For some elderly people risks may outweigh benefits for colorectal cancer screening

There is general agreement that the benefits of beginning screening at age 50 for people of average risk of colorectal cancer outweigh its potential risks. However, it isn’t clear at what age risks no longer are balanced by benefits.

Whether or not screening will make a difference for an individual depends on age, other existing illnesses, and potential life expectancy. In addition, some older people may experience more complications during screening tests increasing their risk.

Researchers at the University of Washington in Seattle report an analysis of screening benefits in the elderly in the October 2005 issue of [*Gastroenterology*](http://www.gastrojournal.org/article/PIIS0016508505013910/abstract). Cynthia Ko and her team looked at men and women, aged 70 to 94 years of age with various health conditions and life expectancies. They determined the number of people it would be necessary to screen to prevent one colon cancer-related death and also the numbers necessary to encounter a complication for three different approaches to screening — annual fecal occult blood tests, flexible sigmoidoscopy every 5 years, or colonoscopy every 10 years.

For instance, one cancer-related death would be prevented by screening 42 healthy men aged 70–74 years with colonoscopy, 178 healthy women aged 70–74 years with fecal occult blood tests, 431 women aged 75–79 years in poor health with colonoscopy, or 945 men aged 80–84 years in average health with fecal occult blood tests. While colonoscopy had the greatest benefit, it also had the greatest risk of complications. However, at all ages and life expectancies, the potential reduction in mortality from screening outweighed the risk of colonoscopy-related death.

The study identified four groups of elderly people for whom screening with colonoscopy was likely to have more risk than benefit:

+ Women aged 70 to 79 years in poor health
+ Women aged 85 to 89 years in average health
+ Men aged 70 to 74 years in poor health
+ Men aged 90 to 94 years in good health

Dr. Cynthia Ko told [*Reuters Health*](http://today.reuters.com/news/newsArticle.aspx?type=healthNews&storyID=2005-11-15T183409Z_01_FLE566824_RTRUKOC_0_US-COLON-CANCER-SCREENING.xml&archived=False)

The decision to pursue screening should be individualized and should take into account a patient’s life expectancy, comorbidity, and preferences.

In an [accompanying editorial](http://www.gastrojournal.org/article/PIIS0016508505017506/fulltext) Carmen Lewis reminds readers that the study assumes information about life expectancy that may not be true for an individual and urges that information from the research be used to guide discussions between patients and their doctors in making screening decisions:

Ko and Sonneberg have provided important estimations helpful for individualized decision making for colorectal cancer screening in patients ages 70 and older. However, their findings are estimations based on average life expectancies of the US population. Physicians’ abilities to accurately estimate life expectancy for individual patients is poor and, at present, even calculated estimations are of questionable validity. Furthermore, patients may vary significantly in how they value the potential benefits from screening compared with the potential harms Therefore, this information should be used as an aid to help inform patients about the risks and benefits of colon cancer screening, and then with their physicians, patients can explore their personal values and make the decision that is right for them.

Posted by Kate Murphy on November 15th, 2005
Posted in: Research & Treatment News | No Comments »

Phase I trial of immunology therapy at Mt. Sinai

Mt. Sinai School of Medicine has begun [Phase I human immunology trials](http://www.cancer.gov/search/ViewClinicalTrials.aspx?cdrid=335463&version=Patient&protocolsearchid=1942444) of a special gene designed to enter cancer cells and make them visible to the human immune system. Patients with liver metastases from colorectal cancer are sought for the trial.

In laboratory animal studies, the treatment extended life for all animals with breast or colorectal cancers and completely destroyed all tumors in 20 to 30 percent of them.

During tumor immunization researchers are able to insert a gene into the cancer cell that tells the cell to produce Interleukin-12, a protein that is a powerful signal to particular white cells in the body’s immune system to destroy the cancer cell. Ordinarily, cancer cells are ignored by the immune system and are able to continue to grow unchecked.

In a [news release](http://fusion.mssm.edu/media/content.cfm?storynum=266) from Mt. Sinai,Savio Woo, Ph.D., Professor and Chairman of the Department of Gene and Cell Medicine at Mount Sinai School of Medicine, explained,

“Cancer cells are able to grow unimpeded by the body’s defenses because they look very similar to healthy cells, with only very subtle differences that pass under the radar screen of the body’s immune cells. We use gene transfer technology to insert an immune enhancing gene into the cancer cells that makes them visible to the body’s natural immune defenses.”

Max W. Sung, M.D is leading the clinical trial. He explains the procedure that will be used to inject the gene into a liver tumor,

“The procedure does not require surgery and is done with just local anesthesia to the skin, Using one to three needles, the disarmed virus harboring the IL12 gene is injected through the skin into a metastatic tumor in the liver. We perform an ultrasound exam at the same time to track the needles so that we can deliver the virus to the correct location. The entire procedure can be completed within half an hour.”

For more information on the clinical trial patients or their doctors should contact Vivian Mitropoulou at (212) 241-6046.

An article in [Science Daily](http://www.sciencedaily.com/releases/2005/11/051107083122.htm) has more information about immunology research at Mt. Sinai.

Posted by Kate Murphy on November 13th, 2005
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Acrylamide in diets doesn’t increase risk of colorectal or other cancers in European study

Acrylamide is a chemical produced when potatoes and other foods high in carbohydrates are fried or baked at high temperatures. It is particularly high in fried potatoes, cookies, pastries, bread, rolls, and toast. Acrylamide has also been shown to cause cancer in mice and rats.

The possibility that it also can cause cancer in humans has been unclear.

However, an analysis of a large number of Swiss and Italian cancer patients matched with similar patients without cancer but admitted to the same hospitals showed no connection between the amount of acrylamide in their diets and several different cancers, including colorectal cancer.

In the study, 2,280 cases of colorectal cancer matched to 4,765 controls. After adjusting statistically for other known colorectal cancer risk factors, the odds of getting colorectal cancer were almost identical for those with the highest intake of acrylamide foods and those with the lowest.

In a report in the [*International Journal of Cancer*](http://www3.interscience.wiley.com/cgi-bin/abstract/110559366/ABSTRACT) researchers from concluded,

This uniquely large and comprehensive data set does not show any consistent association between intake of acrylamide and the risk of breast and several other common cancers

In 2002 Swedish scientists unexpectedly found [acrylamide in food](http://www.slv.se/templates/SLV_Page.aspx?id=4119) prepared at high temperatures, especially potato chips and french fries.

Early this year the World Health Organization (WHO) recommended that [acrylamide levels in food should be reduced](http://www.who.int/mediacentre/news/notes/2005/np06/en/index.html) because of it is carcinogenic in animals.

In 2003 the FDA in [*Turning Up the Heat on Acrylamide*](http://www.fda.gov/fdac/features/2003/103_food.html) warned consumers not to overcook food but to be sure to cook it well enough to destroy bacteria and virusesthat might cause illness. They also urged balance among food choices including carbohydrates with fiber.

Posted by Kate Murphy on November 11th, 2005
Posted in: Research & Treatment News | No Comments »

Labor-HHS Approrpriations Bill in Conference; Cancer Funding Cuts Possible

The Labor-HHS appropriations bill for fiscal year 2006 is now in conference. This is because the Senate and the House of Representatives passed differing versions: the Senate version raised National Institutes of Health (NIH) funding by $1 billion while the House version approved an increase of $145 million

The Senate version is a 3.7% increase which is about equal to the medical research inflation rate. The House version is essentially a cut because of inflation and it would probably hit NIH with a cut of about $100 million.

The ultimate fate of the Senate increase is in doubt due to major pressure in both the Senate and the House for cuts in mandatory and discretionary spending. There is legislation in both houses which cuts between $40 and $50 billion in mandatory spending. There continues to be discussion of an across-the-board cut in discretionary spending which would include cuts in NIH and the Centers for Disease Control and Prevention (CDC).

Just last month, 92 Senators and 280 Representatives signed a letter in support of the Bush Administration’s goal to eliminate suffering and death due to cancer by 2015. Cutting funding for cancer research and other cancer programs is a step in the wrong direction. It would mean delays in new cancer drugs, new cancer screenings and life-saving cancer treatments. By depriving cancer programs of critical funding Congress goes back on the commitment it made its letter to reach the 2015 goal.

Some in Congress say we cannot afford to spend more on cancer research. We say “Can we afford not to?”

Call your Senators and Representatives to tell them to fully fund cancer programs. You can also click on the “One Minute Advocate” link to send a message to Congress.

Posted by Dusty Weaver on November 11th, 2005
Posted in: Policy & Advocacy News | No Comments »

Asbestos exposure increases colorectal cancer risk

Men who have been exposed to asbestos as part of their employment are at higher risk for colorectal cancer according to a study in the November 1, 2005 issue of tbe [*American Journal of Epidemiolog*y](http://aje.oxfordjournals.org/cgi/gca?gca=162%2F9%2F868&sendit=Get+All+Checked+Abstract%28s%29). Furthermore, those who had changes in their lungs caused by asbestos had an even higher risk, one that increased with the worsening asbestosis.

Heavy smokers who had also been exposed to asbestos were 36% more likely than similar male smokers who had no occupational exposure. Those with changes in their lungs caused by asbestos had a 54% increased risk.

Reseachers found 3,900 men who had worked with asbestos in their jobs among participants in the *Beta-Carotene and Retinol Efficacy Trial (CARET)* which was looking at the role of supplements to prevent lung cancer.

Read more about the study on [*Reuters Health*](http://today.reuters.co.uk/news/newsArticle.aspx?type=healthNews&storyID=2005-11-10T162423Z_01_HAR059014_RTRIDST_0_HEALTH-ASBESTOS-RISK-DC.XML)

Dr. Mark R. Cullen from Yale University School of Medicine, a study author, told *Reuters Health*.that colorectal screening for men with a history of asbestos exposure “should be aggressively pursued in view of their higher risk.”

Posted by Kate Murphy on November 10th, 2005
Posted in: Research & Treatment News | 2 Comments »