Briefly

Factors related to the patient, year of surgery, and tumor itself and not surgeons or pathologists explain low lymph node counts after colon and rectal surgery.  Lack of colorectal cancer screening leads to emergency surgery and complications and death among the elderly.

Americans without health insurance are more likely to die, even when factors like overall health, smoking, and income are considered, and cancer patients who have support from family and friends at diagnosis are much more likely to look on the entire experience as a chance for positive growth years later.

Finally, FDA has a good video to help people avoid health care frauds.

Happy Holidays.  Enjoy family, friends, and lights.

Research Highlights

• Why are too few colon cancer lymph nodes tested?  Is it the surgeon removing too few or the pathologist not examining them all?  Or something entirely different?  Reviewing lymph node reports from 430 colon cancer patients operated on in one large hospital in a period just over four years from 2003 through 2007, researchers found no difference among 18 surgeons nor any difference that could be attributed to 10 pathologists or 3 pathology assistants.  Instead, the age of the patient, the site of the tumor, the stage of the cancer, and the year the surgery was done contributed to inadequate lymph node counts.  James W. Jakub, MD, and his team reported their study in the Archives of Surgery, December 2009.
• Lack of colorectal cancer screening leaves elderly patients at risk for emergency surgery when growing cancer blocks or perforates the colon.  About a third (30 percent) of 292 emergency colorectal surgeries in a large university hospital were due to either colon obstruction or perforation.  Fifteen percent of all patients older than 65 who had emergency colorectal surgery died, and 35 percent had at least one serious complication.   In their conclusion in the December 2009 Archives of Surgery, Edward A. McGillicuddy, MD and the Yale University team point out, “These procedures frequently involve locally advanced colorectal cancer, emphasizing the need for improved colorectal cancer screening.”
• When cancer patients receive emotional support in the three months after their diagnosis, they are much more likely to look on their cancer experience as an opportunity for positive growth many years later.  Eight years after diagnosis, cancer survivors who got reassurance, comforting, and help with problem solving from family and friends reported positive outcomes from their illness, what researchers termed posttraumatic growth. Maya J. Schroevers and her team discuss their study in Psycho-Oncology, January 2010.
• Lack of health insurance increases risk of dying, even when other factors like smoking, obesity, income, and overall health are taken into account.   Americans from 17 to 64 who are uninsured are twice as likely to die.  When the Boston research team adjusted their analysis to include race, ethnicity, income, education, body mass index, exercise, smoking, alcohol use, and how both individuals and their doctors rated their health, the uninsured were 40 percent more likely to die than the general population.  The December 2009 issue of the American Journal of Public Health reports the analysis by Andrew P. Wilper, MD, MPH and colleagues.

Other Headlines

• The FDA has a good video to help consumers become aware of health fraud. The Consumer Update shows Internet users how to spot and avoid unproven and unsafe treatments for cancer and increasing fraudulent products to prevent or treat H1N1 flu.  FDA 101: Health Fraud Awareness has more detailed information on common types of health fraud and how to avoid becoming a victim of them.

Through the Colorectal Cancer Control Program, five-year grants ranging from $358,283 to $1.1 million will support support screening and diagnostic follow–up care, data collection, outreach and public education, health care provider education, and program evaluation.  Projects can choose from among recommended screening methods including colonoscopy, sigmoidoscopy, or stool tests.

The new funding builds on the successful CDC Colorectal Cancer Screening Demonstration Program in five sites across the US, including Baltimore, Long Island, Seattle and King County, Nebraska, and Missouri.

CDC Director Thomas Frieden, MD, MPH, pointed out,

Colorectal cancer kills more people than any other cancer except lung cancer. These colorectal cancer screening awards will save lives. We need to reach more adults aged 50 and over and others at high risk to prevent colorectal cancer.

Laura Seeff, M.D., the medical director of CDC′s colorectal cancer screening efforts, continued,

Screening tests can detect colorectal cancer at its earliest stages, when it is most treatable. This screening program has tremendous potential to address the disparities that exist in colorectal cancer screening and to save lives.

What This Means for Colorectal Cancer Prevention

C3 applauds this CDC initiative to reach and screen more uninsured people and people whose insurance does not cover colorectal cancer screening.  There is good evidence that screening saves lives.

However, we remain committed to see that all Americans can be screened for colorectal cancer using any of the recommended screening methods that they choose in consultation with their doctors.

• We support the passage of HR 1189  – the Colorectal Cancer Prevention, Early Detection, and Treatment Act — which would provide colorectal cancer screening to all uninsured and underinsured  Americans and treatment for colorectal cancers detected during screening as part of the program.
• We also support all efforts to provide full insurance coverage for colorectal cancer screening.

President Obama recognizes the value of colorectal cancer screening when he called it out in  his speech to Congress on September 9, 2009:

And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies. Because there’s no reason we shouldn’t be catching diseases like breast cancer and colon cancer before they get worse. That makes sense. It saves money and it saves lives