Long time readers of this blog will recall that I am 1) a strong advocate for evidence-based health screenings (e.g., pap smears), 2) approaching the age of 50 -when certain health screenings should begin- and 3) holding out hope that something noninvasive will replace the colonoscopy. The colonoscopy is currently the gold standard for detection of precancerous tissues (polyps) that form in the intestines or rectum and can lead to cancer (colorectal cancer).
This month, in an unprecedented move, Medicare approved coverage for a new test at the same time that the FDA approved its use. The unprecedented part is that the approval and coverage occurred at the same time - which is the result of a new pilot parallel research program that I am not going to discuss here. My focus is the new colon cancer screening test, which is conducted on a persons stool (bowel movement).
The test, Cologuard, is different from currently approved and recommended fecal occult tests because it also tests the stool for DNA found in the cells of cancerous polyps (adenomas). The FDA press release explains how shedding cancerous cells can be collected by the stool as it passes through the body for elimination.
Currently, the American Cancer Society, CDC and the US Preventive Task Force recommend three screening tests for colorectal cancer, but only one diagnostic test - the colonoscopy. The three tests are the Fecal Occult Blood Test (FOBT), the flexible sigmoidoscopy and the colonoscopy. The tests are repeated at different intervals, the least invasive one, the FOBT, is done yearly; the next least uncomfortable, the sigmoidoscopy, every five years; and the colonoscopy, which allows for the removal of polyps if they are found during the procedure, is currently recommended every ten years. For most people, the screening should begin at age 50.
So far, the only insurance company to approve coverage of the new DNA test is Medicare and most people must be age 65 to receive Medicare; however; private insurance companies usually follow the same guidelines as Medicare - so I'd keep a watch on that.
You can see the screening recommendations here, but keep in mind, they have not been updated to included the Cologuard test - (yet?)
Showing posts with label colon cancer. Show all posts
Showing posts with label colon cancer. Show all posts
Saturday, August 30, 2014
Tuesday, January 29, 2013
Diverticulosis
There was a time when diverticulosis, a condition under which tiny sacs grow on the wall of the colon, and diverticulitis, when those sacs become painfully inflamed, were treated with diet restriction. The way to prevent those painful flair ups, it was thought, was to avoid eating foods or meals that had seeds, kernels etc (tomatoes, popcorn, nuts) in them. I know this to be true because I live it - vicariously. A loved one of mine was diagnosed with the disease (via the emergency room) and we (his family) were put on high alert to make sure no seedy foods landed on his plate. As it turns out, diverticulosis has more to do with ones overall lifestyle and diet patterns and not seeds or nuts. In fact, the risks for diverticulosis are similar to those of colon cancer, and include eating a lot of red and processed meats (some say more than once a week is a lot), consuming a diet high in refined grains (white breads, pasta, baked goods) and not getting enough fiber (from food)- while also being overweight and exercising too little. Gee - this sounds familiar! Those same things are related to many different diseases.
I remembered this story from my past after reading about the seed myth in the current issue of the Nutrition Action Newsletter. I have to mention the article because there is something I want to quote from it - which is quite funny, in that sad but true way.
If you have read my blog for any length of time, you've seen my posts about colon cancer and colonoscopy as a preventative measure. I have talked about fecal occult tests used to detect abnormalities as well. Anyways, in the CSPI Newsletter, it was pointed out that colon cleansing - tonics and such that are sold direct to consumers, are not necessary and could be harmful. A physician with Georgetown University Medical center, Ranit Mishori was interviewed for the story. She said a few things worth repeating.
One is that the ads suggest that using a colon cleanser will reduce ones stress. She advises that "yoga, exercise, walking, talking, and even having a glass of wine" will do the same thing and are safe. She doesn't understand why people think that they need to "detoxify and get the gunk out." But her best point was made when she compared the preparation for a colonoscopy to the aftermath of a cleansing drink or suppository. Recall this blog post where I shared my friends story of her first colonoscopy.
Dr. Mishori said, "in either case you are sitting on the toilet for two days and its uncomfortable." She said she was puzzled by peoples eagerness to do it for some hyped up claim on a commercial and unwillingness to do it so that they can have a cancer screening exam. Good point.
(the article I quoted from was the cover story for the Nutrition Action Newsletter Jan/Feb 2013, but there was no author listed)
I remembered this story from my past after reading about the seed myth in the current issue of the Nutrition Action Newsletter. I have to mention the article because there is something I want to quote from it - which is quite funny, in that sad but true way.
If you have read my blog for any length of time, you've seen my posts about colon cancer and colonoscopy as a preventative measure. I have talked about fecal occult tests used to detect abnormalities as well. Anyways, in the CSPI Newsletter, it was pointed out that colon cleansing - tonics and such that are sold direct to consumers, are not necessary and could be harmful. A physician with Georgetown University Medical center, Ranit Mishori was interviewed for the story. She said a few things worth repeating.
One is that the ads suggest that using a colon cleanser will reduce ones stress. She advises that "yoga, exercise, walking, talking, and even having a glass of wine" will do the same thing and are safe. She doesn't understand why people think that they need to "detoxify and get the gunk out." But her best point was made when she compared the preparation for a colonoscopy to the aftermath of a cleansing drink or suppository. Recall this blog post where I shared my friends story of her first colonoscopy.
Dr. Mishori said, "in either case you are sitting on the toilet for two days and its uncomfortable." She said she was puzzled by peoples eagerness to do it for some hyped up claim on a commercial and unwillingness to do it so that they can have a cancer screening exam. Good point.
(the article I quoted from was the cover story for the Nutrition Action Newsletter Jan/Feb 2013, but there was no author listed)
Monday, May 24, 2010
The Meat of the Matter
The red meat association with colon cancer has gained acceptance in the public health community in the last few years. The most established causal link is related to processed meats and eating meats that have been grilled at extremely high temperatures as in both cases chemical agents are created and are hazardous to the body. With colon cancer there is also a synergistic effect with a diet low in fibrous foods. There does continue to be some debate over colon cancer causation.
What has been less challenged is the deleterious effect of saturated fat in red meat, especially in regards to heart disease. A study recently published in the journal of the American Heart Association found that consumption of red meat itself did not correlate to new cases of coronary heart disease. However, there WAS a significant relationship between processed meats and heart disease and possibly diabetes as well. The concern is related to both nitrates and sodium. A high salt diet, especially as it can lead to hypertension, is damaging to artery walls and that damage - inflammation for example, can lead to plaque buildup. Processed meats include lunch meat, bacon and sausage. What did not bear out as a risk factor was eating a steak for example. However, saturated fat does increase caloric density. For that reason, serving size and frequency of consumption must be moderated. The serving size is 3-4 ounces and the frequency is just a few days a week at most. Saturated fat is a problem as is overconsumption of any nutrient which can lead to obesity and the host of problems that involves.
Take home message is that though red meat intake may not be as severe a threat as once thought, it is still something that should be moderated.
The research was one that reviewed over 20 other studies for outcomes based on the food histories of the persons involved. It is not a controlled experiment or clinical trial so the force of the conclusion is somewhat diluted. You can see the abstract of the study here.
Remember also that the AHA has many great resources on its website, including guidance to prevent heart disease in what it calls the Simple Seven.
What has been less challenged is the deleterious effect of saturated fat in red meat, especially in regards to heart disease. A study recently published in the journal of the American Heart Association found that consumption of red meat itself did not correlate to new cases of coronary heart disease. However, there WAS a significant relationship between processed meats and heart disease and possibly diabetes as well. The concern is related to both nitrates and sodium. A high salt diet, especially as it can lead to hypertension, is damaging to artery walls and that damage - inflammation for example, can lead to plaque buildup. Processed meats include lunch meat, bacon and sausage. What did not bear out as a risk factor was eating a steak for example. However, saturated fat does increase caloric density. For that reason, serving size and frequency of consumption must be moderated. The serving size is 3-4 ounces and the frequency is just a few days a week at most. Saturated fat is a problem as is overconsumption of any nutrient which can lead to obesity and the host of problems that involves.
Take home message is that though red meat intake may not be as severe a threat as once thought, it is still something that should be moderated.
The research was one that reviewed over 20 other studies for outcomes based on the food histories of the persons involved. It is not a controlled experiment or clinical trial so the force of the conclusion is somewhat diluted. You can see the abstract of the study here.
Remember also that the AHA has many great resources on its website, including guidance to prevent heart disease in what it calls the Simple Seven.
Friday, April 30, 2010
A Better Colon Cancer Screen - and I try not to be cynical
I am NOT cynical about the alternative cancer screen - only about its near absence in any of the literature we see in the USA about preventing colon cancer. A study that was printed in the journal Lancet this past week, involves the use of a flexible sigmoidoscope, in screening for polyps which often precede colon cancer.
In the UK, the standard colon cancer screen is a fecal blood test every other year - at home -this is for persons between the ages of 60 and 74. I recall writing about the use of the blood test in the USA several years ago and that it IS effective in reducing incidence of colon cancer.
In the research study, which I have read, nearly 200,000 people were randomly assigned to a control or intervention group. Years later, the groups were compared for colon cancer outcomes. The intervention group (when complying) had the sigmoidoscopy and the control group did not. There was a significant difference in the number of persons who got cancer and who died from cancer between these two groups, but NOT between men and women. During the screening, small polyps could be removed, if larger ones were discovered, a colonoscopy was ordered. The study conclusion is this:
Flexible sigmoidoscopy is a safe and practical test and, when offered only once between ages 55 and 64 years, confers a substantial and longlasting benefit.
The test or screening used in this study is much less invasive and expensive that the more common colonoscopy used in the USA after the age of 50. It is certainly safer than the CT scan - which exposes the person to radiation. There are additional studies on the effectiveness of this test, both published and on going.
In a news story about the research, it was noted that the American Cancer Society does recommend several different options for colon cancer screening, including the blood fecal test and this flexible sigmoidoscopy - but to tell you the truth, I have never heard of it and I READ ALOT.
I will tell you also that in the news story I read, it was stated that the US hardly ever uses this test in deference to the colonoscopy which the reporter noted lasted 20 minutes and was conducted under sedation. The reporter went on to say that there was NO RESEARCH to prove that this procedure was best for screening. In other words, the procedure removes polyps best, but maybe a lot of people are going through it that do NOT need to have polyps removed.
Also, the researchers for the study I am addressing today stated that this test only needs to be completed once and that if polyps have not formed by ones 60s they won't. I can assure you that this information is informing my decision about colon cancer screening and that, as no one in my family has had this disease, I will likely wait until age 60 and opt for this flexible sigmoidoscopy test.
I cannot link you to the complete study as I accessed it through a secure site, but here is the summary which tells you about the study and has the proper citation.
In the UK, the standard colon cancer screen is a fecal blood test every other year - at home -this is for persons between the ages of 60 and 74. I recall writing about the use of the blood test in the USA several years ago and that it IS effective in reducing incidence of colon cancer.
In the research study, which I have read, nearly 200,000 people were randomly assigned to a control or intervention group. Years later, the groups were compared for colon cancer outcomes. The intervention group (when complying) had the sigmoidoscopy and the control group did not. There was a significant difference in the number of persons who got cancer and who died from cancer between these two groups, but NOT between men and women. During the screening, small polyps could be removed, if larger ones were discovered, a colonoscopy was ordered. The study conclusion is this:
Flexible sigmoidoscopy is a safe and practical test and, when offered only once between ages 55 and 64 years, confers a substantial and longlasting benefit.
The test or screening used in this study is much less invasive and expensive that the more common colonoscopy used in the USA after the age of 50. It is certainly safer than the CT scan - which exposes the person to radiation. There are additional studies on the effectiveness of this test, both published and on going.
In a news story about the research, it was noted that the American Cancer Society does recommend several different options for colon cancer screening, including the blood fecal test and this flexible sigmoidoscopy - but to tell you the truth, I have never heard of it and I READ ALOT.
I will tell you also that in the news story I read, it was stated that the US hardly ever uses this test in deference to the colonoscopy which the reporter noted lasted 20 minutes and was conducted under sedation. The reporter went on to say that there was NO RESEARCH to prove that this procedure was best for screening. In other words, the procedure removes polyps best, but maybe a lot of people are going through it that do NOT need to have polyps removed.
Also, the researchers for the study I am addressing today stated that this test only needs to be completed once and that if polyps have not formed by ones 60s they won't. I can assure you that this information is informing my decision about colon cancer screening and that, as no one in my family has had this disease, I will likely wait until age 60 and opt for this flexible sigmoidoscopy test.
I cannot link you to the complete study as I accessed it through a secure site, but here is the summary which tells you about the study and has the proper citation.
Wednesday, March 31, 2010
Radiate me NOT
Well, how interesting for me that two issues I have oft addressed appear in the same news story!
The issues are colon cancer screening and radiation from medical testing.
I am very concerned about exposure to radiation and do not believe that we should submit ourselves to a CT scan every time something hurts nor do I think that CT scans or x rays should be used as preventative devices or screening tools. This has long been my stance – five years at least.
It has only been in the past year however that the concern about use of radiation and the adverse consequences – cancer- has been gaining momentum. The FDA has been called upon to look into this matter, especially after the incidents of acute radiation poisoning that occurred in California this past year. The FDA began an exploratory review this week. As I have said before, of great concern is the frequency of scans that occur over a lifespan. The current under age 30 population has had and will have a lot more access to this type of radiation than the over 60 population. Because the scans begin earlier, are used more often and are used over lifetimes, the risk of cancer (and that cancer does not occur immediately after an Xray, but often in the next decade) is significant. We do not have time to wait until our children are middle aged and terminally ill before addressing the issue. The FDA can weigh the evidence and make a statement with regard to the use of CT scan and other medical radiation.
As you know, the FDA has to approve medications and medical devices. They usually convene expert panels to review a new product and then take those recommendations into consideration when making a final decision. After which, that medicine or device can be used as a clinician sees fit, but can only be advertised or marketed to treat what the FDA approved it to treat or test. I had known this, but had not made the same “off label” connection in my mind when it comes to devices.
This brings me to the second issue. Colon or colorectal cancer is one that can be prevented if polyps that might turn cancerous are found and removed. The gold standard for this screening is the colonoscopy. In case you haven’t heard, that involves being sedated while a tiny camera searches your colon or intestines – the day before your test you are told to drink a beverage referred to as bowel prep – in other words, you clean yourself out. The day before is said to be worse than the procedure itself. The colonoscopy is generally recommended at age 50. Enter the virtual colonoscopy – I have described it elsewhere. I have been vocal in my hopes that the virtual colonoscopy or something like it will be perfected and accepted for use prior to my 50th birthday. I have, in my explanation of it, promoted it – in a way. but for the small fact that it involves a CT scan.
Back to the story. The FDA began addressing the radiation issue as a former FDA employee spoke out about his job loss possibly related to his refusal to go along with a recommendation for the CT scanner to be used for colon cancer screening. The device maker would be the one asking for the new FDA approval so that they could begin marketing the machine for this test. Dr. Julian Nicholas has been vocal in his concern that the amount of radiation that people are exposed to is NOT an acceptable amount. He contends that we certainly do not need to add another source, especially because we have an accurate test for this condition that does not use ANY radiation. He has also stated that 1.5 to 2% of all cancers are related to CT scanning. I was pretty shocked because in reading the story, it seemed that the manufacturer of the device had been putting a lot of pressure on the FDA in general, to get it approved.
I expect that we will hear more about radiation in medical testing as the year progresses and the scientists, under additional scrutiny for possible industry ties and bias, look into the matter.
At this time, I do want to clarify that I would NOT take the virtual colonoscopy over the standard version unless it did not involve any radiation.
Also, I have spoken out against airport scanners and tanning beds, but not laser therapy. Why would I? I am not sure, but when I was at a “spa” to get a message, I saw a sign on a door behind which people were getting laser hair removal and the sign warned of radiation! So I have to look into that one.
The FDA does have information on all devices that emit radiation and I invite you to check it out. I have to say that I was unaware of the link until today and am just fascinated by all the different devices that emit radiation. Click on some of the tabs when you go to this site. There are tables that divide the products by use and by radiation type. You can learn about risks and benefits of each procedure as well. I have forgotten about cell phones, but they are here. Also you can find information on laser therapy and laser lights, like in an electronic pointer. Tanning beds and MRI machines are also on the list. In fact, I noticed that ultrasounds were listed as well and that made me wonder if the traditional colonoscopy did expose us to some amount of radiation. I still am unclear – in that I do not know what is used to see the “movie” during the colonoscopy. However, the ultrasound machines use non ionizing radiation which is not the kind linked to cancer. Of course, in light of what Dr. Nicholas was offering today, I can’t be confident that the safety information provided here is trustworthy.
The issues are colon cancer screening and radiation from medical testing.
I am very concerned about exposure to radiation and do not believe that we should submit ourselves to a CT scan every time something hurts nor do I think that CT scans or x rays should be used as preventative devices or screening tools. This has long been my stance – five years at least.
It has only been in the past year however that the concern about use of radiation and the adverse consequences – cancer- has been gaining momentum. The FDA has been called upon to look into this matter, especially after the incidents of acute radiation poisoning that occurred in California this past year. The FDA began an exploratory review this week. As I have said before, of great concern is the frequency of scans that occur over a lifespan. The current under age 30 population has had and will have a lot more access to this type of radiation than the over 60 population. Because the scans begin earlier, are used more often and are used over lifetimes, the risk of cancer (and that cancer does not occur immediately after an Xray, but often in the next decade) is significant. We do not have time to wait until our children are middle aged and terminally ill before addressing the issue. The FDA can weigh the evidence and make a statement with regard to the use of CT scan and other medical radiation.
As you know, the FDA has to approve medications and medical devices. They usually convene expert panels to review a new product and then take those recommendations into consideration when making a final decision. After which, that medicine or device can be used as a clinician sees fit, but can only be advertised or marketed to treat what the FDA approved it to treat or test. I had known this, but had not made the same “off label” connection in my mind when it comes to devices.
This brings me to the second issue. Colon or colorectal cancer is one that can be prevented if polyps that might turn cancerous are found and removed. The gold standard for this screening is the colonoscopy. In case you haven’t heard, that involves being sedated while a tiny camera searches your colon or intestines – the day before your test you are told to drink a beverage referred to as bowel prep – in other words, you clean yourself out. The day before is said to be worse than the procedure itself. The colonoscopy is generally recommended at age 50. Enter the virtual colonoscopy – I have described it elsewhere. I have been vocal in my hopes that the virtual colonoscopy or something like it will be perfected and accepted for use prior to my 50th birthday. I have, in my explanation of it, promoted it – in a way. but for the small fact that it involves a CT scan.
Back to the story. The FDA began addressing the radiation issue as a former FDA employee spoke out about his job loss possibly related to his refusal to go along with a recommendation for the CT scanner to be used for colon cancer screening. The device maker would be the one asking for the new FDA approval so that they could begin marketing the machine for this test. Dr. Julian Nicholas has been vocal in his concern that the amount of radiation that people are exposed to is NOT an acceptable amount. He contends that we certainly do not need to add another source, especially because we have an accurate test for this condition that does not use ANY radiation. He has also stated that 1.5 to 2% of all cancers are related to CT scanning. I was pretty shocked because in reading the story, it seemed that the manufacturer of the device had been putting a lot of pressure on the FDA in general, to get it approved.
I expect that we will hear more about radiation in medical testing as the year progresses and the scientists, under additional scrutiny for possible industry ties and bias, look into the matter.
At this time, I do want to clarify that I would NOT take the virtual colonoscopy over the standard version unless it did not involve any radiation.
Also, I have spoken out against airport scanners and tanning beds, but not laser therapy. Why would I? I am not sure, but when I was at a “spa” to get a message, I saw a sign on a door behind which people were getting laser hair removal and the sign warned of radiation! So I have to look into that one.
The FDA does have information on all devices that emit radiation and I invite you to check it out. I have to say that I was unaware of the link until today and am just fascinated by all the different devices that emit radiation. Click on some of the tabs when you go to this site. There are tables that divide the products by use and by radiation type. You can learn about risks and benefits of each procedure as well. I have forgotten about cell phones, but they are here. Also you can find information on laser therapy and laser lights, like in an electronic pointer. Tanning beds and MRI machines are also on the list. In fact, I noticed that ultrasounds were listed as well and that made me wonder if the traditional colonoscopy did expose us to some amount of radiation. I still am unclear – in that I do not know what is used to see the “movie” during the colonoscopy. However, the ultrasound machines use non ionizing radiation which is not the kind linked to cancer. Of course, in light of what Dr. Nicholas was offering today, I can’t be confident that the safety information provided here is trustworthy.
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