Men and women in Baltimore County who don’t have health insurance or whose health insurance doesn’t cover colorectal screening may be eligible for a free screening colonoscopy.  They must also meet income guidelines for the special program.

Medical service is provided by private physicians throughout the Baltimore area.  Program participants have help from a nurse case manager.

Jim Smith, the Baltimore County Executive, and Health Officer Dr. Pierre Vigilance held a news conference on March 5th to promote the free program.

Smith said,

We’re trying to get the word out about the free screening. Maybe if people knew the benefits of the screening, they will be more willing to be tested.

Dr. Vigilance added,

There’s somewhat of a stigma and a bit of a phobia for some people. They perceive it to be a bit uncomfortable and maybe a bit embarrassing. We’ve got to get beyond that phobia.

For more information about the program or to sign up:

• Baltimore County Department of Health
• Cancer Prevention Program
• 6401 York Road, 3rd Floor
• Baltimore, MD 21212-2130
• Phone:  410-887-3456 or toll-free 866-632-6566
• Email: mdcolon@co.ba.md.us
• 

As body mass index increases, women — but not men — are more likely to have serious pre-cancerous polyps or cancer found during their colonoscopies.  Obese women are at especially high risk.

Body mass index (BMI)is a ratio of weight to height that measures underweight, overweight or obesity.

Researchers collected data for nearly 2,500 patients who were having a screening colonoscopy.  They found that there was more advanced neoplasia in women with high BMI.  Obese women with BMI over 40 were at the greatest risk.

Advanced neoplasia included colorectal cancer, adenomatous polyps with unusual cellular changes, large adenomas 1 centimeter or greater, or more than two adenomas.

Writing in the March 2007 Journal of Clinical Oncology, Joseph C. Anderson and his research colleagues said,

Increasing BMI, in our population, was associated with an increase risk for colorectal neoplasia in female patients. This study reinforces the importance of screening colonoscopy especially in obese women.

SOURCE: 

Anderson et. al.,Journal of Clinical Gastroenterology. 41(3):285-290, March 2007

In recognition of Colorectal Cancer Awareness Month, the American College of Obstetricians and Gynecologists are urging their members to remind their patients over age 50 to be screened for colon and rectal cancer.

Frequently, obstetricians-gynecologists are the only doctors that women see regularly.  As such, they can help increase colorectal screening rates and prevent colorectal cancer.

Colorectal cancer is an equal opportunity killer, affecting both men and women equally. In 2007, nearly 75,000 women will be diagnosed with colorectal cancer and more than 26,000 will die from it.

Douglas W. Laube, MD, MEd, president of the American College of Obstetricians and Gynecologists points out,

Despite the promising decline in colorectal cancer deaths in the US, many women are still not getting screened for colorectal cancer.  Ob-gyns can really help by making sure that all eligible patients leave their office with screening recommendations. ACOG encourages its members to educate women about the importance of routine colorectal cancer screening.

After reviewing existing evidence for use of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS) to prevent colorectal cancer, the US Preventive Services Task Force (USPSTF) has concluded that its harms outweigh its benefits.

The USPSTF assessment:

Overall, the USPSTF concluded that harms outweigh the benefits of aspirin and NSAID use for the prevention of colorectal cancer.

The recommendation applies to adults at average risk of colorectal cancer without symptoms, including those with a family history of colon or rectal cancer.  It does not include people with familial adenomatous polyposis (FAP), hereditary nonpolyposis colorectal cancer (Lynch I or II), or a history of colorectal cancer or adenomatous polyps.

The Task Force did say that doctors should continue to discuss the use of low-dose aspirin to prevent coronary heart disease because there is evidence that aspirin does reduce deaths from heart disease.

Colorectal cancer is the third most common cancer for both men and women and the second leading cause of cancer death.  Most colorectal cancer begins with adenomas (polyps) in average risk people over the age of 50.

The USPSTF is an independent panel of experts in primary care and prevention that systematically reviews evidence and effectiveness for clinical preventive services and develops recommendations for the use of those interventions.

USPSTF found the following evidence of benefits of aspirin or NSAID use:

• Fair to good evidence that aspirin and NSAIDS taken in higher doses over longer periods of time reduce the incidence of adenomatous polyps.
• Good evidence that low-dose aspirin does not reduce incidence of colorectal cancer.
• Fair evidence that aspirin in higher doses than those used to prevent coronary artery disease and NSAIDS may be associated with a reduction in the incidence of colorectal cancer.
• Fair evidence that aspirin used over longer periods of time may be associated with lower incidence of colorectal cancer.
• Poor evidence that aspirin and NSAID use reduces death from colorectal cancer.

The panel also found evidence of harms of aspirin and NSAID use:

• Good evidence that aspirin increases the risk of gastrointestinal bleeding related to dosage.
• Fair evidence that aspirin increases the risk of a hemorrhagic stroke.
• Good evidence that NSAIDS increase the risk of gastrointestinal bleeding and kidney problems, particularly in the elderly.
• Good evidence that one type of NSAIDS — COX-2 inhibitors — increase the incidence of kidney problems.
• COX-2 inhibitors appear to be associated with increased risk for cardiovascular events.
• Overall there is good evidence for at least moderate harms associated with aspirin and NSAIDS.

More than 80 percent of colorectal cancers will arise from adenomas, which are very common in people over the age of 50.  Thirty to fifty percent of adults over 50 will develop adenomas, but few of those polyps will progress to colorectal cancer.  Risk of polyps and of colorectal cancer increases as people get older.

The Task Force emphasizes the importance of screening for colorectal cancer, regardless of aspirin or NSAID use.   The USPSTF strongly recommends screening for all men and women over 50 for colorectal cancer.

SOURCE:  Annals of Internal Medicine, March 6 2007, Volume 146,Issue 5, Pages 361-364.

WHAT THIS MEANS FOR PATIENTS AND THE COMMUNITY

Routine use of aspirin and NSAIDS is more harmful than beneficial in preventing colorectal cancer.  It takes a higher dose of aspirin over a longer period of time to prevent the type of polyps that have the potential of turning into cancer.  Doses high enough to prevent adenomatous polyps also carry a risk of gastrointestinal bleeding, stroke, and kidney problems.  The elderly are especially at risk.

COX-2 inhibitors, such as Vioxx® and Celebrex®, increase the risk of kidney problems and appear to be associated with cardiovascular events.

The recommendations against routine aspirin or NSAID use do not apply to people with genetic conditions including FAP and hereditary non-polyposis colorectal cancer or to people with a history of polyps or colorectal cancer.  These individuals should discuss the risk and benefits of aspirin or NSAID use with their doctors.

However, the recommendation does apply to people with a family history of colorectal cancer who do not have a known genetic mutation.

Governor of Michigan Jennifer M. Granholm has recognized March 2007 as Colorectal Cancer Awareness Month, part of a national effort to increase awareness of a serious, but preventable, disease that affects many citizens of Michigan.

Janet Olsweski, Director of the Michigan Department of Community Health said,

Colorectal cancer is one of the most preventable forms of cancer. Screening not only detects the disease at an early, curable stage, but it can also prevent it by finding and removing polyps-or precancerous growths-that might become colorectal cancer.

Although the Michigan Cancer Consortium recommends colorectal cancer screening for men and women beginning at age 50, only 53 percent of Michigan adults age 50 and older have been screened.

Colorectal cancer is the second leading cause of cancer-related death in Michigan.  According to American Cancer Society estimates 1,750 people in Michigan will die of colorectal cancer in 2007 and there will be 5,570 new cases of colon or rectal cancer diagnosed.