This week we review research on the impacts of colonoscopy screening in Germany, folic acid flour supplementation in Chile, and untreated anxiety and pain during the last months of life on surviving spouses of cancer patients.
In the news are reports of colon cancer surgery using a tiny incision in the belly button, requirements for KRAS testing before insurance will pay for Erbitux or Vectibix treatment, and information about how stem cells in the intestinal tract become cancer stem cells, driving the development and progression of colorectal cancer.
- In late 2002 colonoscopy became the primary colorectal cancer screening tool in Germany. Since then 1,875,700 men and women have had colonoscopies. The German Cancer Research Center estimates that the program will have prevented 15,000 colorectal cancers by 2010. The reduction happened despite a fairly low turnout for screening, 30 percent for men and 40 percent for women between the ages of 55 and 69. Hermann Brenner and his team discuss their study in the European Journal of Cancer, published online March 16, 2009.
- Colon cancers have increased in Chile since mandatory wheat flour fortification with folic acid began in 2000. Comparing the years 1992-1996 and 2000-2204, colorectal cancer rates for men and women from 45 to 64 were more than two and a half times higher. For older people 65 to 79, rates almost tripled. While this suggests a temporal connection between folic acid and colon cancer, there may be other reasons for increased rates including access to health care, increased obesity, and reporting methods. Similar changes were seen in the United States and Canada after folic acid fortification began in those countries in 1996 and 1997. Sandra Hirsch’s research is published in the European Journal of Gastroenterology and Hepatology ahead of print, February 2, 2009.
- When their wives with cancer suffered from unrelieved anxiety or pain in the last three months of life, widowers had trouble sleeping as long as four and five years later. Wives’ anxiety caused almost twice as many men to have trouble falling asleep after the women died, and the men had five times the risk of waking up with anxiety themselves. Their wives’ unrelieved pain doubled the chances that men would have a hard time falling asleep. Researchers emphasized the importance of recognizing and treating cancer pain and anxiety for both patients and their surviving spouses. Junmei Miao Jonasson reports her findings in the European Journal of Cancer online March 5, 2009.
- St. Louis University Hospital is doing unique single-incision GI operations that include colectomies for colon cancer. Unlike more common laparoscopic surgery that uses several incisions in the abdomen, single-incision surgery is performed through a small, half-inch opening in the belly button. Patients have less pain and fewer scars. The procedure uses flexible scopes and instruments that can move easily within the body, producing views from all angles. Board-certified colorectal surgeon Dr. Ovunc Bardakcioglu leads the minimally invasive surgical team developing and teaching the techniques.
- Beginning April 1, 2009 UnitedHealthcare insurance programs will require KRAS testing before paying for colorectal cancer treatment with Erbitux® (cetuximab) or Vectibix™ (panitumumab). Only patients with non-mutated (wild-type) KRAS in their tumor tissue will be considered for coverage. They recommend, “We encourage physicians to obtain KRAS testing for their colorectal patients as soon as reasonable, and especially prior to starting the drugs cetuximab and panitumumab or earlier if clinically appropriate. “ United has contracts with two national laboratories — Genzyme Genetics and LabCorp — to provide testing.
- Stem cells constantly are repairing and renewing the lining of the colon. Changes can lead them to becoming cancer stem cells, critical to the development and progression of colorectal cancer. Scientists at the UK National Stem Cell Network conference say that they know such cells exist, but are not sure exactly which normal cells in the bowel can become cancer stem cells. Professor Malcolm Allison, the London School of Medicine, told the conference, “Drugs could be targeted to specifically work on cancer stem cells and so provide a more direct approach for treating bowel cancer.” Professor Allison says that he sees patient trials within three years to target and knock out cancer stem cells. Michelle Roberts has written a story about the conference and colorectal cancer stem cells for BBC News.