Colon and Cervical Cancer
(3/21/19)- Colorectal cancer is the second most common cause of cancer deaths in this country, with more than 51,000 people expected to die from it this year. Even though the overall death rate has continued to drop over the last few decades, deaths among young people under 55 years of age has increased by 1 percent a year since 2007.
Last year the American Cancer Society lowered the recommended age to start screening to 45 from 50. In 2016, only about 49 percent of adults aged 50 to 54 had been screened, according to Dr. Richard C. Wender, chief cancer control officer of the cancer society
(3/3/19)- A recent study that looked at 568 people who had died in hospitals and whose average age was 70 or more, found that more than half had sepsis and it was the immediate cause of death for nearly 200 of them; another 100 had sepsis but didnít die from it.
Only 36 of the sepsis deaths might have been prevented with earlier antibiotic treatment, or other measures.
Dr, Chanu Rhee, an infectious disease and critical care physician at Brigham and Womenís Hospital was the lead author of the study which was published in JAMA Network Open.
One million to three million Americans are found to have sepsis each year and 15% to 30 % of them die from it, according to the Centers for Disease Control and Prevention (CDC).
(2/18/19)- Supreme Court Justice Ruth Bader Ginsberg returned to the court on Friday to participate in a private conference at which the justices considered adding cases to the courtís docket. It was her first appearance at the court since undergoing lung cancer surgery in December.
Justice Ginsberg, 85, missed two weeks of arguments in January but participated by reading briefs and transcripts. Surgeons removed two nodules from her left lung. She is expected to be back on the bench Tuesday when the court returns from a four-week winter break
Justice Ginsberg has been treated for cancer twice before, as we mentioned in several items below.
(6/4/18)- The American Cancer Society issued a new guideline that extends routine colorectal cancer screening to an additional 22 million Americans between the ages of 45 and 49.
Over 140,000 Americans are expected to be diagnosed with colon or rectal cancer this year. The disease causes an estimated 50,000 deaths annually, making it the 2nd leading cause of cancer deaths among American adults. Lung cancer is the leading cause of cancer deaths in this country.
(1/26/17)- The death rate from cervical cancer in the U.S.is considerably higher than prior estimates, according to a study published recently in the journal cancer. These figures are particularly disheartening in light of the fact that when screening guidelines, as detailed in our item dated 4/22/12 below, and follow-up monitoring is pursued, death from cervical cancer is largely preventable.
Anne F. Rositch the lead author of the study, who is an assistant professor of epidemiology at the John Hopkins Bloomberg School of Public Health, said that data from 2000 to 2012 was analyzed, but the study excluded women who had hysterectomies, since that meant they no longer had a cervix.
The study concluded that the mortality rate for black women was 10.1 per 100,000, but was only 4.7 per 100,000 for white women.† About 20% of the women in the U.S. have hysterectomies.
(8/14/14)- The Food and Drug Administration (FDA) approved the first screening test for colon cancer in people with a lower risk of developing the disease. The test uses the patientsí DNA to help spot potentially deadly tumors and growths.
The test is called Cologuard, and it finds genetic mutations in the patientsí stool associated with cancerous and precancerous growths in the colon. The test kit is made by Exact Sciences, and doctors must prescribe it, but patients collect the stool sample at home and send it on to a lab.
Exact Sciences said the test would cost $599 per patient.
Colon cancer is the fourth most common type of tumor, and was responsible for about 51,000 deaths in the U.S. last year, according to the National cancer Institute.
(5/30/14)- The incidence of colon cancer in people over 50 has dropped 30% in the last 10 years, according to a report published by the American Cancer Society. In the year 2010, 55% of Americans ages 50 to 65 had been tested for colon cancer, nearly three times the rate i9n 2000.Thatís the good news. The bad news is that 50,310 are expected to die of the disease this year, along with 136,830 new cases.
For those who are not high risk candidates for the disease, or those who had no polyps found in prior screenings, most medical experts recommend a test every 10 years.
A recent edition of the New England Journal of Medicine included the results of a new type of stool test, named Cologuard. The test checks DNA from intestinal cells that have been shed from the stool and looks for alterations that may signal cancer. If abnormalities are found, the patient is advised to have a colonoscopy.
The study involved comparing the Cologuard test versus a fecal immunochemical test (FIT), and then comparing their results for the patients, who were then given a colonoscopy. The colonoscopy found 62 cancers, and the Cologuard test found 92% of the 65. It also detected 42% of the 757 potentially precancerous polyps that the colonoscopy had found. The FIT test found 74% of the cancers and 24% of the polyps. The standard FIT test costs about $35.
On the negative side of things, the DNA test found more false positives than did the FIT test. The Cologuard test requires that patients send an entire bowel movement for testing, as opposed to the FIT test which only requires a small sample to be tested. An advisory panel of the FDA is expected to review the Cologuard test shortly and make a recommendation as to its approval or rejection.
(3/23/14)- The results of a recent study of government data conducted by the American Cancer Society indicated that the death rate from colon cancer has been almost halved in the last 35 years. The incidence of colon cancer has decreased almost 30% among Americans 50 and older, since the mid-1980s.
The study data also indicated that the rate of colon cancer among Americans 65 and older dropped about 7% a year from 2008 through 2010.††††††† The percentage of Americans who have received some form of colon cancer screening has risen from 55% to 65% during the past decade.
The problem has not gone away as shown by the fact that there are about 135,000 new diagnosis of the disease in this country occurevery year, which in turn has resulted in about 50,000 colon-cancer deaths expected this year in this country. It is the third-most-common cause of cancer deaths.
Colon cancer is considered to be closely linked to heredity. Experts recommend that people in the high risk category begin getting screens when they are 10 years younger than the youngest relative was at the time of diagnosis.
The Affordable Care Act requires all insurance policies that began after September 2010 to cover the older colon-cancer-screening tests with no out-of-pocket costs to patients. If polyps have been found during a screening, some health plans no longer consider subsequent screenings to be preventive, and require a co-pay. Medicare follows similar rules.
Medicare presently does not cover virtual colonoscopies, while some private plans do cover it.
(11/13/13)- An estimated 28% of U.S. adults aged 50 to 75 have never been screened for colorectal cancer, according to an analysis of data from the 2012 Behavioral Risk Factor Surveillance System survey, published in MMWR.
Roughly two thirds of respondents were up-to-date with fecal occult blood testing (FOBT), sigmoidoscopy, or colonoscopy, as recommended by the U.S. Preventive Services Task Force. Colonoscopy was the most commonly used test (62% of screened respondents).
(8/5/13)- Twenty-three percent of colonoscopies performed in patients age 70 and older may be inappropriate, according to a study of Texas patients reported in JAMA Internal Medicine, and among those 76 to 85, up to 39% were considered inappropriate.
Researchers also found more than 40% of tests performed by some physicians involved patients who likely did not need the screening. "There's very limited data for any cancer test that it leads to any benefit for older adults," said Dr. Mara Schonberg
(4/22/12)- Three medical societies (American Cancer Society (ACS), the American Society for Colposcopy and Cervical Pathology (ASCCP), and the American Society for Clinical Pathology (ASCP)) have updated guidelines for physicians to follow in testing for cervical cancer. These guidelines represent an analysis of the latest research findings and should provide physicians and their patients standards that could maximize positive treatment results.
It should be understood that it is still up to the physician and patient to make the decision as to testing steps they want to take. For those women over 65, recommendations for screening for cervical cancer are as follows:
"When there is evidence of adequate negative previous screening and no history of cervical intraepithelial neoplasia of grade 2 or higher (CIN2+) in the previous 20 years, cervical cancer screening can be stopped in women older than 65 years. Once screening is discontinued, it should not be resumed for any reason, even if the woman has a new sexual partner.
The rationale for this recommendation is that the prevalence of advanced lesions or cervical cancer is rare in women who have been adequately screened in the United States. Because the transmission of a new carcinogenic HPV infection will most likely clear on its own, the benefit of screening in this population does not outweigh potential harms."
"Women of any age who have had a hysterectomy and their cervix removed should not be screened for vaginal cancer, and evidence of adequate negative previous screening is not required. The rationale for this recommendation is that vaginal cancer is uncommon, and abnormal vaginal cytology is rarely of clinical importance."
" Until the next update, these recommendations reflect the participants' judgment of the best evidence-based practice for the prevention of cervical cancer morbidity and mortality through currently available screening tests that maximizes protection against cervical cancer while minimizing the potential harms associated with false-positive results and over-treatment," conclude the authors.
(3/1/12)- The results of a 20-year death-rate study that tracked 2,602 patients who had adenomatous polyps removed during their colonoscopy from 1980 to 1990, determined that the test did help to reduce the death rate by 53%. Adenomatous polyps are pre-cancerous growths that were removed during the colonoscopy.
The results of the study were published in a recent edition of The New England Journal of Medicine. Dr. Sidney J.Winawer, a gastroenterologist at Memorial Sloan Kettering Cancer Center in New York, led the researchers. The researchers did not compare the results with other colon cancer screening tests, and the clinical trial used was not a randomized one.
The researchers compared the death rate form colorectal cancer with that of the general population, where 25.4 deaths from the disease would have been expected in the group. In the polyp group that had the adenomatous polyp removed during their colonoscopy only12 deaths occurred. That translates into a 53% reduction in the death rate.
Health experts anticipate that there will be 143,000 new cases of colon cancer diagnosed this year, and there will be 51,000 deaths this year as a result of the disease. It is estimated that only 6 out of 10 individuals who should be getting colonoscopies are actually getting them.
(10/2/11)- Howard Koh, assistant secretary of health for the Department of Health and Human Services said that cancer-drug shortages "were dramatically affecting" hundreds of clinical trials, causing them to be stopped or delayed. Dr. Koh made his remarks while testifying before the House Energy and Commerce Subcommittee on Health.
More than 300 clinical studies being paid for by the National Cancer Institute involve a drug that is in short supply, according to his testimony.
The FDA reported a record 178 drug shortages in 2010, and Dr. Koh said these is "an even greater" number of shortages this year.
(11/4/10)- Don't cancel your colonoscopy exam yet, but some interesting alternatives may be available a few years down the road. Colon cancer is diagnosed in about 150,000 people a year in the United States at an estimated cost of $14 billion to treat.
Two new DNA-based tests have come into the limelight recently with the hope that this type of testing will be able to detect colon cancer at an early stage.
One of the tests was developed by Exact Sciences of Madison, Wis., which reported on the results of its test study at a recent meeting of the American Association of Cancer Research. Their test exams stool samples and costs about $300. The company reported in July that its tests were done directly on cells taken from tumors, rather than on feces, from which DNA samples are much harder to obtain..
Stool samples provide a much more difficult testing environment since only 0.01% of the DNA is in human feces.
The other test examines for DNA changes in a single gene, Septin 9, which is not in the Exact Sciences' panel of four genes that it looks for. Epigenomics AG of Germany developed this test. Promising results for its blood-based tests were revealed at a recent meeting in Spain.
(12/17/09)- Cancer is this country's No.2 killer, behind heart disease, and accounts for nearly a quarter of annual deaths. Cancer diagnoses and deaths continued to decline in the U.S. according to the latest available data, helped by efforts to reduce risk, provide early detection and develop therapies.
The report was issued from a group of cancer and health organizations including the National Cancer Institute.
All three leading causes of cancer deaths in men, lung, prostate and colorectal declined as did two of the three leading causes of death among women, namely breast and colorectal (lung cancer deaths did not decrease among women).
New diagnoses for all types of cancer combined in the U. S. fell on average almost 1% from 1999 to 2006. Cancer deaths decreased 1.6% a year form 2001 to 2006.
In the last quarter of the 20th century, colorectal cancer incidence fell 22%, due equally to wider screening and risk reductions such as improved diets.
(8/25/09)- Researchers from Harvard Medical School, Massachusetts General Hospital and the Dana-Farber Cancer Institute, writing about their study in a recent edition of the Journal of the American Medical Association found that patients who took aspirin had a much better chance of surviving colorectal cancer than non-users. Previous studies had shown that people who took aspirins regularly were less likely to develop tumors of the colon.
The study showed that patients with colorectal cancer who regularly used aspirin before and after a diagnosis were almost one-third less likely to die of the disease than non-users. The patients were all being treated for nonmetastic, or localized, cancers, and were followed for an average of 12 years.
There were 1,279 men and women in the observational study group, all with nonmetastic colorectal cancer. This is not the type of study that is considered the gold standard, which is one in which you have a placebo group compared to a group taking the medication.
There is a clinical study that is presently underway in Asia, where the National Cancer Center of Singapore is enrolling 2,660 patients with nonmetastatic disease in Hong Kong, India, Indonesia and Singapore. The patients will continue their treatment and be randomly assigned to either get aspirin or a placebo daily for up to three years, according to the National Cancer Institute Web site.
(5/27/09)- Colon cancer is the third leading cause of cancer deaths in the United States. The results of a recent study, that was sponsored by Genomic Health Inc., a Redwood City, Calif., company has given them encouragement to market its test kit, which it feels can determine whether patients are at low, intermediate or high risk for a reccurrence of colon cancer after an initial operation.
The test is based on an analysis of seven different genes found in colon-cancer tumors. Oncologists said the test might help doctors and patients decide whether to undergo a course of chemotherapy after surgery, or to avoid its costs and harsh side effects.
The test kit is called the Oncotype DX colon-cancer test, and Genomic Health said that it intends to begin marketing the kit by the end of this year.
The results of the study did not meet its secondary goal of predicting which patients would benefit from chemotherapy. The company already markets a similar test that is for patients with early-stage breast cancer.
The colon-cancer study was based on an analysis of tumors from nearly 1,500 patients, half of whom had chemotherapy and half of whom did not. After more than 6 years of tracking, the study found that 44% of the patients had tumors that had a 12% risk of reccurrence within three years, which researchers considered a low risk.
An additional 26% had a three-year recurrence risk of 22%, which researchers put in the high-risk group.
(5/6/09)- Roche Holding AG, the Swiss pharmaceutical company announced that the clinical trial, called C-08, of its drug Avastin failed to show a significant effect on preventing the reoccurrence of colon cancer. Roche said that it would present the data from the trial at the meeting of the American Society of Clinical Oncology that begins in late May.
Avastin is currently approved only for late-stage colon, breast and lung cancers, wherein the drug has been shown to extend the life of late-stage cancer patients for about 4 1/2months.
The company had hoped that the C-08 clinical trial would show that the drug could be effective earlier in the course of the disease, namely shortly after surgery removed the cancer to prevent the disease from showing up in the form of additional tumors, but unfortunately this was not the case.
The trial involved about 2,700 patients who underwent surgery to remove their cancer, and were then divided into two groups. One group received chemotherapy alone for 6 months, and the other chemotherapy plus Avastin for 6 months, followed by an additional 6 months of Avastin alone.
The Avastin group failed to meet the trials primary aim of significantly lowering the risk of the cancer returning.
(3/24/09)- U.S. Supreme Court, Justice Ruth Bader Ginsburg, 76, who had pancreatic cancer surgery last month, as we mentioned in our items dated 2/20/09 and 2/15/09, will undergo a course of chemotherapy at the National Institute of Health in Washington. "Thereafter, it is anticipated that I will require only routine examinations to assure my continuing good health", Justice Ginsburg went on to say.
Justice Ginsburg also stated recently that she expected that at least one Supreme Court Justice will be retiring shortly.
(2/20/09)- U.S. Supreme Court, Justice Ruth Bader Ginsburg has returned to her home in Washington after her release from Memorial Sloan-Kettering Cancer Center in New York where she was operated on for pancreatic cancer on February 5. The one-centimeter growth that doctors found during a CT scan in late January turned out to be benign.
A second small tumor that was found during the operation was analyzed to be malignant. Doctors classified that tumor to be an early stage, or Stage 1 malignancy. Her lymph nodes revealed no cancer, and doctors did not find that the cancer had spread elsewhere in her body. Her office announced that she is expected to be back at the court when justices next hear arguments on February 23.
(2/15/09)- According to a statement that was released by the press office of the U.S. Supreme Court, Justice Ruth Bader Ginsburg underwent surgery at Memorial Sloan-Kettering Cancer Center in New York on February 5, for what was apparently early-stage pancreatic cancer.
Justice Ginsburg had her annual physical at the National Institutes of Health in Bethesda, Md, where the one-centimeter across tumor was discovered in the center of her pancreas. A spokeswoman for Justice Ginsburg said that she planned to be back at work on February 23 for the Supreme Court's next public session.
We have highlighted an earlier item that we wrote back in 1999 about her battle with colon cancer. That item is highlighted in red at the end of this article. American Cancer Society (ACS) statistics indicates that pancreatic cancer has one of the lowest five-year survival rates, at about 5% for all stages.
The ACS survival rate figures indicate that the 5-year survival rate is about 15% for lung cancer, whereas it is at 64% for colon and rectal cancer. There is no test for early detection of pancreatic cancer, so that is why the survival rate is so low.
Justice Ginsburg was appointed to the Supreme Court by President Bill Clinton in 1993. She is considered one of the members of the liberal wing of the court. Justice John Paul Stevens is the oldest member of the Supreme Court, and he will turn 89 in April.
(9/26/08)- In addition to the study that we noted in our item dated 9/20/08, a second study, the results of which also appeared in the New England Journal of Medicine concluded that less frequent and less invasive colon exams be administered to people over 50. Colon cancer accounted for over 52,00 deaths in the U.S. last year.
The second study involved 1,256 patients who had tested negative for growths, found that five years later, none of the patients had developed colon cancer. Dr. Thomas Imperiale of the Indiana University School of Medicine, who was the study's leader, concluded that for patients with low-risk factors, a ten-year interval between screenings is sufficient.
The study of the CT scans discussed below on 2,531 patients at 15 study centers around the country concluded that the CT scan picked up all but 10% of the large growths that were found with the colonoscopy..
(9/20/08)- The results of a large federal study indicated that a "virtual colonoscopies" is a good indicator of who needs a regular colonoscopy, since it was better at ruling out cancer than in detecting it.
The virutal colonsocopy, or X-ray alternative identified 9 out of 10 people who had cancers or large growths as seen by a regular colonscopy. The results of the study appeared in a recent edition of the New England Journal of Medicine.
Colonoscopies can cost up to $3,000, while the X-ray test costs $300 to $600. Medicare still has not approved payment for this type of testing.
(6/11/08)-If your parent or sibling has had colon cancer, the odds are about one-in-ten that you too will develop the disease. The odds are about 1-in-twenty if you do not have this type of family history for the disease. There were an estimated 153,000 cases of colon and rectal cancer diagnosed in the United States in 2007, according to the American Cancer Society, and about 50,000 people will die from it.
In a recent study of the disease conducted by researchers at the Dana-Farber Cancer Institute, the results of which were published in a recent edition of the American Medical Association it was determined that patients who had a family history of the disease, had a better chance of surviving than did patients with no family history of the disease.
The study followed 1,087 patients being treated for Stage 3 colon cancer, which means that the cancer had spread to nearby lymph nodes but not to other organs. Of those patients, 195 or about 18% had a parent or a sibling with the disease. Of those who had a least one close relative with the disease, 25% were less likely to die of the disease during the 5.6 years of patient follow-up than those with none.
The risk of dying was even lower for those with two or more relatives with the disease. Those patients had a 51% lower risk of cancer recurrence or death. Researchers have hot been able to determine why this is proving to be the case.
(3/15/08)- The American Cancer Society and other leading health groups are recommending two more tests for colon cancer detection or prevention that they had not previously endorsed.
One test is virtual colonoscopy, which uses a CT scan to look for abnormal growths and, unlike the standard colonoscopy, does not require inserting a camera-tipped tube rectally. The other test involves an examination of stool samples to find abnormal DNA associated with cancer, and requires an entire bowel movement to be packed in a kit and sent to a laboratory.
There are now 7 tests that are on the accepted list of options available to test for colon cancer. Colorectal cancer is the second leading cause of cancer death in the U.S., accounting for 49,960 deaths and with148,810 new cases expected in 2008.
The new guidelines organize the tests in two groups and specify the intervals to perform them.
The first group consists of tests that can detect cancer or prevent it by finding pre-cancerous growths. They include:
The second group detects cancer, rather than preventing it. Two of the tests look for blood in the stool, and the third is the stool DNA test. Blood in the stool does not necessarily indicate cancer, since an illness like hemorrhoids can cause blood to appear in the stool.
(1/4/08)- Aetna, the health-insurance company with over 16.6 million members sent a letter to all doctors in its plan that it no longer would cover the anesthetic drug Propofol when used during colonoscopy procedures, except in rare cases. The policy will go into effect as of April 1, 2008. The company therefore joins WellPoint Health and Humana in calling the drug "medically unnecessary" for the procedure. United HealthCare will however continue to coverage usage of the drug during colonoscopies.
The anesthetic eliminates a good deal of the discomfort in undergoing the procedure in which doctors explore the lower intestine to identify, and if necessary remove, developing polyps or tumors before they become dangerous.
Popofol was originally marketed as Diprivan, and is now relatively cheap because its patent has expired and a generic version is available. It is however a tricky drug since it acts rapidly and no rescue drug is available to counteract its effects if a patient begins to have trouble breathing. The FDA has recommended that trained specialists who are not otherwise involved in the procedure administer it.
In using an anesthesiologist the cost of the procedure can increase by anywhere from $300 to $1,000. Aetna asserted that its billing records showed that 77% if colonoscopy patients in the New York metropolitan area receive Propofol, compared with 10% or less in other regions.
(2/5/05)-For the first time, cancer has replaced heart disease as the number one killer of Americans younger than 85 years of age according to a statistical report that was issued from the American Cancer Society. In 2002, the most recent year for which this data is available, 476,009 Americans in that age category died from cancer, compared with 450,637 who died from heart disease.
According to Dr. Eric Feuer, chief of statistical research for the National Cancer Institute, people younger than 85 account for 98.4 percent of the population. Dr. Feuer was the head statistician for the project. The report found that one of the biggest reasons for the drop in deaths from both causes was that fewer people were smokers.
Between 1965 and 2000, the number of Americans who were smokers dropped from 42% to 22%. The report went on to state that one third of all cancers were related to smoking. Another one third of cancers are related to obesity, poor diet and lack of exercise. Incidentally these same factors contribute to heart disease also.
There is some good news in connection with the battle against cancer. Cancer deaths have declined about 1 percent each year since 1996. With that said, there will be estimated 1,372,910 new cancer cases discovered this year. Of that number, it is estimated that there will be 570,260 cancer deaths. The five-year survival rate has risen to 74 percent from the 50 percent mark of the 1970's.
Lung cancer is the number one killer among cancer victims, with it claiming about 163,500 victims this year. Prostate cancer will be diagnosed in about 232,000 men this year, and it will kill about 30,350 of them. Breast cancer will be diagnosed in about 211,200 women, and it will kill about 40,410 in 2005.
(2/20/04)-The FDA has approved Erbitux for sale in connection with the treatment for colon cancer. Even though it is supposed to be used only in cases involving terminal cancer for those who have not been helped by chemotherapy, doctors will have the legal right to prescribe it for other uses also. Erbitux targets a "growth factor" protein that plays a role in the uncontrollable spread of tumor cells. Even though Erbitux has not been shown to prolong life, trials have shown that it does shrink tumors for a few months.
Although the exact pricing for Erbitux has not been established, cancer experts have estimated that it will cost about $30,000 a year, which is roughly the same price that Genentech's Avastin is expected to cost. Eventually the drug may be used in combination with other cancer fighting drugs in the form of a "cocktail drug" similar to that used in connection with the fight against AIDS.
Genetech's cancer fighting drug Avistan is expected to gain approval from the FDA shortly in the fight against colon cancer. The results of the late-stage clinical trial for its drug Avastin were impressive. To the surprise of many it appears that the drug starves tumors of oxygen and nutrients and has prolonged the lives of patients with colorectal cancer. The results came as a surprise since previous trials to starve tumors of oxygen and nutrients had failed. Avastin had previously failed in clinical trials aimed at halting breast cancer. The process of starving a tumor of its oxygen and nutrients is known as angiogenesis inhibition.
According to Genetech, patients given Avastin along with conventional chemotherapy lived significantly longer that those who were given the chemotherapy alone. "This is to my knowledge the first major randomized study that validates the concept" behind Avastin and similar drugs, said Dr. Leonard Saltz of Memorial Sloan Kettering Hospital in New York. Thus once approved for sale by the FDA, it is expected that Avastin will be used in conjunction with chemotherapy in the battle against colon cancer. The drug did cause some adverse side effects such as high blood pressure.
In the trial of 800 colon cancer patients, those who received Avastin plus chemotherapy lived an average of 20.3 months, compared with 15.6 months for those on chemotherapy alone. About 45% of the patients who were on Avastin saw their tumors shrink by a least half, compared with 35% who only received the chemotherapy.
At the same ASCA meeting in Chicago wherein the data for Avastin was presented, Imclone announced that its colon cancer drug Erbitux also provided substantial benefits to the patients who were given the drug. Erbitux is a genetically engineered antibody that blocks a growth factor on the surface of many cancer cells. In conjunction with chemotherapy, it extended survival by 1.7 months. In the trial group of 329-patients the drug shrunk the tumors of 50% or more of the patients while those on Erbitux alone had only an 11% shrinkage rate.
There are now 5 targeted cancer therapies on the market, which is up from 3 just two months ago which have been approved by the FDA. Two other drugs, AstraZeneca PLC's Iressa and Millenium Pharmaceuticals Inc.'s Velcade received FDA approval in May.
In 2000, Medicare paid for 2,2211, 925 colonoscopies; by 2002 the figure had risen to 3,135,738. Most medical professionals feel that a colonoscopy is the most effective test for determining the presence of cancer in the colon. On the other hand there has been a sharp decrease in some of the other testing methodologies for determining the presence of colon cancer.
A sigmoidoscopy procedure, which looks only at the lower part of the colon, where most cancers occur, was used in 236,139 Medicare beneficiary's tests in 2002, down from 543,502 in 2000. In 2000 Medicare paid for 1,759,880 fecal occult blood tests, while in 2002 that number dropped to 1,609,39. The fecal test screens for blood in the stool, which can be a sign of polyps in the colon.
Heart disease was the leading cause of death in the U.S. last year, followed by cancer in the number two slot. Lung cancer will cause an estimated 157,000 deaths in the U.S. this year, followed by colon cancer (57,000), breast cancer (40,000) and prostate cancer (29,000). According to a report from the National Cancer Institute, the Centers for Disease Control and Prevention, the American Cancer Society and the North American Association of Central Cancer Registries, the death rate has declined for all four of these types of cancers since 1990.
Colon cancer is the 2nd leading cause of death from cancer in this country, exceeded only by lung cancer. It is the 3rd leading diagnosed life threatening cancer in this country exceeded only by lung and breast cancer. It is estimated that 147, 500 will be diagnosed with the disease this year, of whom death will claim 57,100. But colon cancer is the most curable of the major cancers when treated while it still is localized.
According to the latest statistics, 90% of patients whose cancers are discovered before they have spread are alive and well five-year later. The rate is 100% among those who have pre-cancerous polyps detected and removed. It can be detected early and cured because it arises slowly in benign growths called adenomatous polyps that are easily detected and removed. Only 5 in 2,000 of these polyps become cancerous, which is a transformation that occurs on average over a 10-year period of time.
Despite all of the above, fewer than 40% of Americans who should be tested undergo any screening tests for colon cancer. Everyone who is over 50 years of age is, by definition, at risk, along with younger people with hereditary or other conditions that increase their risk. Colonoscopy is the most accurate and most expensive screening exam. It should be repeated every 10 years (some medical professionals would use a 5-year period of time as the guideline) after attaining the age of 50.
Arie E. Kaufman, a professor and chairman of computer sciences at the State University of New York, at Stony Brook, and a team of four researchers at the school have won a patent for a new way to scan for colon polyps. The new method does away with the need to drink a gallon of cleansing liquid before taking the exam. No sedative needs to be taken to administer the test.
Patients who undergo the test receive a box of food to eat the day before the exam. The food consists of a mix of apples, crackers and soup. At the beginning of the exam, a half-inch-long tube is inserted at the opening of the rectum, and the colon is inflated with carbon dioxide so that there are no collapsed areas where polyps might be hidden.
CT scans are taken of the patient lying on his stomach and then on his back. This procedure is then followed by two more back and front scans taken while the patient holds his breath for as long as possible. This procedure takes no more than 15 minutes. The data gathered from this procedure is then entered into the computer. The computer will then separate images of the colon from the rest of the pictures from the CT scan.
The computer than uses the data to build a 3-D model of the colon. A doctor uses another computer to "navigate" through the 3-D model, and this procedure can be done in about 15 more minutes. The technology is licensed to Viatronix Inc., a company that makes medical imaging products. According to Professor Kaufman "three or four Army hospitals are doing very extensive clinical studies comparing virtual colonoscopy to the conventional method."
Researchers in two separate studies have shown that aspirin can reduce the risk of developing colon and rectal polyps, the precursors of almost all colon cancer. The studies involved high-risk patients and did not deal with the issue of whether or not aspirin was helpful for people who are at average risk in developing colon cancer. Although few polyps actually do turn into cancer, it is impossible to ascertain which ones of them will become cancerous, so therefore it is necessary to have them removed whenever they are found in the colon. Please also see our article on Aspirin as a Preventive against Cardiovascular Events and its possible beneficial and preventive effects.
Dr. Robert Sandler of the University of North Carolina led one of the studies, and Dr. John Baron of Dartmouth-Hitchcock Medical Center in Lebananon, N.H, directed the other study. The North Carolina study involved 635 patients who had colon or rectal cancer. Half took a regular, 325-milligram aspirin each day, and the others took a placebo. Of the group that was taking the aspirin, 17% had grown new polyps after 31 months, while 27% of the placebo group had developed polyps in the same time frame.
In the Dartmouth study 1,121 patients who had already had polyps which had been removed were randomly divided into one of three groups. One group was given a placebo, the other group was given a regular aspirin and the third group was given an 81-milligram aspirin. Three years later, 38% of the group taking the baby aspirin had new polyps, as opposed to 47% of the group taking the placebo and 45% of those taking the regular aspirin. On the down side is the fact that aspirin can inhibit blood clotting and also can irritate the stomach lining, leading to ulcers.
The FDA approved a new drug, Eloxatin, for last-ditch use by patients with colorectal cancer. The drug is manufactured by Sanofi-Synthelabo, and the FDA review was done on an expedited basis so that the approval was completed after only a seven-week period of time. Eloxatin is already in use in 55 countries, but it is not a miracle drug that can cure colorectal cancer. Colorectal cancer is the second greatest cause of cancer deaths in this country only surpassed by lung cancer. Last year it resulted in the deaths of over 56,000 people.
Eloxatin was approved for use in combination with 5-FU in patients who failed to respond to the combination of 5-FU and irintecan now used for initial cancer therapy. The trial of the drug involved 463 patients and was used in combination with and compared to 5-FU alone. In the trial the combination of the drugs shrank tumors by at least 30 % in 9 % of patients, while either 5-FU or Eloxatin alone shrank the tumors in virtually none of the patients. The combination of Eloxatin and 5-FU also kept tumors from starting to grow again for 4.6 months, or 2 months longer than for 5-FU alone.
According to a study done under the leadership of Dr. David A. Lieberman, chief of gastroenterology at the Portland Veterans Affairs Medical Center in Oregon, colonoscopy proved far superior to the fecal occult-blood test and the sigmoidoscopy test in detecting colon cancer. Even when used together the fecal occult-blood test and the sigmoidoscopy test missed almost one-quarter of the tumors and precancerous growths detected by colonoscopy.
Dr. Lieberman and colleagues at 13 Veterans Affairs medical centers studied 2,885 veterans from 50 to 75 years of age, who volunteered for the colonoscopy. Results from the entire colon were compared with what was seen in just the lower third of the colon, the equivalent of a sigmoidoscopy, and with testing of patients stool samples for traces of blood.The colonoscopy detected cancer in 24 patients and serious precancerous growths in 282 others. The fecal blood test was positive in only 24 % of those cases, the sigmoidoscopy identified 70 % of the tumors and growths, and the two together identified 76 % of them. Colonoscopy is considered the " gold standard" test for colon cancer since it is considered to be 95% accurate. For a family with no history of colon cancer it is recommended that the test be given every 10 years starting with the age of 60. For those with a family history of colon cancer it is recommended that it be given every 5 years starting with the age of 50.
Data from a long time study seems to indicate that even the fecal occult
blood screening test reduces the colon cancer death rate by about 20%. The
study group was led by Dr. Jack S. Mandel, a vice president of Exponent, a
Menlo Park, Cal., research company, and his
colleagues, most of whom are at the University of Minnesota. Dr. Ernest Hawk,
chief of the gastrointestinal cancer group at the National Cancer Institute's
division of cancer prevention, said that the test does reduce the colon cancer
The study was first begun in 1975, and when the first results were published in 1993 it showed that the test resulted in up to a 33% reduction in the colon cancer death rate. In the latest published results of the study 415 cases of the cancer were found among 15,532 people who were offered annual fecal blood tests: 435 cancer cases were found among 15,550 people offered the test every 2 years: and 507 cases among the 15,363 cases of people who did not have the test. According to Dr. Steven Wolf, a professor of family medicine at Virginia Commonwealth University "But early detection presumes the cancer already exists. This takes us to a new level".
The screening fecal-occult blood test should be taken once every 12 months for those 50 and older. It is one of the free preventive screening tests recommended for Medicare beneficiaries. Normally it costs about $10-$25, while a sigmoidoscopy costs $150 to $300 and a colonoscopy costs from $1,000 to $1,500.
The Food and Drug Administration has approved Camptosar as a new first-line treatment for advanced colorectal cancer, saying that the drug prolongs patient's survival time. Camptosar had already been approved as a second-line treatment for the disease. The drug is used in conjunction with traditional radiation therapy (5-fluorouracil and leucovorin).
The drug, which is a topoisomerase I inhibitor, which attacks an enzyme essential for cancer-cell growth. Generically the drug is known as irinotecan. Pharmacia Corp. of Peapack, N.J, manufactures Camptosar. A 6-month treatment with the drug costs about $15,000. The FDA's approval was based on two clinical trials involving about 800 patients that compared Camptosar in combination with 5-FU/LV to 5-FU/LV used alone. In one of the studies the median survival time increased to 17.4 from 14.1 months, while in the other study the median survival time increased from 12.6 months to 14.8 months.
Please also see our article on Can COX-2 Inhibitors Prevent Colon Cancer and Treat Rheumatoid Arthritis at the Same Time?
Supreme Court Justice Ruth Bader Ginsburg had undergone chemotherapy and radiation treatment for her colon cancer. Her sigmoid colon was removed on September 11, 1999 for what had been classified as stage-2 cancer. About 75% of stage-2 colon cancer patients are cured. The treatments began in October, 1999 and ended in June of 2000. The classification system rates the cancers up to stage-4. The sigmoid colon makes up the lower third of the large intestine. It now turns out that the original diagnosis of diverticulitis may also have been correct. The operating surgeon, Dr. Lee Smith discovered a perforation in her upper bowel that was non-malignant. It has been estimated that most patients in Justice Ginsburg's condition need at least 4 to 6 weeks to recuperate from this type of surgery.
Justice Ginsburg who is 69 years of age had been taken ill while teaching this summer on the island of Crete. Her ailment was originally misdiagnosed as acute diverticulitis. This type of misdiagnosis happens fairly often because extensive testing is required to enable the medical professionals to distinguish between the two ailments. In diverticulitis, a disorder of the large intestine occurs when the pouches that form on the outside of the colon become infected. Another famous individual who has been in the limelight in connection with colon cancer is the former New York Yankee and New York Met baseball player Daryl Strawberry. Pathologists perform follow up testing to determine how far the cancer has spread in the tubular bowel system. They also perform tests on the lymph nodes to determine the extent of the spreading of the cancer.
According to statistics from the American Cancer Society colon and rectal cancer is the 3rd leading type of cancer discovered among women. It ranks 2nd behind lung cancer in terms of causing death for both women and men. Cancer of the colon and rectum caused about 65,000 deaths in 1999 or about 11 % of all cancer deaths in the U.S. If detected early colon and rectal cancer has a cure rate of over 90 %, which the best cure rates among all types of cancers if discovered early. It is estimated about 130,000 Americans will be diagnosed with colon cancer this year. In its early stages it begins in the inner lining of the colon or rectum, spreads to the surrounding tissue and lymph nodes, then moves to the liver or lungs.
The simplest and cheapest test for colon cancer is a digital rectal exam by the doctor combined with a fecal occult blood-screening test. The occult blood test helps detect the problem because colorectal cancers and precancerous polyps often bleed slightly, and thus will leave tiny traces of blood on the stool. The Hemoccult II test involves smearing feces on test cards from 3 consecutive bowel movements. The cards are then mailed to a lab for chemical analysis. For the 2 days prior to and for the 3 days of the testing you are advised to avoid certain foods and drugs. Colon cancers usually begin as harmless polyps that can be found and removed fairly easily.
There are 2 other fecal tests on the market EZ Detect and Colocare that have few dietary restrictions and do not require direct handling of feces. The exact accuracy of these tests has not been fully determined.
All other tests require a thorough cleansing of the bowel beforehand via enemas and laxatives. A sigmoidoscope allows the doctor to examine the bottom third of the colon but not the top two-thirds. A colonoscopy uses a lighted scope to examine the entire length of the colon. The doctor can remove suspicious lesions or polyps during the exam. In the double-contrast barium enema test an x-ray examination is performed after the colon is filled with barium and air.
The following symptoms should be checked out more thoroughly if they continually reappear:
The American Cancer Society recommends that women and men over 50 undergo any one of the following cancer testing exams:
High risk individuals should begin a stricter examination routine once they reach the age of 40.
For prostate cancer articles see the following:
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "Selecting a Nursing Home"
By Allan Rubin and Harold Rubin
updated March 21, 2019