The Finns are among the heaviest coffee drinkers in the world, with each person in Finland consuming more than twice as much coffee every year as the average European and nearly three times as much as Americans.

Yet, when more than 60,000 Finns were followed for more than 18 years, there was no difference in colon or rectal cancer between those who drank more than 10 cups a day and those who didn’t drink coffee at all.

Researchers tracked 60,041 Finnish men and women, aged 26 to 74 at enrollment, for an average of 18 years.  None had cancer when they began the study.  During that time there were 538 cases of colon cancer and 234 cases of rectal cancer.

Comparing the group who drank more than 10 cups of coffee a day and those who didn’t drink coffee at all, there was no differencel  in risk for colon or rectal cancer for men, women, or men and women together.

Dr.Siamak Bidel and his team concluded,

In this study, we found no association between coffee consumption and the risk of colorectal, colon and rectal cancer.

SOURCE:  Bidel et al., European Journal of Clinical Nutrition, Volume 64, Number 9, September 2010.

Rectal cancer rates are increasing in people under 40, although rates of colon cancer have remained stable in younger people.

It isn’t clear why, but rectal cancer rates in this young group of men and women began increasing in 1984, rising about 3.8 percent a year.

Increases were similar for both sexes and all races.

A research team found 7,661 patients under 40 with colon or rectal cancer, including 1,922 with rectal cancer in the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) cancer registry database between 1973 and 2005.

More than half of the cases, 52 percent, were in patients from 35 to 39, with 28 percent from 30 to 34, and 20 percent under 30.

Looking through the medical literature,the study authors couldn’t find an explanation for why rectal cancer was going up while colon cancer wasn’t.  Screening or lifestyle issues couldn’t be identified as a possible reason.

Both rectal and colon cancer are rare in people under 40 with slightly over 1 case of colon cancer for every 100,000 people in the United States and less than 0.5 cases of rectal cancer.  This compares to 34.5 new colon cancer cases per 100,000 people and 13.4 new rectal cancer cases in the overall US population of all  ages.

Because the overall incidence of rectal cancer in this age group is so low, the authors do not recommend changes in screening guidelines.  However, they do urge that symptoms of rectal cancer, including rectal bleeding, be followed up.

Dr. Jeffrey Meyer, lead author of the study, recommends,

We suggest that in young people presenting with rectal bleeding or other common signs of rectal cancer, endoscopic evaluation should be considered in order to rule out a malignancy. This is in contrast to what is frequently done, which is to attribute these findings to hemorrhoids. More frequent endoscopic evaluation may be able to decrease the documented delay in diagnosis among young people.

Concluding, Dr. Meyer and his team wrote,

The incidence of rectal and rectosigmoid cancer appears to be increasing in patients aged less than 40 years. Patients presenting with rectal bleeding or other alarming signs or symptoms should be evaluated with this finding in mind.

SOURCE: Meyer et al., Cancer, Early View, August 23, 2010.

Scientists have found increased immune response to antigens produced by a particular intestinal bacteria in patients with polyps and early stage I or II colorectal cancer.

Antibodies against the Streptococcus bovis antigen RpL7/L12 were higher in the blood of polyp and early cancer patients than healthy individuals.  However, the increased immune response had disappeared in patients with more advanced stage III or IV cancer.

No similar antibody increase was found to endotoxin, a key component of cell walls in most intestinal bacteria, leading the scientists to believe that Streptococcus bovis and RpL7/L12 is unique in its ability to cause early polyps to become cancerous.

Annemarie Boleij,MSc and her team in the Netherlands concluded,

These findings are indicative of an increased exposure to antigen RpL7/L12 during early stages of colon carcinogenesis and suggest that intestinal bacteria such as S. bovis constitute a risk factor for the progression of premalignant lesions into early stage carcinomas. Clearly, the current findings emphasize the necessity for further studies on the possible etiologic relationship between intestinal bacteria and human colorectal cancer.

SOURCE: Boleij et al, Cancer, Volume 116, Issue 17, September 1, 2010.

Should cancer care focused on quality of life wait until all treatment ends?  Or can it be integrated with medical treatment as soon as someone is diagnosed with a life-threatening illness?

In a study of 150 advanced lung cancer patients, starting palliative care along with standard life-prolonging treatment when patients were first diagnosed not only improved their mood and quality of life, it actually increased the time they lived.

Although patients who received early palliative care received less aggressive treatment at the end of life, they lived almost 3 months longer than patients who didn’t have such early support.

Study Plan

Newly diagnosed lung cancer patients at Massachusetts General Hospital were invited to participate in a randomized clinical trial where they either  received standard medical treatment for their cancer or had early palliative care along with that treatment.

Ten patients (14 percent) in the standard treatment arm who asked for it were able to receive care from the palliative team, but were not switched to the palliative arm of the trial.

Researchers measured quality of life, mood, and survival time in both groups.  They also looked at aggressive care at the end of life and whether patient’s preferences for resuscitation were recorded in the outpatient electronic medical record.

Palliative care was provided by a team of specialists who followed the guidelines of the National Consensus Project for Quality Palliative Care. Such teams are becoming more common in hospitals and some outpatient settings in the United States and are not limited to hospice programs.  More than 80 percent of large hospitals have them.

Multidisciplinary, they include professionals in the fields of medicine, nursing, social work, chaplaincy, counseling, nutrition, and rehabilitation.

The team paid special attention to:

• assessing physical and psychosocial symptoms
• establishing goals for care
• assisting with decision making regarding treatment
• coordinating care on the basis of the individual needs of the patient

Study Results

Quality of Life

• Compared to patients who received only standard cancer care, those who got early palliative care had scores for quality-of-life improve from the initial test to the one 12 weeks later.  Scores for the standard care group went down.
• The percentage of patients with depression was higher in the standard care group, although about 18 percent of patients in both groups got antidepressant medicines.
• Increased anxiety was about the same for both groups.

End-of-Life Care

When end-of-life care was analyzed, 105 (70 percent) of patients in the study had died.  For that group:

• 28 percent of standard care group had their wishes for resuscitation recorded in their charts, compared to 53 percent of those in early palliative care.
• Those in standard care spent a median of 4 days with hospice care, compared to 11 days for the early palliative care group.
• More than half (54 percent) of the standard group had some kind of aggressive care at the end of life, compared to a third (33 percent) of those who received care from the palliative team.

Aggressive care at the end of life was measured by any one of the following criteria:

• Chemotherapy within 14 days of death
• No hospice care
• Admission to hospice 3 days or less before death

Despite less aggressive care at the end of their lives, the early palliative care group lived a median of 11.6 months after their diagnosis, compared to 8.9 months for those who got standard lung cancer care.

Jennifer S. Temel, MD, and her team concluded,

Among patients with metastatic non–small-cell lung cancer, early palliative care led to significant improvements in both quality of life and mood. As compared with patients receiving standard care, patients receiving early palliative care had less aggressive care at the end of life but longer survival.

In an accompanying editorial, Amy S. Kelley, MD, MSHS., and Diane E. Meier, MD discuss the study in light of common beliefs that palliative care is only provided as an alternative to life-prolonging or curative care — “what we do when there is nothing more that we can do.”  They write,

This study is an example of research that shifts a long-held paradigm that has limited access to palliative care to patients who were predictably and clearly dying. The new approach recognizes that life threatening illness, whether it can be cured or controlled, carries with it significant burdens of suffering for patients and their families and that this suffering can be effectively addressed by modern palliative care teams.

The National Consensus Project for Quality Palliative Care Clinical Practice Guidelines define palliative care this way:

Palliative care is both a philosophy of care and an organized, highly structured system for delivering care. Palliative care expands traditional disease-model medical treatments to include the goals of enhancing quality of life for patient and family, optimizing function, helping with decision making, and providing opportunities for personal growth. As such, it can be delivered concurrently with life-prolonging care or as the main focus of care.

Far from being focused on dying, the Guidelines continue,

Palliative care affirms life by supporting the patient and family’s goals for the future, including their hopes for cure or life-prolongation, as well as their hopes for peace and dignity throughout the course of illness, the dying process, and death.

SOURCES: Temel et al., New England Journal of Medicine,Volume 363, Number 8, August 19, 2010.

Kelley and Meier, New England Journal of Medicine Editorial, Volume 363, Number 8, August 19,2010

What Does This Mean for Patients?

It is important to realize that this study was done with lung cancer patients, not those with colon or rectal cancer.  Only 150 patients at a single outpatient program were involved in the research.

It was completed in an outpatient program at a large Boston research hospital with access to a palliative care team.  Many outpatient settings might not have a similar team available.

While Medicare and insurance pay for palliative care in hospice programs, reimbursement is not as easily available when palliative care is integrated with chemotherapy or other treatment whose goal is to cure cancer or prolong life.

However, for this group of lung cancer patients aggressive care at the end of life did not help them to live longer which might help patients and families with other advanced cancers make decisions about moving to supportive care only near the end of life.

Hillandale Farms of Iowa is recalling shell eggs because they may have been contaminated with Salmonella.

Lab tests have confirmed cases of Salmonella enteritidis associated with eating the eggs.

Eggs were packaged under the names Hillandale Farms, Sunny Farms, and Sunny Meadow and distributed in 14 states.  They have the following plant numbers and Julian dates stamped on the end of the carton or on the label:

• P1860 – Julian dates ranging from 099 to 230
• P1663 – Julian dates ranging from 137 to 230

The plant number begins with the letter P and then the number. The Julian date follows the plant number, for example: P1860 230.

Consumers who believe they may have purchased these shell eggs should not eat them but should return them to the store where they were purchased for a full refund. Consumers with questions should contact Hillandale Farms at (866) 262-4208.

Previously the FDA announced an egg recall from Wright County Egg, another Iowa producer.

We are very pleased to announce the 2010-2011 members of our Grassroots Action Committee.  The Committee is a group of committed, engaged volunteer advocates who take action when asked.  The Committee is the catalyst of our grassroots advocate community, and provides advice to help us achieve our strategic goals and objectives by empowering grassroots advocates across the country.

Members of the 2010-2011 Committee include:

LaRisha Baker, Chair
Portland, OR

Rochelle Joseph
Upper Marlboro, MD

Carol Larson
Minneapolis, MN

Arlene Murphy
Milford, OH

Doug Sharp
Prairie Village, KS

Josh Wimberly
Bessemer, AL

Carlea Bauman, President of the Colorectal Cancer Coalition released the following statement today following the announcement of the 2010-2011 Committee:

“The Colorectal Cancer Coalition is thrilled that LaRisha Baker, Rochelle Joseph, Carol Larson, Arlene Murphy, Doug Sharp, and Josh Wimberly will be joining our 2010-2011 Grassroots Action Committee.  This distinguished group of survivors and caregivers will help us continue the push for research funding, awareness campaigns, access to screening, and treatment coverage.  Colorectal cancer advocates who speak up and demand a change in current colorectal cancer policy will be the ones who make a difference in the fight against this disease.”

Read more about the 2010-2011 Grassroots Action Committee.

Molybdenum-99 isotopes are being harvested again at the Chalk River Laboratory in Canada ending a year-long shortage that has affected medical treatment worldwide.

Atomic Energy of Canada Limited (AECL), which operates the nuclear reactor at Chalk River, announced on August 18, 2010 that the reactor is operating on high power and producing medical isotopes.

Molybdenum-99 (Moly-99) is packed into so-called “generators”  that deliver a supply of Technetium-99m, a key isotope used in medical imaging.  Each generator has a life of about two weeks, so additional Moly-99 is needed regularly.  It cannot be stored.

Before its shutdown last year due to a heavy water leak, the Chalk River nuclear reactor produced about a third of  the world’s medical isotopes, including half of those used in the United States.  But the reactor is now 53 years old and what was expected to be a short-term problem in May of 2009 turned into a major shutdown lasting more than a year.

Medical isotopes (radioisotopes) are very small quantities of radioactive material which can be injected into patients to diagnose or treat illnesses such as cancer or heart disease.  Millions of procedures using medical isotopes are performed worldwide annually, and 70 to 80 percent of them use Technetium-99, derived from Molybdenum-99, produced in nuclear reactors like the one at Chalk River.

Almost the entire supply of Moly-99 is produced in five reactors outside the United States, whose average age of 45 years puts them at risk for maintenance problems and shutdowns.

The Society of Nuclear Medicine has led an effort to create resources for medical isotopes in the United States.  While SNM is “cautiously optimistic” that Chalk River coming back online will provide short-term relief to the most pressing concerns for Moly-99, they point out that is not a “magic bullet” and will not provide a real solution to the isotope crisis.

Dominique Delbeke, M.D., Ph.D., president of SNM said,

Creating and maintaining a sustainable delivery of radioisotopes is one of SNM’s most critical priorities. We continue to work to advocate for a domestic supply of Mo-99 in the U.S. so that nuclear medicine physicians and technologists have a reliable supply of radioisotopes to perform critical imaging tests that patients need for high-quality care.

Fact Facts on the Worldwide Medical Isotope Crisis from SNM.

Faced with the confusing decision about whether or not to have chemotherapy after surgery for your stage II colon cancer?

Join us on September 20th from 8 to 9 pm for a webinar designed to help you make the best choice for you and your own needs.

Dr. John Marshall from the Georgetown Lombardi Comprehensive Cancer Center will join Kim Ryan and Kate Murphy to explore this controversial topic.

Register here for:  Stage II Colon Cancer: Chemo or Not? Find Your Solution.

While adjuvant chemotherapy after surgery is not routinely recommended for all patients with stage II colon cancer, there are some patients at higher risk of cancer spreading (recurrence) who may benefit from chemo.  And some patients, after discussing possible risks and potential benefits with their doctors will want to have chemo even if their benefit may be small.

During the webinar we’ll be looking at:

• What makes stage II colon cancer stage II.
• What current  guidelines and research for stage II chemotherapy say.
• How to figure out the benefit numbers and what they mean.
• What tumor features make a stage II diagnosis high risk.
• What are some features that make people at lower than average risk for recurrence.
• How doctors talk with patients to help them with decisions about chemo or no chemo.

There will be time for questions.

Staging Image courtesy of the National Cancer Institute

Check the eggs in your refrigerator!

The FDA, collaborating with the Centers for Disease Control, the Department of Agriculture, and state health departments, have traced a nationwide spike in Salmonella Enteritidis (SE) infections to a single firm in Iowa.

Eggs shipped from Wright County Egg of Galt, Iowa after May 16,2010 have been recalled.

The CDA received approximately 200 reports of Salmonella Enteritidis every week in late June and early July, more than four times the usual 50 weekly reports over the past five years.

Wright County Egg says that the affected eggs are packaged under the following brand names: Lucerne, Albertson, Mountain Dairy, Ralph’s, Boomsma’s, Sunshine, Hillandale, Trafficanda, Farm Fresh, Shoreland, Lund, Dutch Farms and Kemps in various carton sizes.

Check your egg carton to see if what you have is part of the recall.

The shipment date uses a Julian format ranging from 136 to 225.  Eggs were shipped from plant numbers 1026, 1413 and 1946. Dates and codes can be found stamped on the end of the egg carton. The plant number begins with the letter P and then the number. The Julian date follows the plant number, for example: P-1946 223.

Salmonella infections often cause fever, diarrhea, nausea, vomiting and abdominal pain.  Infections can be serious and even fatal in young children, the elderly or frail, or people with compromised immune systems.  Cancer patients and those undergoing chemotherapy may be at high risk.

Wright County Egg and the FDA urge anyone with eggs involved in the recall not to eat them and either throw them out or return them to the store where they bought them for a refund.  If you think you are sick from eating eggs, call your doctor!

The FDA offers this advice for preparing and eating eggs in general:

• Keep eggs in their shells refrigerated at 45 degrees (Fahrenheit) or lower.
• Never eat raw eggs.
• Throw out dirty or cracked eggs.
• Wash your hands, cooking utensils, and food preparations surfaces thoroughly with soap and water after preparing raw eggs.
• Cook all eggs until both yolks and whites are firm.
• Don’t keep eggs warm or at room temperature more than 2 hours.
• Refrigerate all leftovers containing eggs promptly.
• Avoid estaurant dishes made with raw or undercooked, unpasteurized eggs. Restaurants should use pasteurized eggs in any recipe (such as Hollandaise sauce or Caesar salad dressing) that calls for raw eggs. Ask to be sure.
• Eating raw or undercooked eggs should be avoided, especially by young children, elderly persons, and person with weakened immune systems or debilitating illness.

More information about egg safety from FoodSafety.Gov.

Are you are person living with cancer in New Mexico?

Do you and your family need some time together to learn about managing the challenges of treatment and survivorship?

The Cancer Services of New Mexico offers a three-day escape from the day-to-day challenges of living with cancer this September when the whole family can take part in the Family Cancer Retreat.

The entire weekend is free, but is open only to New Mexico residents. 

• Cancer Family Retreat
• September 24-26, 2010
• LifeWay Glorieta Conference Center
• Glorieta, NM (near Santa Fe)

Supervised child care and recreational activities are provided for children and teens during the educational sessions so that parents can give their full attention to the program.

You can get an application online or from many oncology practices and cancer programs in New Mexico.  For more information call Mike at (505) 239-4239.

View a video about the program.