancer telethon this fall.

CTC test available to colon cancer patients with metastatic cancer

Metastatic colon cancer, breast and prostrate cancer patients and their doctors are using a current version of the CTC CellSearch blood test at clinics like Georgetown University’s Lombardi Comprehensive Cancer Center, advanced CTC/molecular labs in Germany, and the Mayo Clinic to monitor treatment effectiveness, as GYRIG looked at earlier.

Dr. Daniel Haber, one of the CTC CellSearch test inventors, and director of Massachusetts General Hospital’s cancer center, reviews the current and potential impact of this technology on cancer treatment at a conference at MIT’s Koch Institute for Integrative Cancer Research.

There are also a dozen or so CTC blood test technologies in development, as discussed by The National Cancer Institute.

Future as cancer diagnostic tool?

Will the CTC blood test be available at the doctor’s office as a diagnostic tool to screen for cancer, as news headlines suggest? The consensus is not now.

“The technology, although its great, I think it needs to be perfected. We don’t have the sensitivity, in another words the ability to pick up enough cells, to use it as a screening method,” said Dr. Minetta Liu, a breast cancer specialist at Georgetown University’s Lombardi Center. Her dream, she says, would be to use it as a diagnostic test to tell they average person, or someone who’s completed cancer treatment, ‘you don’t have cancer.’ “We’re not there yet,” she said.

Caution about overdiagnosis

Others in the medical community also express caution over its use as a general diagnostic tool.

“The conventional wisdom is people either have a disease or they do not. But, in fact, there are a lot of people somewhere in between,”  says Dr. H. Gilbert Welch of the Dartmouth Institute for Health Policy and Clinical Practice, and Medical Screening Expert for The Today Show and The New York Times, in a piece with CNN.  He cites the PSA blood test for prostrate cancer, as example, saying it resulted in overdiagnosis and “put men at risk of complications from unnecessary treatment.”

“What we have to be careful of with this new technique, is over-treating the dormant cells which were never going to give us any problem, in our attempt to get every cell we can see. We all have cancer cells in our bodies that are not really causing any problem,”  said breast cancer specialist Dr. Susan Love, president and medical director of the Susan Love, MD, Breast Cancer Foundation, and clinical professor of surgery at the David Geffen School of Medicine at UCLA.

Current trials are expected to run five years.

Interested in more?

• “On-Conversation with Dr. Massimo Cristofanilli, Principle Investigator of the CellSearch Circulating Tumor Test
• For an in-depth look, Dr. Haber speaks to the National Institutes of Health (NIH) discussing the technology and its potential for revolutionizing cancer treatment.

Have you had experience with CTC blood tests? Or want to share your view? Join the conversation and tell us what you think at www.facebook.com/getyourrearingear

Patients with advanced colon, breast and prostate cancer got a green light from the FDA to use the current version of the CTC (Circulation Tumor Cell) blood test only a few years ago. Some researchers are calling it a revolutionary tool for guiding treatment decisions and for predicting prognosis.

The Cleveland Clinic ranked it as the “Top Medical Innovation of 2009”, predicting “it will have a significant impact on health care.”

GYRIG rounds up opinion from doctors, scientists and the media who’ve
weighed on the technology’s impact on cancer care.

What’s the test? How does it work?

The CellSearch Circulating Tumor Cell (CTC) test currently in use with metastatic cancer patients counts the number of cancer cells shed by the primary tumor that circulate in the blood and spread to other parts of the body. The rise or decrease in these cells helps doctors determine in real time how a therapy is working.

Inventors say the test can:

• Detect a single cancer cell among a billion healthy ones

• Requires just a teaspoon of blood

• Can be performed quickly and repeatedly

The next-generation CTC test in development runs blood samples through a microchip with bristles to capture whole cancer cells shed by tumors that circulate in the blood, enabling researched to study their genetics.

While normal blood cells pass through, the circulating tumor cells stick to one of the 78,000 tiny posts coated with glue.

“It’s like a pinball machine – the blood has to flow through all of these columns to get to the other side,” said Dr. Daniel Haber, director of the Massachusetts General Hospital Cancer Center and and one of the test’s inventors.

Watch CTC Chip Dream Team video

Personalized cancer treatments

With the ease and speed of test results, doctors have expressed keen interest in its use as a tool chart personalized treatment for cancer patients.”That’s what got the scientific community’s interest,” said Dr. Mark Kris, lung cancer chief at Memorial Sloan-Kettering Cancer Center in New York. “Doctors can give a drug one day and sample blood the next day to see if the circulating tumor cells are gone.”

Compared to CTC test results in eight hours, doctors looking for tumor shrinkage after initiating treatment often have to wait several months with current tests such as the CT scan, MRI, X-ray, according to the Mayo Clinic.

“If you could find out quickly, ‘this drug is working, stay on it,’ or ‘this drug is not working, try something else,’ that would be huge,” said Haber.

Eric P. Winer, M.D., from the Dana–Farber Cancer Center and Harvard Medical School, expresses caution, saying, “I don’t feel the data [on CTCs] are sufficiently mature.”

Current use for metastatic colon cancer treatment

Currently centers like Georgetown University’s Lombardi Comprehensive Cancer Center, advanced CTC/molecular labs in Germany, and the Mayo Clinic use the CTC technology for monitoring and treating colon, breast and prostate cancer patients with metastatic disease (or cancer that has spread).

In a study published in Clinical Cancer Research, Dr. G. Thomas Budd, professor of medicine at the Cleveland Clinic in Ohio, reported that the “number of CTCs in the blood was a better indicator of disease progression than traditional imaging techniques such as computed tomography and magnetic resonance imaging; CTCs were more reproducible, were better predictors of survival, and estimated disease progression earlier.”

“It’s widely available and most insurance providers are covering it. Unfortunately I don’t think it’s being used as widely as it could be,” said Dr. Minetta Liu, a breast cancer specialist at the Lombardi Center who uses the CTC blood test routinely in her practice along with scans, and feels its aids day-to-day decisions with some patients.

The next-generation of CTC blood test in development by Massachusetts General Hospital and partner Johnson & Johnson, in trials right now with cancer patients at four medical centers in the United States, holds promise as a predictive blood test. As GYRIG examines in a second article, doctors could then see ahead of time which treatments would offer the best response based on genetic analysis of the cancer found, sparing the patient toxicity and side-effects from therapies that would be ineffectual.

Have you had experience with CTC blood tests? Or want to share your view?
Join the conversation and tell us what you think at www.facebook.com/getyourrearingear

“A simple blood test correctly identified most colorectal cancers in an early trial of the technology, offering the possibility of a convenient screening test that could be done during routine checkups, the company which developed it said on Wednesday.”

Read the full article at Reuters.com

Read more:

• Millions need colon cancer screening says CDC
• Ask the doctor: sigmoidoscopy vs. colonoscopy
• Colon cancer as dinner conversation?
• A legacy of colon cancer becomes a gift of life

Screening tools help guide patients to physicians who can find cancer in it's early stages

A recent study published in the Annals of Internal Medicine reported that colonoscopy risks may outweigh the benefits for some patients over the age of 85.   Elderly patients with a medical history of stroke, diabetes, heart failure and atrial fibrillation are encouraged to consider alternatives such as the fecal occult blood test.  These less invasive tests minimize risks which may be present during a colonoscopy such as bleeding colon perforation and heart problems.

“Somebody who is older and not in great health might benefit from a fecal occult blood test, and if the result is positive then a colonoscopy may be needed,” said lead researcher Joan L. Warren in a HealthDay interview.  Colonscopy is considered the “gold standard” for the detection and prevention of colon cancer.  If polyps are detected during the procedure they can be removed.  Warren goes on to say “overall, the risks from colonoscopy are quite low, however, there are some groups of people for whom the risk was significantly elevated.”

For more information on colon cancer and a list of screening tests, visit the Colon Cancer Coalition website at GetYourRearInGear.com

Source: University of Minnesota Medical Center Fairview Health Update

A new study published in the Archives of Internal Medicine indicates that important test results including cholesterol blood work, mammograms, Pap smears and screening tests for colon cancer are not always shared with patients.  According to an Associated Press report, “the first study of its kind finds doctors failed to inform patients of abnormal cancer screenings and other test results 1 out of 14 times.”

“Our goal is not to indict physicians.  It’s about working smarter and getting processes in place.” said researcher Dr. Daniel Dunham who was interviewed for the report.  In many cases, medical offices had no system in place for informing patients of test results.  Offices with computer based systems fared worse in many cases than those without.

Both Dunham and fellow researcher Dr. Lawrence Casalino explained that the test results in question were those in which “any doctor would agree patients should be informed.”  Physicians were also given an opportunity to explain when medical charts did not indicate that patients had been contacted with information about potentially harmful medical test results.

The study underscores the importance of patient involvement and self-advocacy.  “If you’ve had a test, whether it be blood test or some kind of X-ray or ultrasound, don’t assume because you haven’t heard from your physician that the result is normal,” Casalino said.

At least 50% of the Western population develops a colorectal tumor by the age of 70, and about 1 in 10 of these individuals, progress to malignancy. As a result, colorectal cancer is the second leading cause of cancer death in the United States and first when smoking-related cancers are excluded (1).

It is estimated that more than half of all new cancers and cancer deaths worldwide are potentially preventable by altering lifestyle. Of course excessive alcohol, smoking, and obesity are the most common causes but certain cancers are also related to infectious agents, such as hepatitis B (HBV), human immunodeficiency virus (HIV), human papilloma virus (HPV), and helicobacter pylori (H. pylori). They could be prevented through known interventions such as vaccines, antibiotics, improved sanitation, and education. Some cancers (colorectal and cervix) can be avoided by detection and removal of pre-cancerous lesions through regular screening examinations by a health care professional.

Colorectal cancer is one of the most preventable. There are several things you can do to avoid this type of cancer:

• Avoid high levels of animal fats, eating more fish, chicken and vegetables (2).
• Try to eat 40% of your diet as vegetables and no, fries and ketchup are not included. Particularly, stop eating preserved meats; bacon, sausages and ham are at the top of the list of things to avoid. Also don’t burn your steak.
• Cut back on simple carbohydrates, high simple sugar like sucrose and high fructose corn syrup as well as refined white flour. Rough and tough carbohydrates or low GI are the best (3). The roughage from the box many foods come in is better than the refines foods within.
• Keeping your blood sugar down is a key to avoiding colorectal cancers (4).
• Lastly, many experts suggest vegetables high in certain compounds are helpful, try eating more cruciferous vegetables and more sulphur containing vegetables like garlic and onions (5). Loosening weight and being fit will benefit you in a number of ways, including lower tumor rates (6).

While much has been written about the genetics of cancer, genes are not destiny; at most it’s only 15% of all colorectal cancers are attributable to genes (1). Its what is turned on or off that counts, its what you do with your genes not what your genes do to you.

Some herbs are also found useful. Natural anti-inflammatory compounds abound in the herbal world and are found in green tea, the spices turmeric and rosemary, feverfew and others (7).

References:
1) Cell, Vol. 87, 159–170, October 18, 1996
2) American Journal of Epidemiology Vol. 109, No. 2: 132-144
3) International Journal of Cancer. Volume 32 Issue 1, Pages 1 – 5
4) JNCI Journal of the National Cancer Institute 1999 91(13):1147-115
5) Cancer Causes and Control. Volume 2, Number 6 / November, 1991
6) Journal of the National Cancer Institute, Vol. 82, No. 11, 915-926, June 6, 1990
7) J. Nutr. 131:3034S-3036S, November 2001