Only 60% of the eligible U.S. population gets screened for colon cancer

Only 61% of the eligible population in the USA gets screened for this common cancer, according to The Lancet.

Here are some excerpts from the new guidance for colorectal cancer screening by the American College of Physicians (ACP):

- colorectal cancer screening should start at the age of 50 years for people at average risk, and at 40 years (or 10 years before the age of the youngest case of colorectal cancer in a family) for people at high risk

- stool-based tests, flexible sigmoidoscopy, and optical colonoscopy are all acceptable screening options for people at average risk

- the gold standard—optical colonoscopy—is recommended for people at high risk

- screening should be stopped for adults aged over 75 years or who have a life expectancy of less than 10 years

Colorectal cancer screening can lead to harmful outcomes such as perforation, bleeding, and false-negative results.

10 Questions You Need to Ask About Colonoscopy

From The NYTimes:

1. Why is effective bowel preparation important?
2. How can I maximize my chance of an effective bowel preparation?
3. Are there certain medications I should stop taking before colonoscopy?
4. Are all colonoscopists equally effective at finding polyps and cancers during colonoscopy?
5. How can I be sure that my colonoscopist will do a careful examination?
6. How can I reduce the risk of a complication during colonoscopy?
7. Should I try colonoscopy without sedation?
8. If I undergo sedation, should it be given by an anesthesiologist?
9. Do all colonoscopists follow the same rules to determine when my colonoscopy should be repeated?
10. Why aren’t the problems with the delivery of colonoscopy already solved?

Questions # 1, 2, 3, 6, 7 are very important, question # 10 probably not so much.

17% of U.S. hospitals now provide virtual colonoscopy


Medicare does not currently reimburse routine screening with virtual colonoscopy, but it does cover evaluations with "regular" colonoscopy.

References:

New guidance for colorectal cancer screening. The Lancet, Volume 379, Issue 9820, Page 978, 17 March 2012.
Virtual Colonoscopy Gains in Popularity. Is It Right for You? TIME.
Colonoscopy Developer Dies at 94 - NYTimes http://goo.gl/iBnOp - Dr. Wolff was unconventional and surely made headlines in his day.
When President Obama underwent his first-ever colon cancer screening last year, he chose virtual colonoscopy. USA Today.
Cleveland Clinic Colorectal Cancer Risk Assessment Tool. Get your score in 2 minutes (free).
Image source: Colon (anatomy), Wikipedia, public domain.

NYT weekly column: Life, Interrupted: Facing Cancer in Your 20s

Suleika Jaouad, a writer and recent college graduate, is chronicling her experiences as a young adult with cancer in a weekly column for the NYTimes: http://well.blogs.nytimes.com/author/suleika-jaouad

Can hot peppers fight cancer? CBS video

Super hot peppers can make you sweat and tear up, but CBS News reports how they also may fight cancer:

China's "Cancer Rivers" - DW video

Edgar Wolf reports on a member of China's budding environmentalist movement. Huo Daishan has fought to save the Huai river for decades. And his efforts are paying off.

Dogs Can Smell Cancer - BBC video

The first serious suggestion that dogs could "sniff out" cancer appeared in a letter to The Lancet in 1989.

From Dogs Can Smell Cancer - Secret Life of Dogs - BBC - YouTube:  "Dogs watch us all the time and read our body language like a sixth sense. They also smell our bodies for changes. Max smelt cancer in Maureen before any medical scans could pick it up. Dogs do this naturally and can be trained to pick up on tiny volatile chemicals given off by cancerous tumors. They can even be taught to alert diabetics to low blood sugar levels."



Related:

BBC News - Medical Detection Dogs train animals to 'sniff out' breast cancer http://buff.ly/1mju3fG

SNIFFER DOGS IN THE MELANOMA CLINIC? : The Lancet http://buff.ly/1lFD0S9

Life With a Dog: You Meet People - NYTimes on health benefits of having a dog as a pet http://bit.ly/1e62kQq

Lung cancer - Lancet review

Small-cell lung cancer

Diagnosis relies on histology, with the use of immunohistochemical studies to confirm difficult cases.

Typical patients are men older than 70 years who are current or past heavy smokers and who have pulmonary and cardiovascular comorbidities.

Patients often present with rapid-onset symptoms due to:

- local intrathoracic tumour growth
- extrapulmonary distant spread
- paraneoplastic syndromes
- a combination of these features

Staging aims ultimately to define disease as metastatic or non-metastatic:

- Combination chemotherapy (platinum-based plus etoposide or irinotecan) is the mainstay first-line treatment for metastatic small-cell lung cancer.

- For non-metastatic disease, early concurrent thoracic radiotherapy is indicated.

Prophylactic cranial irradiation should be considered for all patients, even without metastases, whose disease does not progress after induction chemotherapy and radiotherapy.

Despite high initial response rates, most patients eventually relapse. Except for topotecan, few treatment options then remain.

Non-small-cell lung cancer (NSCLC)

The recently introduced 7th edition of the TNM classification relates better to other prognostic factors such as biological markers.

The advances in treatment include:

- a new generation of chemotherapy agents
- a proven advantage to adjuvant chemotherapy after complete resection for specific stage groups
- new techniques for radiotherapy
- new surgical approaches

References:

Small-cell lung cancer. The Lancet, Volume 378, Issue 9804, Pages 1741 - 1755, 12 November 2011

Non-small-cell lung cancer. The Lancet, Volume 378, Issue 9804, Pages 1727 - 1740, 12 November 2011

Image source: A CXR shows a right upper lobe (RUL) mass due to lung cancer. Source: Finger Clubbing due to Lung Cancer. Clinical Cases and Images.

Green tea may be a cancer fighter - Cleveland Clinic video

A new study finds the tea shows promise as a possible oral cancer fighter. Green Tea Doesn’t Prevent Breast Cancer, Study Finds http://goo.gl/j5xZ

Related:

Coffee vs. Tea - Infographic of Health Benefits and Risks http://goo.gl/StIsrGreen Tea Decreases Total and LDL Cholesterol by 5 mg/dL http://goo.gl/AwVDr and http://goo.gl/Ku55O

What's in Your Green Tea? Loose tea leaves are perhaps the best and most potent source of antioxidants http://buff.ly/1avSe3p

The Colonoscopy Song - March is National Colorectal Cancer Awareness Month

Peter Yarrow of the musical group Peter, Paul and Mary appeared on the CBS Early Show to sing a song he composed about his own colonoscopy:



In the video below, Dr. Paul Limburg, a Mayo Clinic Gastroenterologist, provides background on colorectal cancer and the screening methods:

Related reading:

Cleveland Clinic Colorectal Cancer Risk Assessment Tool. Get your score in 2 minutes (free).
Colon cancer and colonoscopy - Cleveland Clinic YouTube playlist 
Dr. Oz Has Colon Cancer Scare During Taping of His Colonoscopy for the TV Show http://goo.gl/F4CX

Fear was the No. 1 reason people gave to explain why they hadn’t gone in for a colonoscopy to screen for colon cancer. NYTimes.

Get your colonoscopy in the morning - each hour brings a 4% reduction in the number of polyps the doctors spotted http://goo.gl/2FGQt

Dr. Oz: What I Learned from My Colon Cancer Scare http://goo.gl/q7rjD
Colonoscopy Developer Dies at 94 - NYTimes http://goo.gl/iBnOp - Dr. Wolff was unconventional and surely made headlines in his day.

Martina Navratilova Fighting Breast Cancer - ABC Video

In February 2010, the tennis legend was diagnosed with an aggressive form of ductal carcinoma in situ (DCIS), considered the earliest form of breast cancer. Navratilova had a lumpectomy in February, during which her doctors determined that the cancer had not spread to her lymph nodes. She says there is only a "very small chance of it coming back."

Navratilova's cancer was diagnosed during a routine mammogram, after not having one for four years, and she hopes that speaking out will inspire other women to get mammograms.

"The reason I wanted to speak about this is to encourage these woman to have mammograms," she said. "I just want to encourage women to have that yearly check-up."

References:
Martina Navratilova Fighting Breast Cancer

Rock legend Ronnie James Dio is fighting stomach cancer

On 25 November 2009, Dio's wife and manager announced that he was diagnosed with stomach cancer:

"Ronnie has been diagnosed with the early stages of stomach cancer. We are starting treatment immediately at the Mayo Clinic. After he kills this dragon, Ronnie will be back on stage, where he belongs, doing what he loves best, performing for his fans. Long live rock and roll, long live Ronnie James Dio. Thanks to all the friends and fans from all over the world that have sent well wishes. This has really helped to keep his spirit up." -- "He has had a few hiccups between Christmas and New Year's," she said in a statement to fans. "He has had a blood clot, a trip to the emergency room, and a three-day stay at the hospital."

ArtisanNewsService — April 13, 2010 — "One of heavy metal's premiere vocalists Ronnie James Dio shares his thoughts on his battle with stomach cancer at the Revolver Golden Gods awards." On 14 March 2010, Dio's wife and manager Wendy posted an online update on his condition: "It has been Ronnie's 7th chemo, another cat scan and another endoscopy, and the results are good - the main tumour has shrunk considerably, and our visits to Houston (MD Anderson Cancer Center in Texas) are now every three weeks instead of every two weeks."

Ronnie James Dio passed away on May 16, 2010 at age 67. The music lives on: http://www.ronniejamesdio.com

References: Ronnie James Dio. Wikipedia. Black Sabbath, Dio singer Ronnie James Dio gives cancer update. NME.com.

Eddie Trunks Metal show with guests Ronnie James Dio & Geezer Butler, May 30, 2009.

Metal legend Ronnie James Dio dead at 67. USA Today, 2010. Ronnie James Dio, Rock Singer, Dies at 67. NYTimes, 2010. Ronnie James Dio died at age 67. YouTube. Ronnie James Dio Remembered By Metallica's Lars Ulrich. MTV. The Lighter Side of Ronnie James Dio. NYTimes. Lars Ulrich's letter to Dio.

Dio, another day. Nigel Britto, TOI Crest, May 22, 2010. Dio monument in Bulgaria - source one, two, three (in Bulgarian), 10/2010. Cortland native Ronnie James Dio will be honored Thursday with the SAMMYs Lifetime Achievement Award, 2014 http://buff.ly/1lHk3j5

Updated: 10/24/2010

Occupation may be a key factor in lung cancer

While cigarettes are by far the most important cause of lung cancer, chemicals and other on-the-job hazards "play a remarkable role" in lung cancer risk.

5% of lung cancers in men are job-related. Men in the known to be risky occupations were 74% more likely to have been diagnosed with lung cancer.

The strongest associations were seen for ceramic and pottery jobs and brick manufacturing, as well as for those working in manufacturing of non-iron metals.

A CXR shows a right upper lobe (RUL) mass due to lung cancer. Source: Finger Clubbing due to Lung Cancer. Clinical Cases and Images.

References:

Occupation a key factor in men's lung cancer risk. Reuters, 2010.
http://www.reuters.com/article/idUSTRE61E53920100215

TED Talks: A new strategy in the war on cancer

From TED Talks/TED Med: Traditionally, David Agus explains, cancer treatments have had a short-sighted focus on the offending individual cells. He suggests a new, cross-disciplinary approach, using atypical drugs and computer modeling.

P.S.A. testing can’t detect prostate cancer, says its discoverer

Richard J. Ablin in the NYTimes:

"Approved by the Food and Drug Administration in 1994, the P.S.A. test’s popularity has led to a hugely expensive public health disaster. It’s an issue I am painfully familiar with — I discovered P.S.A. in 1970.

The annual bill for P.S.A. screening is at least $3 billion, with much of it paid for by Medicare and the Veterans Administration.

As I’ve been trying to make clear for many years now, P.S.A. testing can’t detect prostate cancer and, more important, it can’t distinguish between the two types of prostate cancer — the one that will kill you and the one that won’t."

References:
The Great Prostate Mistake. NYTimes.
Image source: Wikipedia, public domain.

The Value of YouTube Videos for Cancer Patients - Mayo Clinic

Ruben Mesa, M.D., describes his experience using YouTube videos to provide in-depth information about blood cancers.

Michael Douglas on Having Throat Cancer - Late Show with David Letterman (video)

Oropharyngeal cancer is increasing at a "dramatic" rate, particularly in the male population http://goo.gl/JAko

Related:
Michael Douglas Has Stage IV Throat Cancer; Experts Weigh In. WebMD.
Catherine Zeta-Jones's fury at the doctors who missed her husband Michael Douglas's throat cancer. Daily Mail.

Update 01/11/2011:

Michael Douglas says his throat cancer tumor is in complete remission ("gone") after 7 weeks of radiation/chemotherapy, but salivary glands not working http://goo.gl/zfR9Z

Short telomeres lead to chromosomal instability and increased cancer risk and mortality

Telomeres are essential to preserve the integrity of the genome. Critically short telomeres lead to replicative cell senescence and chromosomal instability and may thereby increase cancer risk.

Leukocyte telomere length was measured by quantitative polymerase chain reaction in 787 participants free of cancer at baseline in 1995 from a prospective, population-based study in Italy. The follow-up period was 10 years.

Human chromosomes (grey) capped by telomeres (white). Image source: Wikipedia, public domain.

11.7% of participants developed cancer (incidence rate, 13.3 per 1000 person-years).

Short telomere length at baseline was associated with incident cancer independently of cancer risk factors (hazard ratio [HR] 1.60).

Compared with participants in the longest telomere length group, the HR for incident cancer was 2.15 in the middle length group and 3.11 in the shortest length group. Furthermore, short telomere length was associated with cancer mortality and individual cancer subtypes with a high fatality rate.

There is an inverse relationship between telomere length and both cancer incidence and mortality.

References:
Telomere Length and Risk of Incident Cancer and Cancer Mortality. Peter Willeit, MD; Johann Willeit, MD; Agnes Mayr, MD; Siegfried Weger, MD; Friedrich Oberhollenzer, MD; Anita Brandstätter, PhD; Florian Kronenberg, MD; Stefan Kiechl, MD. JAMA. 2010;304(1):69-75.

Aspirin 75 mg daily reduces incidence and mortality due to colorectal cancer

High-dose aspirin (≥500 mg daily) reduces long-term incidence of colorectal cancer, but adverse effects (bleeding) might limit its potential for long-term prevention. The long-term effectiveness of lower doses (75-300 mg daily) is unknown. This study in The Lancet assessed the effects of aspirin on incidence and mortality due to colorectal cancer over 20 years.

In the four trials of aspirin versus control (mean duration of treatment 6 years), 2·8% of 14,000 patients had colorectal cancer during a follow-up of 18 years.

Aspirin reduced the 20-year risk of colon cancer (incidence hazard ratio [HR] 0·76, but not rectal cancer (0·90).

Where subsite data were available, aspirin reduced risk of cancer of the proximal colon (0·45), but not the distal colon (1·10). Benefit increased with duration of treatment - aspirin taken for 5 years or longer reduced risk of proximal colon cancer by 70% and also reduced risk of rectal cancer (0·58).

There was no increase in benefit at doses of aspirin greater than 75 mg daily. However, risk of fatal colorectal cancer was higher on 30 mg versus 283 mg daily.

Aspirin taken for several years at doses of at least 75 mg daily reduced long-term incidence and mortality due to colorectal cancer. Benefit was greatest for cancers of the proximal colon, which are not otherwise prevented effectively by screening with sigmoidoscopy or colonoscopy.

References:
Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials. The Lancet, Volume 376, Issue 9754, Pages 1741 - 1750, 20 November 2010.

Image source: Colon (anatomy), Wikipedia, public domain.

Kylie Minogue on cancer - BBC video

Kylie Minogue on cancer - Friday Night with Jonathan Ross - BBC One.