You think we’ve made a lot of noise during this Colorectal Cancer Awareness month?

We’re only going to get louder. On Monday morning, Fight Colorectal Cancer survivors and advocates will ring the opening bell on NASDAQ—representing 1.2 million colorectal cancer survivors in the U.S. who are only going to get louder as our numbers grow.

Good news or bad news? Both, really. As Boomers age, more Americans will get cancer—and with better treatment and earlier diagnosis, there will be more cancer survivors.

In just 10 years, the number of cancer survivors in the U.S. will increase by nearly a third—to almost 18 million survivors of all types of cancer in 2022. That population explosion and other eye-opening facts are reported in “Cancer Treatment & Survivorship Facts & figures 2012-2013,” a 35-page report just released by the American Cancer Society.

Some facts about colorectal cancer:

• Colorectal cancer is the second most common in the nation’s current 13.7 million cancer survivors. (Among men, 43% are prostate cancer survivors, with colorectal cancer second at 9%. Among women, 41% are breast cancer survivors, with colorectal and uterine cancer second at 8% each.)
• Almost half (45%) of all cancer survivors are 70-plus years old. For colorectal cancer, the median age for diagnosis is 70.

Survivor care needs to catch up

Survivors cover a wide spectrum—from those who’ll never have another trace of the cancer to those who live with continuous therapy to keep the cancer controlled.

Yet “many survivors, even among those who are cancer free, must cope with the long-term effects of treatment….As more people survive cancer, it is vital that healthcare providers are aware of the special needs of cancer patients and caregivers,” the study’s senior author Elizabeth R. Ward, Ph.D., told Reuters Health News Service .

But a 2012 study presented at last summer’s (June 2012) ASCO annual meeting found that only 22% of 1000 primary care providers correctly identified peripheral neuropathy—which can persist for months, years, or permanently–as a late effect of the commonly used chemotherapy Eloxitan (oxaliplatin).

“Most long-term survivors of colorectal cancer report a very good quality of life,” the American Cancer Society report noted,  but some survivors will have bowel problems, and as many as 40% of those treated for local or locally advanced colorectal cancer (which has invaded nearby organs) will have a recurrence.

Delayed diagnosis: so much more to do

Of the 10 most common cancers, only lung and non-Hodgkin lymphoma had a higher percentage of new cancer cases diagnosed at the regional or metastasized stages, according to the new report.

During the 2001-2007 time period, only 39% of colorectal cancers were diagnosed when it was still localized, when the 5-year survival rate is 90%. A full 20% (and 24% among African Americans) were diagnosed when the disease had already spread (metastasized), when the average 5-year survival rate hovers at 12%.

Take-away for colorectal cancer survivors

• Whether you’re discharged as “free of cancer” or still under active treatment, be sure your oncologist sends complete information to your primary care provider.
• Develop and understand your own “survivorship plan.” (Read here for specifics.)
• Help us improve those statistics–real people–diagnosed late instead of early when this cancer is curable: All year long, educate your family, friends, neighbors, political representatives about the need to get screened for colorectal cancer.

Sources: “Cancer Treatment & Survivorship Facts & figures 2012-2013,” American Cancer Society, March 2013;  “Number of US Cancer Survivors to Increase by a Third by 2022,” March 20 2013 Reuters, and “Better Information Needed for Primary Care Providers Who Treat Cancer Survivors,” June 15 2012 ASCO Post.

Goooooooood morning!

Today is a big day. Our advocates at the 2013 Call-on Congress head to Capitol Hill. Meetings with senators, house representatives and subcommittee members abound!

It’s going to be a great day!

Not so fast… we need YOUR help.

Yes – you… if you’re reading this post, we’re talking to YOU.

Please help us boost the power of our advocates on the Hill today. We’ve got big priorities and big asks – and there’s a particular issue we need your help with.

Most likely – colorectal cancer impacted your life, or the life of your loved one.

So get involved in the fight with us today.

Here’s the scoop:

• Please call 1-866-615-3375

• Enter your zip code – you will be directed to your representative

• Tell them your name and where you are from

• Tell them:  You want them to support and co-sponsor the HR 1070 act (eliminates co-pays for screening colonoscopies in Medicare patients)

Your call will help us boost the message that colonoscopy screening should be available to millions.

If you don’t call and help us put colorectal cancer on the map … nobody will.

So call today!

Not so fast…

Before you go, a few things to remember:

• You will be calling your House of Representatives member.
• You can help spread the word – encourage others in your household, workplace, dinner party – whatever – to call in and vote.
• This will only take a few minutes of your time.

“The voices of people pulling together have got to be louder than the voice of those people pulling us apart.” – Martin B. Gold, MPA, JD

Call today – help us take the next step in our fight against colorectal cancer!

After you call – tweet at us and let us know you joined the fight!

Tips From a Member of Our Medical Advisory Board

Al B. Benson III, MD, FACP FASCO is Professor of Medicine, Feinberg School of Medicine,  and Associate Director for Clinical Investigations, Robert H. Lurie Comprehensive Cancer Center, Northwestern University

One of the nation’s most respected experts in colorectal cancer, Dr. Benson has supported and worked with Fight Colorectal Cancer for years as an active member of our Medical Advisory Board.

Written by Dr. Al Benson, March 18 2013, Chicago, Illinois

Although March is Colorectal Cancer Awareness Month, this disease is so frequent yet in most cases preventable that we should be striving every month of the year to make even more people aware of the importance of colorectal cancer and colorectal cancer screening. The good news is that we are seeing a trend that showing more people are getting screened and more people are surviving this disease. Even so, we have much more work to do to prevent and treat colorectal cancer.

Important information to know – from screening to diagnosis for colorectal cancer:

1) Know your family history. In some cases, colorectal cancer risk is inherited and the genetic risk can be passed on to generations within a family. For those with a risk for inherited colorectal cancer, genetic counseling and testing is strongly recommended. Also if you have an immediate family member who has had colorectal cancer, your risk for developing the disease is greater. Let your doctor know about the details of your family history. If you are unsure of your family history, discuss it with your relatives to be as complete as possible.

2) If you are of African-American descent, you are potentially at higher risk for developing colorectal cancer and screening should begin earlier, at age 45.

3) There is growing recognition that obesity, diabetes and lack of exercise are contributing factors to the risk of developing colorectal cancer and these risks should also be discussed with your doctor.

4) Talk with your doctor if you experience bleeding from the rectum. Many people assume bleeding is “just hemorrhoids,” which might be true, but it also could be a sign of colorectal polyps and/or cancer. Discuss any bleeding with your doctor as well as other symptoms including change in bowel habits (e.g., recent but persistent diarrhea and or constipation), persistent abdominal pain, weight loss or loss of appetite, or increasing fatigue.

5) If you are diagnosed with colorectal cancer, make sure you ask which members of the medical team will be important for your care. A gastroenterologist, surgeon, medical oncologist, radiation oncologist (for rectal cancer), nurse, nutritionist, psychologist, social worker, financial counselor, genetic counselor are some examples of team members who you may really need to help with your diagnosis and treatment.

6) Ask if you are a potential candidate to participate in a clinical trial. All of our current therapies and advancements in the treatment of colorectal cancer have come about because people through the years participated in a clinical trial. Oncologists consider clinical trials to be one component of the standard of care. Further advances in colorectal cancer treatment will require many people willing to enroll in our clinical trials.

7) There are resources available for you. Fight Colorectal Cancer has great information available for you. The National Comprehensive Cancer Network (NCCN) has created guidelines for treatment used around the world by health care professionals. There is a patient version of colorectal cancer guidelines  that you can obtain on the internet and bring to your doctor.

I hope some of these tips will offer you and your family some additional guidance as we continue our efforts to control this common cancer.

A study published in the March 11 JAMA-Internal Medicine suggests that 23 percent of over-75-year-olds have colonoscopies that may be “potentially inappropriate” according to national guidelines which include an upper age limit, as well as how often negative colonoscopies should be repeated.

In a retrospective population study, University of Texas researchers looked at billings for 100 percent of colonoscopies performed in Medicare beneficiaries in Texas who were aged 70 years and older who had a colonoscopy in 2008 or 2009. They also examined a nationwide sample of 5% of Medicare claims. Colonscopies were classified as “screening” if records (including claims from 2000 to 2009) did not indicate a diagnosis, or any visits for related symptoms in the previous 3 months.

Colonoscopies were labeled “potentially inappropriate” based on patient age over 75, or because the procedure was done less than 10 years after a previously negative colonoscopy. (The study population did not include anyone with a history of colon cancer, inflammatory bowel disease, colon resection, or whose procedure was performed during a hospital admission or emergency room visit.)

Among Texas residents, overall percentages of potentially unnecessary colonoscopies were:

• Age 70-75: 9.9 % of procedures done
• Ages 76-85: 38.8%
• Aged 86-plus: 24.9%.

There was wide variation in geographic areas of Texas, plus among individual doctors doing the screening procedures. The researchers did note that reasons for doing a colonoscopy in an individual patient cannot be assumed from billing information alone. (In fact only 15% of the claims included a screening code, although experts believe about two-thirds of colonoscopies are for routine screening.) The authors noted that there might be poor communication between a primary care doctor and the gastroenterologist; there could be financial incentives to do the procedure, or doctors might disagree with the national guidelines.

What are the guidelines?

In fact, there are different sets of guidelines. The U.S. Preventive Services Task Force (and recently, the American College of Physicians) specify age limits. The USPSTF says “For adults aged 76 to 85 years, there is moderate certainty that the net benefits of screening are small….and [for] adults older than age 85 years, there is moderate certainty that the benefits of screening do not outweigh the harms.”

However, joint guidelines developed by the American Cancer Society, the U.S. Multi-Society Task force on Colorectal Cancer, and the American College of Radiology do not include age limits. Part of the problem is lack of evidence: experts note that far too few population studies and clinical trials include those over age 75, even though about 30% of colorectal cancers are diagnosed in those 75 or older.

Increased risks might outweigh benefits for colonoscopy in those over age 75

Although the USPSTF urges caution in any screening over age 75, colonoscopy itself carries higher risks to elderly patients. Both this study’s authors and guideline developers urge extra caution—especially in unnecessary procedures—in the elderly who face higher risks from the preparation (fluid imbalance, start of a diarrhea/constipation cycle, dizziness or a rush to bathroom causing falls) plus effects of anesthesia in elderly patients.

Some over 75 will benefit

A caveat common among the experts: Among those who have never been screened, a screening colonoscopy might be indicated—especially if the older person is healthy, active, has few other diseases, and has an expected lifespan of more than 7 years.

Another study in the March 5 2013 Annals of Internal Medicine showed that in four HMOs, screening among people aged 55 to 85 did reduced the risk of advanced colorectal cancer by 70% in average-risk adults. However, the study showed that annual stool samples in this population (particularly when reminders and stool-sample kits were mailed to people’s homes) were as effective as colonoscopy.

What to do?

Probably the Centers of Disease Control & Prevention says it best: “The decision to be screened after age 75 should be made on an individual basis. If you are older than 75, ask your doctor if you should be screened.”

Patient Take-Away

• All guidelines recommend a colonoscopy only every 10 years, unless you have symptoms, family history, or a previous removal of polyps or an adenoma. (In those cases, plan your “surveillance colonoscopy” with your doctor.)
• People aged 75 or older should pause to consider the need for a routine screening colonoscopy, especially if it’s less than 10 years since a previous negative colonoscopy. You can also consider other screening methods, such as a yearly stool sampling that is very effective at finding early cancer.
• Discussions about cancer (and other) preventive screening probably are best with your primary-care doctor, who knows all of your other health conditions, your general fitness level, etc.
• If you do have a colonoscopy, it’s best to get your own written record of the results, including number and type of any polyps. A common cause of getting too-frequent colonoscopies could be that a different doctor doesn’t know the results of your previous test(s).

As always, stay tuned for updates on both screening and colorectal cancer treatment in the elderly: As boomers age in, and hopefully more seniors are included in clinical and prevention studies, the science will get clearer.

For More information:

* CDC brief summary of guidelines

* Choosing Wisely: on colonoscopies

* Who is the USPSTF? “A Conversation with Dr. Virginia Moyer, Chair, U.S. Preventive Services Task Force, Nov. 27 2012 NCI Cancer Bulletin.

Sources:

“Potentially Inappropriate Screening Colonoscopy in Medicare Patients,” Kristin M. Sheffield, Ph.D. et al,  JAMA Internal Medicine, published online March 11, 2013

Other coverage of this study includes: “Seniors Getting Unnecessary Colonoscopies: Study,” Monday, Mar. 11 HealthDay News; and “Many Colonoscopies for Seniors May be Inappropriate,” Christian Nordqvist, 12 Mar. 2013 Medical News Today.

See previous Research News blogs, including the Feb. 14 2013 “Colorectal Cancer is (or Could Be) the Poster Child for Cancer Prevention” and
the May 16 2011 “Fight CRC Site Update: Some People Getting Colonoscopy Screening Too Often.”

Other recent articles about screening: “CRC Screening Tools—The Data and the Guidelines,” Linda Rabeneck, M.D., M.P.H., at January 2013 ASCO GI-Symposium; and  “Screening Colonoscopy and Risk for Incident Late-Stage Colorectal Cancer Diagnosis in Average-Risk Adults,” March 5 Annals of Internal Medicine .

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.