• A Medicare database study found that rates of colonoscopy increased for whites when colonoscopists were present in the community but decreased for black and Hispanic patients, thereby increasing the disparity in receving the screening test for racial/ethnic minorities.

• Note that the investigators had hypothesized that racial disparities for colorectal cancer screening would decrease in areas where colonoscopists were plentiful but found the opposite.

Communities that have more physicians available to perform colonoscopies actually have bigger — not smaller — disparities in screening rates between minority and white patients, according to a recent study of Texas Medicare claims data.

In the study of claims for nearly 975,000 Texas Medicare beneficiaries, colonoscopy use was higher in whites (40.7%) than in blacks (35.0%) or Hispanics (28.7%), reported Taylor S. Riall, MD, PhD, and colleagues from the University of Texas Medical Branch in Galveston.

In areas where the availability of colonoscopists or primary care physicians was higher, there was an association with higher levels of colonoscopy use among whites. For blacks and Hispanics, the usage remained unchanged or actually decreased, they wrote online in Health Services Research.

Studies have shown that there are racial disparities in colorectal cancer screening. To explore the issue further, the researchers examined the associations between the availability of colonoscopists and PCPs, the racial/ethnic differences in use of this procedure, and interactions with availability of both specialist and primary care physicians.

Using the claims and enrollment data for 100% of the Medicare beneficiaries in Texas, the researchers selected those ages 66 to 79 in 2007. After various exclusions (interruptions in Medicare enrollment; race other than white, black, or Hispanic; or enrollment in an HMO during the study period of 2002 to 2007), there were 974,879 participants in the final analysis.

Physician availability was defined as the number of doctors per 10,000 people 65 or older in a given Hospital Service Area (HSA). A colonoscopist was defined as a physician who performed more than five colonoscopies a year as shown in Medicare claims data. A PCP was a general practitioner, family physician, general internist, or geriatrician as designated by their specialty codes on Part B claims.

After adjusting for age, sex, comorbidities, presence of risk factors for colon cancer, and income, the odds of undergoing colonoscopy were 20% lower for blacks (OR=0.80, 95% CI 0.79 to 0.82) and 32% less for Hispanics (OR 0.68, 95% CI 0.66 to 0.69) when compared with whites.

In the model that included availability of a colonoscopist, those living in the area with the highest quartile of availability had higher odds of colonoscopy (OR=1.09, 95% CI 1.02 to 1.18), but neither colonoscopist nor primary care physician availability had an impact on the racial and ethnic disparities.

In fact, the black-white and white-Hispanic disparities increased as the availability of colonoscopists increased. As an example, the author pointed out that blacks living in the HSAs in the lowest quartile of colonoscopist availability were 13% less likely to have the procedure than whites. Those in the highest quartile were 23% less likely than whites to have a colonoscopy.

One of the limitations of the study cited by the authors is that they included colonoscopies performed for any reason, without differentiating between screening and diagnostic purposes. Also, because their cohort included Medicare beneficiaries (all 65 or older) from a single state, the results may not be generalizable to younger populations or those in other states.

The authors also noted that the total number of colonoscopies in the Hispanic population might be reduced because of that group’s tendency to use other kinds of screening tests.

“Our data imply that increasing colonoscopist capacity alone may not improve colonoscopy use and may be associated with increased racial/ethnic disparities,” wrote the authors. “This finding takes on more significance given that our study population was uniformly covered by Medicare Parts A and B.”

The study was supported by grants from the National Institutes of Health and the Cancer Prevention Research Institute of Texas. No author disclosure information was given.  
Primary source: Health Services Research
Source reference:
Benarroch-Gampel J, et al “Colonoscopist and primary care physician supply and disparities in colorectal cancer screening” Health Serv Res 2011; DOI:10.1111/j.1475-6773.2011.01355.x

By Shalmali Pal, Contributing Editor, MedPage Today

December 12, 2011

MedPage Today Action Points

•             A database study determined that the incidence of colorectal cancer has been rising in individuals under the age of 50 since 2001, at a time of decreasing incidence in older patients.

•             The increasing incidence was found especially in cases involving rectal cancer and more advanced stages of colorectal cancer, as well as in patients of nonwhite race/ethnicity and those lacking health insurance or Medicaid coverage.

Review

The incidence of colorectal cancer (CRC) among adults younger than 50 has increased by 2.1% in the past decade, according to results from a study of the National Cancer Database.

“The median age for young-onset CRCs was 44 years, with most (75.2%) occurring between ages 40 and 49 years,” wrote Yi-Qian Nancy You, MD, of MD Anderson Cancer Center in Houston, and colleagues, in a research letter published online in the Archives of Internal Medicine.

The authors identified 64,068 cases of young-onset (before age 50) invasive adenocarcinoma of the colon and rectum between January 1998 and December 2007. The increase was greater for young-onset rectal cancers (annual percentage change [APC] 3.9%, 95% CI 3.1% to 4.7%) compared with colon cancers (APC 2.7%, 95% CI 2% to 3.3%).

These results contrasted with those of people over the age of 50, in whom the incidence of CRC has been falling.

Geography, ethnicity, and financial status also played a role in the distribution of CRC incidence among this population.

“Compared with later-onset disease, young-onset CRCs were more prevalent among patients with nonwhite race/ethnicity (29.5% versus 17.6%, P<.001) who were not insured or insured by Medicaid (16.5% versus 4.7%, P<.001) and who lived in the southern and western parts of the U.S. (56.2% versus 50.3%, P<.001),” the investigators wrote.

In addition, advanced-stage disease (stage III/IV) was diagnosed more commonly in young patients, with an occurrence of 63% for colon cancer and 57% for rectal cancer.

The researchers found that one of the independent risk factors for advanced-stage disease was younger age:

•             Ages 30 to 39 versus 40 to 49 years: hazard ratio 1.21, 95% CI 1.1 to 1.4

•             Ages 18 to 29 years versus 40 to 49 years: HR 1.4, 95% CI, 1.2 to 1.6

Race also was an independent risk factor, with an HR of 1.2 for African Americans versus whites (95% CI 1.1 to 1.3).

Insurance status was another factor:

•             Lack of insurance versus insured: HR 1.2, 95% CI 1.1 to 1.3

•             Lack of Medicaid versus insured: HR 1.6, 95% CI 1.5 to 1.8

The authors commented that contributing factors to these trends may include a reluctance on the part of young adults to seek medical care and the large percentage of young adults without insurance or ready access to care.

Also, there may have been an underappreciation of the increasing risk for young-onset CRC, which led clinicians to overlook or dismiss nonspecific symptoms that may have been consistent with CRC. These symptoms included rectal bleeding, abdominal pain or cramping, and a change in bowel pattern.

Limitations of the research were that it could not establish the mechanisms underlying the observed sociodemographic disparities, nor did it explore the molecular basis of young-onset CRC. In addition, familial adenomatous polyposis was excluded, the authors noted.

The study was funded by a grant from the MD Anderson Cancer Center.

Co-author Barry Feig, MD, reported links with Genomic Health.

Primary source: Archives of Internal Medicine

Source reference:

You YN, et al “Young-onset colorectal cancer: Is it time to pay attention?” Arch Int Med2011.

On Capitol Hill today, colorectal cancer experts and advocates will gather to promote the establishment of a national colorectal cancer screening program in an effort to save lives. In conjunction with National Colorectal Cancer Awareness Month, the American Cancer Society Cancer Action Network (ACS CAN), the American Society for Gastrointestinal Endoscopy (ASGE), Fight Colorectal Cancer, Olympus, and the Prevent Cancer Foundation will hold a briefing on Capitol Hill with several high-profile speakers, including Thomas R. Frieden, M.D., MPH, director, Centers for Disease Control and Prevention (CDC), Rep. Jim McGovern (D-MA) and Tonya L. Adams, M.D., a gastroenterologist and colorectal cancer survivor.
“Federal funding and support for colorectal cancer screening and prevention must remain a national policy priority to save lives and to combat this largely preventable disease,” said Gregory G. Ginsberg, M.D., FASGE, president-elect, American Society for Gastrointestinal Endoscopy. “Prevention is the primary goal of colorectal cancer screening, which is accomplished by the identification and removal of polyps, growths in the colon, before they turn into cancer. Screening not only saves lives, but it saves money.”
The briefing sponsors are advocating for passage of legislation, the Colorectal Cancer Prevention, Early Detection, and Treatment Act, which would establish a national program under the CDC for colorectal cancer screenings and treatments. The program would target the pre-Medicare population – those 50-64 years of age – who are considered at high-risk for colorectal cancer. The program would give priority to low-income, uninsured and underinsured individuals who do not otherwise have coverage for colorectal cancer screening, diagnostic follow up, and/or treatment. The legislation is sponsored in the Senate by Sens. Joseph Lieberman (I-CT) and Kay Bailey Hutchison (R-TX) and in the House by Reps. Kay Granger (R-TX) and Jim McGovern (D-MA).
“While the Affordable Care Act will lower the cost of preventive services like colonoscopies for many Americans, the law will not do anything to increase awareness about the importance of early detection and screening. Today, even among those with health insurance, screening rates for colorectal cancer are much too low – less than half of those who should be screened get screened,” said Nancy Roach, chair of Fight Colorectal Cancer’s board of directors. “When the national breast and cervical cancer screening program was enacted in the mid-80s, the screening rate for breast cancer was around 29 percent. Today, that rate is close to 80 percent. It is time we made the same headway in the fight against colorectal cancer and enacted a national screening and treatment program for colorectal cancer.”
“Olympus has long been a champion of all efforts to fight colorectal cancer,” said Olympus Corporation of the Americas President and CEO, F. Mark Gumz. “Prevention is key for this disease and we’re heartened that our legislators have recognized this important fact and taken bold steps to ensure all Americans can get screened.”
The legislation would expand upon an existing CDC program, the Colorectal Cancer Control Program, which currently provides education and screening programs in 25 states and four tribes. Although the use of colorectal cancer screening has been shown to reduce the incidence of, and deaths from, this disease, utilization rates still lag behind other well accepted preventive services. The CDC reports that if all precancerous polyps were identified and removed before becoming cancerous, estimates show that the number of new colorectal cancer cases could be reduced by 76 to 90 percent and deaths could be reduced by 70 to 90 percent.
“Colon cancer has a five-year survival rate of over 90 percent when diagnosed early, but a survival rate of only 11 percent when diagnosed late,” said Christopher W. Hansen, president of the American Cancer Society Cancer Action Network (ACS CAN). “Colon cancer screening has been proven to prevent cancer through the detection and removal of premalignant polyps. Less than 20 percent of the uninsured have been properly screened for colorectal cancer, which means that too many Americans are going without this lifesaving screening because they cannot afford it. This legislation will help stop a cancer that can be prevented in many cases and help to save lives, prevent suffering, and reduce the cost burden of colon cancer on our country.”
“Educating our policymakers about colorectal cancer and the effectiveness of screening is a high priority,” said Lisa Hughes, director of policy and advocacy for the Prevent Cancer Foundation. “Educational efforts, like the Prevent Cancer Super Colon™ exhibit and Congressional briefing, can have a significant impact on the development of legislation and policy that improves access to screening for all individuals.”
Following the briefing, guests will meet for a reception featuring the Prevent Cancer Foundation’s Super Colon™ exhibit, an 8-foot tall, 20-foot long replica of the human colon that is an interactive educational tool reminding Americans that colorectal cancer is preventable and beatable through proper screening.
About Colorectal Cancer
A report released by leading cancer groups in 2009 showed that from 1975 to 2000, colorectal cancer incidence rates dropped 22 percent and death rates dropped 26 percent. The decline reflects the impact of increased colorectal cancer screening, changes in lifestyle and diet, and improved treatments. Unfortunately, approximately 50,000 people still die each year from colorectal cancer in the U.S. In some ethnic populations and underserved communities, colorectal cancer incidence and mortality rates remain disproportionately higher than in white Americans. Colorectal cancer is the third most common cancer diagnosed in both men and women in the United States, excluding skin cancers, and is the third-leading cause of cancer-related deaths in both men and women. Based on scientific evidence, there is widespread agreement that regular screening can help prevent colorectal cancer.
ASGE screening guidelines recommend that, beginning at age 50, asymptomatic men and women at average risk for developing colorectal cancer should have a colonoscopy every 10 years. People with risk factors, such as a family history of colorectal cancer, should begin screening at an earlier age. Patients are advised to discuss their risk factors with their physician to determine when to begin routine colorectal cancer screening and how often they should be screened. Screening for colorectal cancer is especially important because colorectal cancer is often present in people without symptoms. People should speak to their physicians about an appropriate screening schedule and which screening method is best for them.
For more information about colorectal cancer screening or to find a qualified physician, visit ASGE’s colorectal cancer awareness website at www.screen4coloncancer.org. To get involved in colorectal cancer advocacy and research, log on to the Fight Colorectal Cancer website at www.FightColorectalCancer.org.
About American Cancer Society Cancer Action Network (ACS CAN)
ACS CAN, the nonprofit, nonpartisan advocacy affiliate of the American Cancer Society, supports evidence-based policy and legislative solutions designed to eliminate cancer as a major health problem. ACS CAN works to encourage elected officials and candidates to make cancer a top national priority. ACS CAN gives ordinary people extraordinary power to fight cancer with the training and tools they need to make their voices heard. For more information, visit www.acscan.org.
About the American Society for Gastrointestinal Endoscopy
Since its founding in 1941, the American Society for Gastrointestinal Endoscopy (ASGE) has been dedicated to advancing patient care and digestive health by promoting excellence in gastrointestinal endoscopy. ASGE, with nearly 12,000 members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy, and is the foremost resource for endoscopic education. Visit www.asge.org and www.screen4coloncancer.org for more information and to find a qualified doctor in your area.
About Fight Colorectal Cancer
Fight Colorectal Cancer (formerly the C3: Colorectal Cancer Coalition) is the leading colorectal cancer advocacy organization in Washington, DC and demands a cure for the second leading cancer killer in the United States. In addition to our advocacy work, we offer support for patients, family members, and caregivers and serve as a resource for colorectal cancer advocates, policymakers, medical professionals, and healthcare providers. We also do everything we can to increase and improve research – at all stages of development and for all stages of cancer. Find out how you can get involved at FightColorectalCancer.org.

RELATED LINKS

http://www.asge.org

Posted: 31 Mar 2011 04:02 AM PDT

In 2007, 62 out of every 100,000 black men in the United States were diagnosed with colon or rectal cancer, the highest rate of colorectal cancer of any US group.

Overall, men were more likely to get colorectal cancer than women — almost 53 of every 100,000 American males compared to 40 per 100,000 females.

Reporting colorectal cancer incidence rates for 2007, the Centers for Disease Control and Prevention urged regular colorectal cancer screening for all average risk adults 50 years and older to cut deaths from colorectal cancer.

According to the CDC, 142,672 Americans were diagnosed with colorectal cancer in 2007, including 72,755 men and 69,917 women.

Incidence rate means how many people out of a given number get a disease in a given year.  Colorectal cancer incidence rates are reported per 100,000 people.

Across all groups, 52.7 of every 100,000 men were diagnosed with colorectal cancer in 2007 and 39.7 per 100,000 women.

The incidence rates per 100,000 men were:

• § Blacks: 62.0
• § Whites: 51.5
• § Hispanics: 44.8
• § Asian/Pacific Islanders: 39.7
• § American Indians/Alaska Native: 33.5

For women,  incidence rates were

• § Blacks: 47.1
• § Whites: 38.5
• § Hispanics: 32.6
• § Asian/Pacific Islanders: 31.1
• § American Indians/Alaska Native: 28.8

The CDC estimates that as many as 60 percent of colorectal cancer deaths could be prevented if all men and women age 50 and over were screened routinely.

Data comes from the United States Cancer Statistics: 1999–2007 Cancer Incidence and Mortality Web-based Report.

Posted by Mary Miller on March 26th, 2011

What do they have in common? All are forms of creative expression that cancer patients have used to “add life to their days,” wrote oncologist Evan Lipson, MD, of Johns Hopkins University in the Journal of Clinical Oncology (online edition Feb. 7, 2011).

One of his patients, Mike, was building a stone patio in his backyard because it was “therapeutic, physical, and something I could control and have a sense of accomplishment.”

Among the “unique and remarkable ways that people living with cancer make the most of their time,” Lipson has observed several themes: exercising, leaving a legacy, activism, building relationships, giving. And the most powerful, he thinks, is “creating something.”

It can be painting, pottery, gardening, writing—any outlet to express unspeakable feelings, to get a brief vacation from the roller-coaster of cancer, and/or to leave something behind.

Several studies have shown tangible physical results—improved lung function in patients having asthma; decreased pain in rheumatoid arthritis; and in a 2010 review of 12 studies in cancer patients, improved psychological states and perceived quality of life.

In his own patients, Lipson wrote, he has seen them find “relaxation, solace, calm, catharsis, and healing.” He added, “What you end up creating is not important. What matters is that the process feels good.” If it doesn’t feel good, it’s fine to move on to something else. Instead of judging the outcome according to some external standard, Lipson said, “A project is worthwhile because it comes from inside you.”

Source: Journal of Clinical Oncology (online edition Feb. 7, 2011)

If you have been diagnosed with cancer, where have you found your inspiration to keep going everyday? We would like to hear your stories.

With an estimated 51,370 deaths last year, colorectal cancer is the second leading cause of cancer deaths in the United States. Of the men and women expected to die of colorectal cancer in 2011, 50% could be saved if they were tested earlier.

Screening saves lives in two ways, by preventing cancer when pre-cancerous polyps are…..Find out more information by clicking here!

Among cancers that affect both men and women, colorectal cancer—cancer of the colon or rectum—is the second leading cause of cancer-related deaths in the United States. Colorectal cancer also is one of the most commonly diagnosed cancers in the United States.

The risk of developing colorectal cancer increases with advancing age. More than 90% of cases occur in people aged 50 or older.

Reducing Your Risk

Colorectal cancer screening saves lives. However, many people who are at risk for the disease are not being screened according to national guidelines.

It is estimated that as many as 60% of colorectal cancer deaths could be prevented if all men and women aged 50 years or older were screened routinely. In most cases, colorectal cancer develops from precancerous polyps (abnormal growths) in the colon or rectum. Screening tests can find precancerous polyps, so that they can be removed before they turn into cancer. Screening tests also can find colorectal cancer early, when treatment works best.

Some studies show that increased physical activity and maintaining a healthy weight may decrease the risk for colorectal cancer. Evidence is less clear about other ways to prevent colorectal cancer.

Currently, there is no consensus on the role of diet in preventing colorectal cancer, but medical experts recommend a diet low in animal fats and high in fruits, vegetables, and whole grain products to reduce the risk of other chronic diseases, such as coronary artery disease and diabetes.

In addition, researchers are examining the role of certain medications and supplements, including aspirin, calcium, vitamin D, and selenium, in preventing colorectal cancer. While these supplements may reduce the risk of colorectal cancer, the most effective way to reduce your risk is by having regular colorectal cancer screening tests beginning at age 50.

When Should You Begin to Get Screened?

You should begin screening for colorectal cancer soon after turning 50, then continue getting screened at regular intervals. However, you may need to be tested earlier or more often than other people if:

• You or a close relative have had colorectal polyps or colorectal cancer; or
• You have inflammatory bowel disease.

If you are aged 50 or older, or think you may be at increased risk for colorectal cancer, speak with your doctor about getting screened.

The U.S. Preventive Services Task Force (USPSTF) recommends screening for colorectal cancer for all people until they reach 75 years old and for some people when they are older than 75. If you are in this age group, ask your doctor if you should be screened.

More Information

• Colorectal (Colon) Cancer
• Cáncer colorrectal
• Questions to Ask Your Doctor
• Screen for Life Basic Facts on Screening  [PDF - 321KB] (fact sheet)
• Colorectal Cancer Screening Saves Lives  [PDF - 2.6MB] (brochure)
• Listen to or download a podcast
  • Cancer: What You Don’t Know Can Kill You (2010) [PODCAST - 1:20 minutes]
  • Don’t Pass on this Test (2008) [PODCAST - 4:29 minutes]
• Send a Health-e-Card
  • This Is Personal
  • Colorectal Cancer Screening Saves Lives
  • I Got Screened; Now It’s Your Turn
• Watch a video
  • Terrence Howard: Your Wake-Up Call [VIDEO - 0:60 seconds]
  • Jimmy Smits: The Screening [VIDEO - 0:40 seconds]
  • Diane Keaton: Grammy Keaton [VIDEO - 0:60 seconds]
  • Morgan Freeman: The Picture of Health [VIDEO – 0:30 seconds