FAQ’s

Colorectal cancer (CRC) screening is cost-effective in adults older than 75 years who have not had prior screening, according to a study published in the June 3 issue of the Annals of Internal Medicine.

 The study is the first, according to the authors, to look at the health benefits and cost-effectiveness of CRC screening in people older than 75 years without prior screening.

 “[O]ur study demonstrates that in the 23% of U.S. elderly persons without previous screening, CRC screening should be considered well beyond age 75 years,” write Frank van Hees, MSc, from the Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands, and colleagues. “In unscreened elderly persons with no comorbid conditions, CRC screening should be considered up to age 86 years (up to age 83 years for those with moderate comorbid conditions and up to age 80 years for those with severe comorbid conditions). Screening with colonoscopy is indicated at most ages.”

 The US Preventative Services Task Force recommends screening for CRC from ages 50 to 75 years but does not recommend it for those older than 75 years who have already been screened. However, it remains unclear whether or not those without prior CRC screening should receive it after age 75 years.

 Therefore, the authors used the MISCAN-Colon microsimulation model to simulate life histories and look at the health benefits and cost-effectiveness of CRC screening. Using data from observational and experimental studies, the authors constructed a cohort of 10 million previously unscreened people between the ages of 76 and 90 years, with comorbidities categorized as none, moderate, and severe. Simulations included 1-time colonoscopy, sigmoidoscopy, or fecal immunochemical test (FIT) screening.

 The results suggest that the health benefits of CRC screening decreased with advanced age. Among unscreened elderly patients without comorbidities, CRC screening remained cost-effective up to age 86 years, with colonoscopy indicated up to age 83 years, sigmoidoscopy at age 84 years, and FIT at ages 85 and 86 years. Among those with moderate comorbidities, screening remained cost-effective up to age 83 years, with colonoscopy indicated up to age 80 years, sigmoidoscopy at age 81 years, and FIT at ages 82 and 83 years. Among those with severe comorbidities, screening was cost-effective up to age 80 years, with colonoscopy indicated up to age 77 years, sigmoidoscopy at age 78 years, and FIT at 79 and 80 years.

 Simulations only included those at average risk for CRC, which could have limited the results. In addition, simulations did not include separate analyses for sex, race, or high-risk groups, such as those patients with a family history of CRC.

 The authors explain that although the incidence of CRC increases with advancing age, screening likely does not remain cost-effective among elderly patients in their late 80s and early 90s because of their higher risk for death from other causes, as well as the risk for harm caused by colonoscopy itself. Moreover, screening at these ages could cause overtreatment, which may only add more years of medical treatment rather than prolonging life.

 In an accompanying editorial, Amanda V. Clark, MD, and C. Seth Langefeld, MD, both from the Department of Internal Medicine at the University of Alabama at Birmingham, highlighted 2 main results of the study. First, those aged 76 years and older without prior screening had a prevalence of CRC that was nearly 10 times greater than in those who had negative results on screening colonoscopy at ages 50, 60, and 70 years. Second, life expectancy decreased rapidly in those older than 80 years and among those with comorbidities.

 “This study has important implications regarding unscreened patients over age 75 and provides compelling evidence that these patients would likely benefit from colorectal cancer screening, preferably colonoscopy, and as close to age 75 as possible,” Dr. Clark told Medscape Medical News. “Colorectal cancer screening should be considered in every person over age 75 without fatal illness who has not had prior screening.”

 Although mentioning that results from this study could help guide CRC screening decisions among elderly patients, Dr. Clark emphasized a patient-centered approach.

 “One potential drawback is that [providers] will view these findings as recommendations that can be generalized to every patient,” Dr. Clark emphasized, “The decision for an older person to undergo colorectal cancer screening should be individualized, contemplating both risks and benefits in addition to the patient’s preferences and values.”

Colonoscopy isn’t perfect: About 6 percent of colorectal cancers are missed

SALT LAKE CITY—About 6 percent of colorectal cancers are diagnosed within three to five years after the patient receives a clean colonoscopy report, according to a population-based study by researchers from Huntsman Cancer Institute (HCI) at the University of Utah.

These cancers may have been overlooked at the time of colonoscopy or developed rapidly during the window between colonoscopies and are therefore referred to as “missed” colorectal cancers.

The three- to five-year timeframe is well inside the ten years recommended between colonoscopies for colorectal cancer screening in the general public, as well as the five years indicated for people at increased risk. The research results were published online in the journal Gastroenterology. “Not only did we find that colonoscopy isn’t perfect, we discovered a number of factors associated with these ‘missed’ cancers,” said N. Jewel Samadder, MD, M.Sc., lead author of the study and an HCI investigator. “They tended to appear in patients over the age of 65, patients with a family history of colorectal cancer, and patients in whom polyps were previously found.” The missed cancers were also more likely to appear in the right side of the colon, at the far end of the colonoscope’s reach. “Our first thought was that perhaps doctors did not view the entire colon, or that preparation for the procedure was not complete, which would obscure their view,” said Samadder. “However, the medical records of the patients with missed cancers showed these problems were seldom present.” The study integrated information about colonoscopies performed at Intermountain Healthcare (IHC) and University of Utah Health Care (UUHC) over the 14-year period between 1995 and 2009. Taken together, the IHC and UUHC systems provide care to more than 85% of Utah’s population. The researchers also used the Utah Population Database (UPDB), which combines genealogical, medical, and demographic data with cancer records from the Utah Cancer Registry, which allowed them to count patients who developed colorectal cancer and those who had a family history of the disease while keeping their identities confidential. While the term ‘missed’ may indicate that cancer or precancerous polyps were present but not seen, the category also includes cancers that had no visible evidence at the time of colonoscopy but developed rapidly afterward. According to Samadder, “Cancers in the right side are often biologically different than those in other parts of the colon, arising from different types of polyps. These types of polyps are flatter and faster growing, which may explain why they are not seen during colonoscopy as well as how a cancer could develop even when no polyps were visible.” The study showed that in the United States the rate of cancers missed at colonoscopy is only slightly lower than in Germany and Canada where similar studies have been conducted. In the U.S., most colonoscopies are performed by gastroenterologists who receive extensive training in the procedure.

Previously, American physicians had assumed that the missed cancer rate would be much lower in the U.S., because many colonoscopies in the foreign health care systems are performed by family physicians, internists, and surgeons who may not be as well trained in the procedure. According to Samadder, physicians and patients need to communicate prior to the procedure to ensure that a complete medical history, accounting for older age, family history of colorectal cancer, and prior history of polyps, is known so extra time and care can be taken during the procedure, especially on the right side of the colon. Many organizations, such as the American Society of Gastroenterologists (ASGE), now recommend that physicians spend at least 6-10 minutes closely examining the colon lining for polyps during the procedure’s withdrawal phase (where they have reached the end of the colon and are beginning to come out). “This is not entirely a quality of care issue,” Samadder said. “Our findings implicate genetic and biological issues associated with having previous polyps and having a family history of colorectal cancer.” Samadder’s research team currently has funding from the American College of Gastroenterology (ACG) to analyze various genetic elements of tumor tissues from missed cancers to search out their molecular signatures and determine how they differ from cancers detected during colonoscopy. “Only by understanding the limitations of colonoscopy,” Samadder said, “can we improve its use and ability to detect polyps and thereby reduce the burden of colorectal cancer.”

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The article’s co-authors include Karen Curtin, Ph.D.; Thérèse Tuohy, Ph.D.; Lisa Pappas; Ken Boucher, Ph.D.; Geraldine Mineau, Ph.D.; Ken Smith, Ph.D.; Anne Kirchhoff, Ph.D., M.P.H.; and Randall Burt, M.D., all of Huntsman Cancer Institute. Dawn Provenzale, M.D., M.S., of Duke University, and Kerry G. Rowe, Ph.D., of Intermountain Healthcare, are also co-authors. Funding for this project came from Huntsman Cancer Foundation, the National Cancer Institute (P01-CA073992, R01-CA040641, and P30CA042014), the American Society for Gastrointestinal Endoscopy, and the American College of Gastroenterology. About Huntsman Cancer Institute at the University of Utah Huntsman Cancer Institute (HCI) is one of the world’s top academic research and cancer treatment centers. HCI manages the Utah Population Database – the largest genetic database in the world, with more than 16 million records linked to genealogies, health records, and vital statistics. Using this data, HCI researchers have identified cancer-causing genes, including the genes responsible for melanoma, colon and breast cancer, and paraganglioma. HCI is a member of the National Comprehensive Cancer Network (a 23-member alliance of the world’s leading cancer centers) and is a National Cancer Institute-Designated Cancer Center. HCI treats patients with all forms of cancer and operates several high-risk clinics that focus on melanoma and breast, colon, and pancreas cancers. The HCI Cancer Learning Center for patient and public education contains one of the nation’s largest collections of cancer-related publications. The institute is named after Jon M. Huntsman, a Utah philanthropist, industrialist, and cancer survivor. For more information about HCI, please visit http://www.huntsmancancer.org.

October 23, 2014

PHILADELPHIA — Colonoscopy reduces cancer risk and mortality in patients with inflammatory bowel disease, according to the largest study of its kind, presented here at the American College of Gastroenterology (ACG) 2014 Annual Scientific Meeting.

“Initially, when colonoscopy was adopted and approved, there were no clear data that it reduced incidence or mortality from colorectal cancer, either in the general population or in those with inflammatory bowel disease,” said Ashwin Ananthakrishnan, MD, from Harvard Medical School in Boston. However, “a lot of patients are diagnosed in their 20s, and if they are getting a colonoscopy every 2 to 3 years, as recommended, that’s a lot of colonoscopies over a lifetime,” he told Medscape Medical News.

Current guidelines recommend that patients with inflammatory bowel disease undergo colonoscopy 8 to 10 years after their initial diagnosis, and every 2 to 3 years after the initial exam.

For their study, Dr Ananthakrishnan and colleagues identified 24,000 patients with ulcerative colitis or Crohn’s disease from a multi-institutional electronic medical record cohort. Of these patients, 6823 had a validated diagnosis of inflammatory bowel disease.

Investigators classified these patients into two groups: 2764 had a recent colonoscopy — in the 36 months before the diagnosis of colorectal cancer or before the end of the 8-year follow-up period; and 4059 did not.

During the follow-up period, 154 patients developed colorectal cancer. Patients diagnosed with colorectal cancer were older, more likely to be male, and more likely to have a diagnosis of ulcerative colitis or primary sclerosing cholangitis.

However, there was a clear association between colonoscopy and colorectal cancer. During the follow-up period, the incidence of colorectal cancer was significantly lower in those who had a recent colonoscopy than in those who had not (1.6% vs 2.7%; P < .001), Dr Ananthakrishnan reported.

Guidelines Confirmed In an unadjusted model, a recent colonoscopy reduced the risk of developing cancer by 44%, compared with no recent colonoscopy (odds ratio [OR], 0.56); in a fully adjusted model, recent colonoscopy reduced the risk by 35% (OR, 0.65).

For patients who developed colorectal cancer, the mortality rate was lower in those who had a recent colonoscopy than in those who had not (14% vs 34%;P=.012). The difference was “pretty striking,” Dr Ananthakrishnan noted.

Unfortunately, the investigators were not able to confirm that this reduction in mortality was related to the fact that lesions identified during the procedure were early stage and more amenable to treatment. “We could not look at this directly,” he pointed out, “but I think there are enough data to support this possibility.”

It is also noteworthy that colorectal cancer rates are coming down, not only in the general population in the United States, but also in individuals with inflammatory bowel disease.

“If you look at data from the 1970s and 1980s, you would expect about a 20% colon cancer rate 30 years after diagnosis,” Dr Ananthakrishnan explained. However, “right now, we think the rate is about half that. So what might have been a cost-effective and beneficial procedure back in the 70s and 80s may no longer be cost-effective and beneficial. That was another reason to do this study — to see if current data still support the recommendations.”

It is well known that certain populations are at higher risk for colorectal cancer, although this risk depends on the longevity and the extent of disease involved, explained Paresh Mehta, MD, from Gastroenterology Consultants of San Antonio.

“I think this is an important study because it confirms that we should continue to practice according to the guidelines,” he told Medscape Medical News. “I will continue to follow the ACG recommendations for colorectal cancer surveillance of patients with colitis, which are based on the length of time they’ve had the disease and the total amount of their colon that has been affected.”

Dr Ananthakrishnan and Dr Mehta have disclosed no relevant financial relationships. American College of Gastroenterology (ACG) 2014 Annual Scientific Meeting: Abstract 9. Presented October 20, 2014.

Roxanne Nelson

November 05, 2014

Both the incidence and mortality rates of colorectal cancer (CRC) have been decreasing in the United States, a trend that is largely attributed to the widespread screening of persons aged 50 years and older.

However, researchers from the University of Texas MD Anderson Cancer Center in Houston have highlighted a concerning trend: incidence rates are actually rising in young adults.

The most pronounced increase, which was observed in patients between the ages of 20 and 34 years, was in the incidence of colon and rectal cancer at all stages (localized, regional and distant).

The new article was published online November 5 in JAMA Surgery.

The authors analyzed Surveillance, Epidemiology, and End Results (SEER) data for 393,241 patients with CRC between 1975 and 2010 and evaluated the age at diagnosis in 15-year intervals, beginning at age 20. The overall age-adjusted incidence rates decreased by 0.92% during the study period.

But although there has been a steady drop in incidence among persons aged 50 years and older, the opposite is true for those in younger age groups, according to the authors, led by principal investigator George J. Chang, MD, associate professor, Departments of Surgical Oncology and Health Services Research at MD Anderson.

On the basis of these trends, the authors estimate that by 2020 and 2030, the incidence rate of colon cancer will increase by 37.8% and 90%, respectively, for patients aged 20 to 34 years.

This figure represents a 131.1% incidence rate change of colon cancer by 2030 in younger patients, as compared with patients older than 50 years.

The numbers for rectosigmoid and rectal cancers are similar and are expected to increase by 49.7% and 124.2%, respectively, for this same age subgroup. 

This extrapolates to a 165% incidence rate change, as compared with older patients.

For those aged 35 to 49 years, the incidence rates are also projected to increase, but at a slower pace: 27.7% for colon cancer and 46% for rectal cancer by 2030.

Doubling of Rates “We’ve been seeing a rising incidence rate in younger adults over the past few decades, as the rates in the general population have been declining,” said Dr Chang in an interview. “Our current screening programs don’t target the younger population. But if these trends continue, we are going to see a doubling in the next 15 years.”

One in six cases of colon cancer will occur in patients younger than 50 years, as will one in four cases of rectal cancer, he added.

The authors note that their data are consistent with previous studies that have also used large population-based databases, and they speculate on the possible reasons for this disturbing trend. One is a delay in early detection. Young adults do not undergo routine screening until there is a reason for it, such as a history of familial polyps, and prior to the Affordable Care Act, many patients lacked health insurance, which may have delayed diagnosis.

Younger patients are less likely to be concerned about symptoms and the importance of seeking medical care, Dr Chang pointed out. “Their providers are also less likely to consider cancer as a possible diagnosis.”

Behavioral factors, such as obesity and physical inactivity, may also play a role, the investigators note in their study. The prevalence of obesity has risen in the United States, and that is a known contributor to CRC, along with physical inactivity. The typical Western diet is high in red meat, junk food, and processed meats and is low in vegetables; it too has been associated with an increased risk for colon cancer.

No Changes in Screening for Now

But thus far, although this report is “rather unsettling,” the author of an accompanying commentary does not believe that it represents a call for changing screening guidelines just yet.

Kiran K. Turaga, MD, MPH, of the Medical College of Wisconsin, in Milwaukee, writes that “assuming that this increasing incidence of colorectal cancer in young adults is a real phenomenon, it begs the question of why this is occurring and what one should do about it.” He points out that although continued epidemiologic investigation into the causality of nonhereditary CRC in this population is crucial, a call for widespread screening by colonoscopy is premature. “It is important to note that the absolute incidence of colorectal cancer in the young adults (aged 20-34 years) is 1% of the total colorectal cancer burden and similarly fairly low in the 35-to-49-year-old age group (6.8%).”

“Hence, widespread application of colonoscopic screening might add risk without social benefit,” Dr Turaga adds. “However, this report should stimulate opportunities for development of better risk-prediction tools that might help us identify these individuals early and initiate better screening/prevention strategies.”

Strategies Needed The study authors agree that these results do not call for revisiting screening guidelines at this time. “We tried to highlight that our paper was not designed to address the impact of screening in younger people,” said Dr Chang, “And we do need to look at strategies for prevention and early detection. But in terms of absolute numbers, the number of younger patients with CRC is still relatively small.”

Younger patients do tend to be diagnosed at a later stage, but whether they typically have disease of a more aggressive course is yet unclear. “We know that all colorectal cancers are not the same, and it could be that young patients may have another subtype,” he speculated. “There may be some defining feature, and there is a suggestion that their tumors may be a little different. But I think that the short answer is that we really don’t know.”

“For now, the key message for patients is to seek care and for providers to consider CRC as part of a differential diagnosis, so a delay can be avoided,” Dr Chang said. “And we can all adopt healthier habits, such as exercising and improving our diets. Policy makers should encourage healthier behaviors.”

The study was supported in part by grants from the National Institutes of Health and the National Cancer Institute. The authors have reported no relevant financial relationships. Dr Turaga serves as a consultant for Castle Biosciences and Ethicon. JAMA Surg. Published online November

Laurie Barclay, MD

November 20, 2014

Rates of inflammatory bowel disease (IBD) incidence are significantly increased in people with asthma or chronic obstructive pulmonary disease (COPD),according to findings of a population-based study published online November 19 in the European Respiratory Journal.

“These findings have important implications for the early detection of [IBD] in airway disease patients,” lead author Paul Brassard, MD, from the Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada, said in a news release. “Although a link has previously been suggested, this is the first study to find significantly increased rates of [IBD] incidence in people with asthma and COPD. If we can confirm a link between the two conditions it will help diagnose and treat people sooner, reducing their symptoms and improving their quality of life.”

The researchers compared the incidences of Crohn’s disease (CD) and ulcerative colitis (UC) in patients with asthma and patients with COPD with incidences in the general population, using administrative health databases of Quebec from 2001 to 2006. They used prescription records to identify mutually exclusive asthma and COPD populations, and data from physician and hospital visits to identify CD and UC.

Among 136,178 patients with asthma, the average CD and UC incidences were 23.1 and 8.8/100,000 person-years, respectively. Among 143,904 patients with COPD, average incidences were 26.2 CD and 17 UC cases/100,000 person-years, respectively.

Compared with the general population of Quebec, CD incidence in patients with asthma and patients with COPD was 27% and 55% higher, respectively, and UC incidence was 30% higher among patients with COPD.

The highest incidence rate ratio was observed in children up to 10 years old for the asthma cohort and in adults aged 50 to 59 years for the COPD cohort. In these two subgroups, the incidence of CD was more than twice that in the general population.

“[IBD] and airway diseases may be associated through common inflammatory pathways, genetic and environmental factors,” the authors write. “The intestinal and respiratory epithelia share the same embryologic origin, have a similar anatomic structure and serve as organ barriers between the body and the environment. Immunological dysfunctions triggered by environmental factors are a common element in the pathogenesis of both IBD and airway diseases such as asthma and [COPD].”

Limitations of this study include use of prescription information to identify patients with airway disease, possibly limited generalizability to other populations, and lack of data regarding smoking. “Women with asthma were more likely to develop CD than men, and men with COPD were more likely to develop UC than women,” the study authors conclude. “Confirmation of such results in future studies may have implications in earlier detection of IBD and in the therapeutic management of patients.

Medical professionals involved in the care of airway disease patients who develop digestive symptoms need to be aware of the possible occurrence of new cases of IBD even in older age groups and regardless of smoking status.”

The authors have disclosed no relevant financial relationships. Eur Respir J. Published online November 19, 2014. Abstract

Fran Lowry

March 09, 2015

Vegetarians appear to be at lower risk for colorectal cancer than nonvegetarians, new research shows. In a large observational cohort study of Seventh-Day Adventists, those who consumed a vegetarian diet had a 22% lower risk for all colorectal cancers than those who ate meat. The study was published online March 9 in JAMA Internal Medicine.

Interestingly, the risk of developing colorectal cancer was much lower in pescovegetarians (who ate no meat but who ate fish more than once a month) than other categories of nonvegetarians. The relative reduction in risk was 43%, said lead author Michael J. Orlich, MD, PhD, from Loma Linda University in California.

“We weren’t expecting the pescovegetarians to show the lowest risk,” Dr Orlich told Medscape Medical News. “But the finding for pescovegetarians, compared with nonvegetarians, was highly statistically significant, so this is very unlikely to be due to chance.”

The study is a sequel to previous studies of Seventh-Day Adventists, which have shown certain health advantages for that group, compared with the general population in the United States, including greater longevity and reduced risk for diseases, Dr Orlich said. “This population has a much higher rate of vegetarianism than the general population, so it’s a good group to study vegetarian diets, low meat consumption, and increased consumption of a variety of plant foods, and the impact these factors may have on cancer risk,” he said. “It’s worth pointing out that our nonvegetarians are still a relatively low meat-consuming group. They average about 2 ounces of meat a day, so we are comparing vegetarians with a pretty low meat-consuming group, and a relatively healthy group overall. In fact, after we adjusted for age, race, and sex, in comparison with the overall American population, the rate of colorectal cancer was 0.73 for the nonvegetarians, so they already had 27% fewer cases of colorectal cancer than you would expect for an age-, sex-, and race-matched population in the United States. If we were to compare our vegetarians with a more average population, the effects might even look stronger,” Dr Orlich noted. The Church of Seventh-Day Adventists recommends vegetarianism, expects adherence to kosher laws (abstinence from shellfish, pork, and some other meats), and discourages its members from consuming alcoholic beverages, tobacco, and illegal drugs. Some Adventists also avoid coffee, tea, cola, and other beverages containing caffeine.

Food-Frequency Questionnaire Used More than 96,000 Seventh-Day Adventist men and women were enrolled in the Adventists Health Study-2 — a prospective cohort trial — from January 2002 to December 2007. Dr Orlich and his team analyzed 77,659 Adventists from June to October 2014 to look for an association between vegetarian dietary patterns and risk for colorectal cancers. A food-frequency questionnaire was used to assess diet at baseline. Along with a nonvegetarian diet, four categories of vegetarian diets were identified: vegan (no meats, dairy products, or eggs); lacto-ovo vegetarian (no meats, but dairy products and eggs); pescovegetarian; and semi-vegetarians (meats more than once a month but less than once a week).

Incident cases of cancers of the colon and rectum were identified from state cancer registry linkages.

Vegetarians tended to be older than nonvegetarians, and more likely to have higher education levels, to exercise, and to use calcium supplements. And vegetarians were less likely to have ever smoked, to drink alcohol, to have had a colonoscopy or sigmoidoscopy, to use aspirin or statins, to have been treated for diabetes in the previous year, and to have a history of peptic ulcers. Vegetarians were also leaner, with a lower body mass index and less intake of total fat, saturated fat, and all meats, including red meat and processed meat, but a more intake of fiber.

During a mean follow-up of 7.3 years, 380 cases of colon cancer and 110 cases of rectal cancer were documented. Vegetarian diets were associated with a lower overall risk for colorectal cancer, a 19% lower risk for colon cancer, and a 29% lower risk for rectal cancer.

Table. Colorectal Cancer by Category of Vegetarian

A Well-Designed Study “This study adds novel evidence of a pescovegetarian, or fish-rich diet, a specific pattern of vegetarians, in lowering the risk of colorectal cancer to the already quite established red meat–colorectal cancer connection,” said Ting-Yuan David Cheng, PhD, from the Roswell Park Cancer Institute in Buffalo, New York. “In addition to the many advantages of a well-designed cohort study, the study population was relatively homogeneous, which might have reduced the influence of other risk factors on the findings,” Dr Cheng told Medscape Medical News. “The data also suggest, although this is not explicitly noted by the authors, that people may need to stick fast to the dietary pattern for 2 decades in order to start to see the benefit of preventing colorectal cancer in their 60s or even their 70s,” he added.

The study was funded by the National Cancer Institute and the World Cancer Research Fund. Dr Orlich and Dr Cheng have disclosed no relevant financial relationships.

JAMA Intern Med. Published online March 9, 2015. Abstract

Zosia Chustecka

March 13, 2015

 Two out of three people diagnosed with invasive cancer in the United States are living for 5 years or longer, notes the Centers for Disease Control and Prevention (CDC).

The best survival rates are seen in the most commonly diagnosed cancers ― with 97% of prostate cancer patients surviving for 5 years or longer, followed by breast cancer patients (88% survival at 5 years) and colorectal cancer patients (63% survival at 5 years).

However, the outlook is less favorable for another of the most commonly diagnosed cancers – only 18% of patients with lung cancer are still alive after 5 years.

This is the first time that the CDC has reported cancer survivor data, but it will now do so annually, the agency said in a statement. The results are published in the March 13 issue of Morbidity and Mortality Weekly Report. The findings come from an analysis of data in the CDC’s National Program of Cancer Registries. The authors reviewed the most recent data, from 2011, on cases of invasive cancers (defined as cancer that has spread to surrounding normal tissue from where it began, with the exception of bladder cancer). The report also includes data on cancer incidence; the most common cancer sites continue to be the following:

• Prostate cancer (128 cases per 100,000 men)
• Breast cancer (122 cases per 100,000 women)
• Lung and bronchus cancer (61 cases per 100,000 persons)
• Colorectal cancer (40 cases per 100,000 persons)

These four sites accounted for half of the cancers diagnosed in 2011, the researchers note.

Disparities in cancer incidence still persist, the authors state, with greater rates among men than women and the highest rates among blacks. Additionally, 5-year relative survival after any cancer diagnosis was lower for blacks (60%) than for whites (65%). Data by state show that there are geographical differences in cancer incidence, with a range from 374 cases per 100,000 persons in New Mexico to 509 cases per 100,000 persons in the District of Columbia.

“These data are an important reminder that a key to surviving with cancer is making sure everyone has access to care from early diagnosis to treatment,” said Lisa Richardson, MD, director of the CDC’s Division of Cancer Prevention and Control, in a statement. “We know, for example, that early detection of colorectal cancer has had the largest impact on long-term survival rates.”

In the article, the CDC researchers, led by Jane Henley, MSPH, say that these data are being used by states to effectively develop comprehensive cancer control programs.

For example, in Vermont, cancer registry data were used to identify two counties with a high incidence of melanoma, which led to pilots of a new program for cancer prevention, they note. MMWR Morb Mortal Wkly Rep. 2015;64:237-242. Full text

By: Anthony Brino

Highmark is expanding a low-cost approach to colon cancer screening that could help increase early detection while also avoiding the discomfort of invasive scoping and high treatment costs.

The Pittsburgh-based Blue Cross insurer of 5.2 million members in Pennsylvania, West Virginia and Delaware is offering seniors in its Medicare Advantage plans free fecal immunochemical test (FIT) kits for self-administered at-home screening.

The FIT kits detect blood in a person’s stool, which can suggest the presence of a malignancy that can be investigated by a colonoscopy or lower gastrointestinal probe. The tests are about 80 percent accurate for indicating colon cancer.

Though not a wholesale replacement for colonoscopies, the “gold standard for colon cancer prevention, non-invasive biochemical tests like FIT kits can be a good option for people reluctant to undergo the full colonoscopy probe.

 It’s estimated that only about half of Americans 50 and older are actually getting the recommended colonoscopy, which can detect and also remove precancerous lesions. “By receiving routine health exams, like the FIT screening, seniors can stay healthier and avoid or delay the onset of illness down the road,” said Donald Fischer, MD, Highmark’s senior vice president and chief medical officer.

Highmark is offering the FIT kits to Medicare Advantage members through primary care doctors and its House Call Program, which brings members free at-home health assessment visits from an advanced practice nurse, using the contractor Matrix Medical Network.

 The FIT is effective at finding blood in the stool, but members should “still have a colonoscopy every ten years because it finds such health issues as ulcers, colon polyps, tumors and areas of inflammation or bleeding,” noted Fischer.

 At the same time, given that a significant percentage of Americans are reluctant to undergo a colonoscopy, Highmark sees value in giving members the choice of the FIT screening. 

In one Kaiser Permanent study, colon cancer screenings increased by 40 percent when immunochemical tests were mailed to patients’ homes.

 Last year, some 4,700 Highmark members completed FIT screenings. In a survey, the insurer found that members in the House Call Program who took a FIT screening and received a “high alert” warning in the results were highly likely to consult a primary care doctor; 51 percent ended up getting a colonoscopy and 21 percent ended up being diagnosed with colon cancer or another condition.

Highmark, which is also the owner of a health system in greater Pittsburgh, is watching to see if the FIT screening and House Call Program can make a dent in the quality and costs of GI healthcare for its 300,000-plus Medicare Advantage members.

 The average colon cancer treatment cost for a Medicare Advantage patient is approximately $30,000, Fischer noted.

 “Providing care during the earliest stages of an illness is not only less expensive, but the success rate of treatment during this time is also more significant,” he said. “Although a newly diagnosed condition can be extremely challenging for our members, being able to identify the issue early on helps us to connect them with the care they need so they can achieve successful health outcomes.”