February is Cancer Prevention Month, and colorectal cancer (CRC) is a poster child, as one of the few cancers that can be literally seen and removed before it becomes cancer, or can be caught early enough in regular screening to be literally cured.

Ponder these facts, based on 20 years of experience and summarized by Linda Rabeneck, MD, MPH of Cancer Care Ontario at the recent “GI-ASCO” (Gastrointestinal Cancers Symposium of the American Society of Clinica Oncology):

• Annual stool tests (fecal occult blood test, or FOBT) reduce deaths from colorectal cancer by 15 to 33 percent.
• The newer FIT stool test (fecal immunochemical test) appears to be even better than the FOBT stool test at detecting CRC and early adenomas.
• Flexible sigmoidoscopy (a scope exam of the lower colon) can reduce the cases of CRC by 21%, and deaths from CRC by 26%.
• So-called ‘virtual colonoscopy’ (a special screening CT scan) finds up to 90% of people having adenomas or cancers that are at least 1 cm in diameter.

Colonoscopy (examining the entire colon with an endoscope) is still considered by many to be the “gold standard” for detecting and removing precancerous lesions. Dr. Rabeneck noted, however, that colonoscopy continues to be much more effective in detecting lesions in the left (lower) colon than the upper (proximal) right colon, where hard-to-spot “flat” lesions are more likely to occur. (Evidence in the past few years shows that these flat “serrated sessile polyps” may develop differently and more quickly into CRC.)

Dr. Rabenick told the conference that updated national screening guidelines will be released in coming months; one likely change is removing barium enemas as a tool for CRC screening. Other research has raised the question about whether African Americans should start screening earlier (e.g. at age 50): Stay tuned.

We can do better; much better

Despite the remarkable ability to detect and even prevent CRC, about 40% of Americans still don’t get the recommended screening. A recent study of 4000-plus Utah residents showed that 37% didn’t have recommended screening, even if they had a family history of colorectal cancer. The numbers of unscreened were much higher in rural areas.

Although it can be harder for some people (especially rural residents or those without full insurance coverage) to get a screening colonoscopy, they have choices:

• A simple yearly stool test (high-sensitivity FOBT or FIT) that is done at home and mailed in;
• Flexible sigmoidoscopy done every 5 years (most doctor’s offices do this test) along with stool tests every 3 years
• A colonoscopy every 10 years or CT colonoscopy every 5 years.

People aged 76 to 85 without risk factors (such as a family history or certain number of polyps found over the years) usually don’t need routine screening (and those over age 85 can skip it because risks outweigh benefits).

Get more information and breaking CRC news

• See a chart here that describes each screening option.
• Stay tuned here for screening updates, and….

Learn more news with GI-ASCO Keynoter

Next Tuesday, Feb. 19, 2013, from 8 – 9:30 pm (EST), the ASCO-GI keynote speaker, internationally renowned CRC specialist (and member of our own Medical Advisory Board) Dr. Richard Goldberg will talk directly to and with you at our webinar “The Latest in Colorectal Cancer.” He’ll share a “Decade of Progress” plus also give us his take on the most interesting news to come out at ASCO-GI. You don’t get many chances to listen to a world-renowned expert: Register to join it live, or listen later to this and all archived webinars. 

Sources: “CRC Screening Tools–The Date and the Guidelines,” ASCO-GI Jan. 26 2013; “Screening for CRC: which Tool and How Often,” ASCO-GI Educational Summary  and “Rural vs. Urban Residence Affects Risk-Appropriate CRC Screening,” in press Clinical Gastroenterology and Hepatology.

Provided by Kaiser Health News

Experts were surprised this week when the latest government survey showed that consumers actually paid a slightly smaller share of the nation’s total health bill in 2011, even though more people now pay higher deductibles.

Total U.S. spending on health care grew 3.9% in 2011 (including all medical goods and services, public health, cost of health insurance, investments, and government costs). That equals 17.9% of Gross Domestic Product (the same as 2009 and 2010) or about $8,680 per person in the nation.

Consumers paid just over one-quarter (28%) of total costs. Meanwhile, federal government health spending has risen more than three times as fast as consumer health spending since 2007, largely due to increased Medicare and Medicaid services for seniors and the disabled.

But many households hit hard by high deductibles

Even though the federal government is paying more of the nation’s total bill, individuals and families are paying a higher percentage of their personal income on health care. Household medical expenses are rising faster than the families’ income, according to government statistician Micah Hartman.

In 2012, one worker in three had medical insurance with a deductible of $1000 or more, meaning they must pay $1000 “out of pocket” before most expenses are covered. (In 2006, only one in 10 workers had a high-deductible plan.)

At the moment, the cost of higher deductibles is being partly offset by lower average prescription costs, as low-cost generics become more available for common medicines.

But more and more employers—as well as insurers under the new “health exchange” insurance marketplaces coordinated by the Affordable Care Act—will offer only high-deductible plans with pretax health savings accounts in the near future, according to employer and insurer surveys.

Fight Colorectal Cancer Answer Line and Upcoming Webinar Both Offer Advice

Public health officials worry that high deductibles may keep patients from getting needed screening or early treatment.

“One of the most common calls to our Answer Line right now is from people due for a colonoscopy, or unable to pay treatment copays, because they can’t afford their high deductible,” says Tavia Gilchrist, one of the friendly voices of Fight Colorectal Cancer’s Answer Line.

People may not have enough cash to pay a plan’s high deductible; or they’ve been laid off and lost all insurance; or they’re in a ‘grandfathered’ plan that isn’t yet required to offer free screenings. Gilchrist helps people define exactly what issue they’re facing, whether it’s insurance or Medicare rules, confusion about what a doctor is ordering, or a lack of local screening programs. “Every state – even areas within a state – is different,” she notes. Her job is to get callers started in the right direction to find answers to their specific question.

Webinar features expert on handling cancer finances

Speaking of questions, you can listen to plenty of answers in the live webinar “Addressing the Financial Burden of Cancer” on Wednesday, Jan. 16 from 8 to 9:30 pm EST. It features Elaine Martinez, a case manager with the Colorectal CareLine at the Patient Advocate Foundation.

Elaine serves as a liaison between colorectal cancer patients and their insurers, employers and/or creditors to resolve insurance, job, and/or debt problems. She helps investigate reimbursement levels for prescribed treatments, researches available clinical trials, and helps people enroll in resource programs for both uninsured and underinsured patients.

If you can’t listen in on Wednesday, the webinar will be archived for later listening, too.

Either way, you can’t afford to miss it.

Sources:

• “Who Knew? Patients’ Share of Health Spending Is Shrinking,” Jan. 14 Kaiser Health News;
• “Employer Health Benefits: 2012 Summary of Findings,” Kaiser Family Foundation and Health Research & Education Trust;
• 2011 National Health Expenditures report, Centers for Medicare & Medicaid Services;

• Fight Colorectal Answer Line: 1-877-427-2111

• Webinar: “Addressing the Financial Burden of Cancer”

This past year has brought remarkable scientific advances in the understanding of colorectal cancer (CRC), and—as usual with science—opened up even more questions to be answered in 2013 and beyond. Here are just a few highlights:

Your BODY: Peering inside cells

In 2012, scientists penetrated deeper inside cells to better understand why and how normal cells become cancerous and spread (metastasize) through the body.

(1)   For the first time ever, 150 researchers with the Cancer Genome Atlas Project—a collaboration of dozens of U.S. institutions–mapped the entire genome for each of 250 different colorectal cancers. Instead of just looking for specific mutated genes, they mapped literally the entire DNA package of 3.5 billion pairs of the 4-letter genetic “alphabet” contained in each cancer sample.

1. One surprise was that colon and rectal cancer are genetically virtually indistinguishable, putting to rest a long-held theory that rectal and colon cancers are somehow different.
2. By comparing cancer cell genomes to normal cells, they identified 24 separate genes involved with colorectal cancer—including 3 new genes. They also identified two other “over-active” genes directing cell proliferation, as well as changes in three different “signaling pathways” that turn genes on or off during cell growth.

(2)   A month later, a 9-year international collaboration called ENCODE (the Encyclopedia of DNA Elements) simultaneously published a blizzard of 30 journal articles, summarizing their findings about how at least four million gene switches can flick genes on and off, or, like an electric outlet dimmer, work together to turn genes up or down. Previously, scientists have only understood about how approximately 3% of DNA matter is normally active in directing cell functions. By analyzing data from 1,600 sets of standardized experiments using the equivalent of 300 years of lightning-fast computer analyses on more than 15 trillion bytes of raw data, scientists took a giant leap forward in understanding how the other 97% of the human genome (previously nicknamed DNA “dark matter”) might explain why many diseases appear.

Both major advances will not only help researchers find new treatments and tests for individual cancers, but they also might begin to explain how non-genetic factors like diet or exercise could affect whether cancer begins, recurs, or spreads.

Your LIFESTYLE: Population studies reveal roles of diet, exercise, aspirin,

While some scientists peered deep into cells, others looked at patterns in whole populations of people who have and don’t have colorectal cancer.

1. More than half of all cancers could be prevented, a researcher told the International Cancer Control (UICC) World Cancer Congress 2012 , if only people actually followed the lifestyle recommendations and screening or other interventions that we already know prevent cancer, including and perhaps especially colorectal cancer.
2. Researchers from Dana-Farber Cancer Institute found that those who consistently ate a high-carbohydrate, sugar-laden diet appeared to have markedly higher recurrence rates  of their disease than patients whose diets were more varied and contained less-sugar.
3. More studies in 2012 strengthened the evidence that daily exercise is closely related to a better quality of life for those having and recovering from CRC, and start regular, moderate exercise is associated with a significantly lower risk of recurrence.
4. In 2012, studies showed people who take low-dose aspirin—especially those with Lynch syndrome—show lower rates of having colorectal cancer recur.

Your TREATMENT: Two new drugs for metastatic CRC, and a cost challenge

For the first time since 2006, two new drugs—Zaltrap (ziv-aflibercept)  and Stivarga (regorafenib) were approved by the FDA to treat metastatic colorectal cancer which has progressed despite other chemotherapy.

The oncology world was a bit stunned in September 2012, when leaders of the world-renowned Sloan-Kettering Cancer Center in New York City publicly announced they would not use the latest new drug (Zaltrap) because it was no more effective but priced twice as high as Stivarga. The makers of Zaltrap subsequently announced a 50% discount in the price . However, that discount may not immediately apply to patients themselves, so Fight Colorectal Cancer staff remain closely involved in discussions with the FDA and others.

Your COSTS: Drug shortages, grey-markets, fake Avastin, screening coverage

1. Fight Colorectal Cancer’s Kate Murphy closely followed crucial shortages in CRC treatment drugs in early 2012, as well as a developing “grey market” where those drugs were sold for exorbitant prices, and even the appearance of fake Avastin in the U.S. briefly during the spring of 2012. Leucovorin remains on the FDA’s list of drugs in short supply as 2012 ends.
2. Also in 2012, Fight Colorectal Cancer worked with Kaiser Family Foundation and other cancer organizations to provide a detailed report to Congress  investigating the problem of patients being billed unexpectedly for costs of screening colonoscopies when polyps are removed.

We at Fight Colorectal Cancer know—and our advocates continually tell their families, communities, and legislators—that the very best way to stop colorectal cancer in its tracks is to never let it get started.

Our Future: The greatest hope of all is prevention and early detection

• In March 2012, Kate Murphy reported on the first definitive study to prove that colonoscopy and polyp removal reduce deaths from colorectal cancer : In a large followup of the National Polyp Study, people who had adenomas removed—the risky kind of polyps—were half as likely to die from colon or rectal cancer than  the general US population.
• In its annual summary and budget discussion for 2012-2013, the National Cancer Institute wrote, “Through molecular, epidemiologic, and mathematical studies of colorectal cancer… we now know that…a death from colorectal cancer today will most likely occur because the cancer or its precursor adenoma was not detected during the preceding 27 years.”

Forward into 2013

Science will drive us forward in 2013. Facts show that African Americans get colorectal cancer, and die from it, more often than other groups: We need to reach those populations with better screening. We know that the majority of people at risk for having Lynch syndrome—with its multiple cancers—don’t know they’re at risk, and we must help find and educate those families.

Even as we celebrate the enormous scientific strides forward in 2012, we could lose all momentum and years of invaluable work if we allow cancer research funding to dry up.  And so we keep fighting:

1. Fight Colorectal Cancer has given its first-ever two-year Lisa Fund grant to a young researcher whose laboratory is using a whole new method of quickly testing different treatments for metastatic colorectal cancer.
2.  We are training, as we speak, a whole new class of Research Advocates to take the patient’s voice and perspective to the decision-makers in research programs and funding. These 20 new advocates will be stepping into the shoes of two deeply respected advocates whom we lost in 2012: Pat Steer and also Kate Murphy, the founder of this Research News blog.

Here’s part of what Kate wrote last New Year’s Eve. Her words still ring as true as ever:

* Come to Call-on Congress and make sure that programs and funding for colorectal cancer prevention and research are strong and growing.

* Do one last, very important thing: Make a gift to Fight Colorectal Cancer and ensure that our programs and research grants continue until we end suffering and death from colon and rectal cancer.

Here’s to “Another year, full of hope and promises.”

For the first time, a two-time colorectal cancer survivor will direct and shape daily broadcast news coverage from the U.S. on a global scale. It was announced last week that Jeff Zucker, age 47, will become the president of CNN Worldwide, after serving as executive producer of Katie Couric’s new talk show, Katie, and after heading up NBC Universal.

Beyond Zucker’s and Couric’s latest teaming, there’s a lesser known cultural history of how Zucker and Couric, former co-host of NBC’s Today show, worked as colleagues starting in the late 1990s to bring colorectal cancer coverage out of health story shadows and into mainstream media reports.  

Most TV viewers are not aware that Zucker was diagnosed with colon cancer at age 31 (then again at 34), and that he scheduled chemo sessions on Fridays to minimize work absences. The world did hear about the surprising death in 1998 of Jay Monahan, Couric’s husband and an NBC News legal analyst: he died at age 42 from colon cancer. Thus began a remarkable public campaign. Read the rest of this entry »

Fight Colorectal Cancer is pleased to announce that we will be providing scholarships for advocates to attend Call-on Congress 2013!

Scholarship applicants must be:

• A voting resident in Arizona, Illinois, Indiana, Louisiana, Ohio, or Wisconsin
• A colorectal cancer survivor or patient currently in treatment
• A first time Call-on Congress attendee
• “Like us” on Facebook

One person from each of the target states listed above will be selected to receive a scholarship to attend Call-on Congress. The scholarships are made possible through a private donation in memory of advocate and friend Joyce Anne Ware Longfellow, who passed away earlier this year. The aim is to help survivors come to Washington, DC and make their voices heard for the first time at Call-on Congress.

The deadline to apply is December 1st.

Get more information and apply today!