2020 has been a challenging year in so many ways, but especially for the cancer community. However, colon cancer does not stop for Covid-19 and neither do we! We were extremely excited to continue the legacy of the physical Colon Cancer Challenge by going virtual this year. 2020 also marked the 17th year of the Challenge, where teams of families, friends, co-workers, local and national corporations come together to raise awareness of colorectal cancer, support those battling the disease and raise funds for the Colon Cancer Challenge Foundation’s strategic initiatives of Public Awareness, Prevention, and Research. 

We were blown away by the support of our community during this unprecedented time, and are happy to recognize Maya Degnemark and Darryl Gross for their efforts and support during the Challenge. They ran over 1,200 miles collectively during our virtual event, each for their own reasons which you can learn more about below:

 

Maya Degnemark, top female winner of the Global Colon Cancer Challenge

My name is Maya Degnemark, I am 16 years old and I live in Brooklyn, New York. I have watched my uncle, Sanjay Bery, battle colon cancer for many years and now I proudly stand beside him fighting for this cause. Though I have been on my school’s running team since I began high school and have participated in many local races (including the physical race for colon cancer the last couple of years), I have never been so serious about running or about staying healthy. Things changed, however, in mid- March when my packed everyday life quickly changed (and ultimately became more relaxed), and I saw the opportunity to set both a weight loss and general health goal for myself (and compete in this virtual challenge, which I did not know was this great when I started!) Since then, I have been staying very active – even reaching my 100th day of running (between 3 and 6.5 miles) on July 26th. Now looking back on the past few months and this challenge, I am proud of myself for achieving my personal goals but for also using my own determination to fight for a much greater cause. I thank everyone who participated in this challenge, donated to this organization, or just helped raise awareness for this cause. I am dedicated to continue working with this organization in the years to come and continuing to commend them for their fantastic fight.

Darryl Gross, top male winner of the Global Colon Cancer Challenge

I became involved with CCF after my wife, Jessica, was diagnosed with colon cancer back in April. It’s been a whirlwind since then with surgeries and having to then start chemotherapy.  The experience has been very hard especially during these times. The positive is that her cancer was caught relatively early due to her proactivity.  She knew her body and she felt something was not right and pressed the issue of getting a colonoscopy with her gastroenterologist even as the world was shutting down in March due to Covid-19.   Knowing her body, her intuition was right as she had a cancerous polyp that was removed during her colonoscopy.  She then had to have an additional colorectal surgery before starting chemo.  Chemotherapy will be done in November just in time for the holiday season! She’s 36 and her prognosis is great because she was proactive in getting a colonoscopy even during these uncertain times. It’s been an extra challenging time with everything else going on but we are pushing through. I know both my wife and our world will be better soon! Through this whole situation we have realized how important friends and family are and the power of positive thinking! We are very grateful for everyone in our lives!

As far our involvement with the foundation, it’s new but will be a cause we will support for the rest of our lives.  I saw the notification of the activity challenge and as a family who supports physical activity (we are both runners), I thought it was something great to get involved with.  I plan on participating for many years to come!

 

A recent report by Blue Cross Blue Shield examined the rate of colorectal cancer diagnoses among people with chronic conditions and those over the age of 50, both of which are at an increased risk of colorectal cancer (CRC). Chronic conditions associated with an increased risk of CRC have risen significantly among millennials, or those aged 22-37 years, between 2014 and 2018:

  • Crohn’s disease and ulcerative colitis increased by 14%
  • Type I and type II diabetes increased by 35%
  • Diagnosed obesity increased by 100%

A study found that those who are obese are 30% more likely to develop CRC than those who are not.

There are several reasons for this: obese individuals tend to have inflammation caused by visceral fat, which can cause damage to the body and increase the risk of cancer. This inflammation can also cause insulin resistance, in which the body doesn’t respond properly to insulin and thus produces more to offset the loss from the resistance. Increased insulin in the body can also boost the availability of estrogen, which can lead to increased cell production and tumor growth.

Increased insulin production also affects individuals with type I & II diabetes. Hyperinsulinemia, a condition where the amount of insulin in the blood is higher than normal, can create an environment in the colon that promotes the development and growth of cancer. There are other theories that hyperglycemia, or having too much sugar in the blood, and chronic inflammation from diabetes raises the risk as well. Further research is needed to examine the link between type II diabetes and colon cancer, but it’s noted that injected insulin used to treat type II diabetes is not linked to colon cancer. The risk is from the type II diabetes itself.

Individuals who have inflammatory bowel disease (IBD), like Crohn’s disease or ulcerative colitis, are at a higher risk of CRC due to inflammation of the colon. Individuals who have had IBD for many years tend to develop dysplasia, especially if their IBD has been left untreated. Dysplasia is a condition where cells in the lining of an organ look abnormal but aren’t yet cancerous, but can develop into cancer over time. It’s important to note that IBD is different from irritable bowel syndrome (IBS), which is not linked to an increased risk of colon cancer.

When compared to those who do not have a diagnosed chronic condition, those who do had a significantly higher risk of CRC:

  • People aged 18-64 with Crohn’s disease and ulcerative colitis had an almost two-times greater risk of CRC.
  • People aged 18-64 with diabetes had a 1.7-times greater risk of CRC and tend to have a less favorable prognosis after diagnosis
  • People aged 18-64 with diagnosed obesity had a 1.3-times greater risk of CRC, with a stronger link among men

Only 31% of people under 50 with Crohn’s or ulcerative colitis have received colon cancer screenings. Data obtained from the Blue Cross Blue Shield Axis survey that examined attitudes toward colorectal screening found that 58% of 18-49 year olds with Crohn’s disease or ulcerative colitis cited knowledge barriers as the reason for not getting screened for CRC. Both age groups—over 50 years and 18-49 years—said they were unaware of the need to be screened because their primary care physician had not recommended it. 61% of study participants over the age of 50 admitted that attitudinal reasons were the main barrier to getting screened for CRC. These reasons range from being uncomfortable with the screening process to being fearful of the results. 48% of 18-49 year olds admitted that they do not believe they’re at risk for CRC, therefore they have not been screened. External barriers, such as testing costs and being too busy, accounted for 26% of reasoning for those over 50 and 25% of those aged 18-49.

Increased awareness of CRC risks and symptoms can lead to a decrease of the amount of late stage diagnoses—if diagnosed early, the 5-year survival rate for CRC is 90%. The American Cancer Society recommends that people with an increased risk of CRC should start screening before the age of 45 and be screened more often. Gastrointestinal specialists advise individuals diagnosed with Crohn’s disease to begin regular colonoscopies 15 years after diagnosis or when they reach the age of 50, whichever comes first, and should continue to get screened every one to three years. Individuals diagnosed with ulcerative colitis are advised to begin regular colonoscopies 8 years after diagnosis or at age 50, whichever comes first, and continue every one to two years.

Sources: https://www.mdanderson.org/publications/focused-on-health/how-does-obesity-cause-cancer.h27Z1591413.html

First introduced in February 2017, the Removing Barriers to Colorectal Cancer Screening Act of 2019 (H.R. 1570/S. 668) aims to waive Medicare coinsurance for colorectal cancer (CRC) screening tests, regardless of the code billed for a resulting diagnosis or procedure. The bill sponsors are: Representatives Donald Payne, Jr. (D-NJ), Rodney Davis (R-IL), Donald McEachin (D-VA), and David McKinley (R-WV) in the House and Senators Sherrod Brown (D-OH), Roger Wicker (R-MS), Ben Cardin (D-MD) and Susan Collins (R-ME) in the Senate.

The bill acknowledges that CRC is largely preventable if polyps are detected early and removed before they become cancerous. But there is a large gap in CRC screening rates in the country, with 60% of CRC cases and 70% of deaths occurring in those 65 and over. In order to improve colonoscopy rates, the bill, if passed, will eliminate any unexpected costs, and remove financial barriers that prevent seniors from being screened.

In a statement supporting H.R. 1570 and S. 668, the American Cancer Society Cancer Action Network (ACS CAN) explains that seniors who set up a screening colonoscopy visit do so assuming there is no cost sharing since it’s a screening procedure. However, detection and removal of a polyp during the screening can result in the enrollee facing a surprise medical bill because removing the polyp changes the colonoscopy to a diagnostic process. Medicare enrollees are responsible for a 20% copay on diagnostic procedures, and this amount may vary based on the procedure and the facility where it was conducted. ACS CAN says that Medicare beneficiaries may be sensitive to such out-of-pocket (OOP) costs, and it may deter them from undergoing screening colonoscopy.

ACS CAN is hopeful that removal of this OOP cost loophole can not only save lives by catching CRC at an earlier stage, but it will also result in savings for Medicare, which is expected to spend $20 billion on CRC treatment in 2020 alone.

Jamie Crespo, 29

What is your experience with Colon Cancer? (Are you a patient, survivor, advocate, or caregiver?)

Both my parents were diagnosed with colon cancer in 2017.This was unexpected since cancer did not run in my immediate family. My dad showed signs of weight loss and anemia. He eventually was scheduled for a colonoscopy. In my gut feeling, I knew what the worst diagnosis would be and did not want to believe that it could be cancer. In mid-April, my parents and I found out that my dad had a large mass in his colon and needed surgery. This was the worst news that my family and I received. He was supposed to have surgery mid-summer but had a reaction to a cardiology test that pushed his surgery back to August. My dad had a colectomy to remove the part of the colon that had the mass. He stayed in the hospital for a few days. He had to undergo eleven rounds of chemotherapy with diagnosis of stage 3 colon cancer. With good news, he has been in remission since then.

 

While my dad was going through chemotherapy, my mom scheduled a colonoscopy that was long overdue from the beginning of the year. Unfortunately, her gastroenterologist told me he found polyps and a small mass in her colon that needed surgery to be removed. In November, she had laparoscopic colon surgery to remove the mass and was successful. She stayed in the hospital for a few days as well. Luckily, they removed everything and she did not need chemotherapy for treatment.

 

Did you have any family history of colon cancer before your parents were diagnosed?

I did have a cousin that was diagnosed before my parents.

 

Has your experience impacted your lifestyle? If yes, what are some changes you’ve made?

Exercising regularly, healthy eating habits, seeing a primary care physician yearly. 

 

Is there someone or something that you have leaned on for support during this time? How did they help you?

When my parents were both diagnosed the same year, my support group, that included my family and close friends, came to visit when my parents were in the hospital. If I needed to talk to them they were there for me. 

 

What advice would you give to others who are experiencing the same situation as you?

Definitely have a support group that you can talk to and get a colon cancer screening at age of 50 if not sooner. 

 

A recent study published by the American Journal of Cancer Research examined the impact of geographic disparities on the survival of men with early-age onse­­­­t colorectal cancer (EAO-CRC). The goal of the study was to identify gender-specific differences among those with EAO-CRC, while examining individual and county-level factors.

Data from the Centers for Disease Control and Prevention (CDC) and the Surveillance, Epidemiology, and End Results (SEER) were analyzed to study CRC patterns among men aged 15 to 49 years who were diagnosed between 1999 and 2017. EAO-CRC deaths were classified as deaths among US residents aged 15-54 from 1999-2017. Men aged 50-54 were included to account for patients diagnosed at age 49 with standardized 5-year follow-ups. In identifying hotspots, researchers at the CDC used the International Classification of Diseases, Tenth Revision (ICD-10) codes to identify county-level EAO-CRC frequencies,crude rates, and age-adjusted rates. U.S. counties were then classified as hotspots if they had high rates of EAO-CRC mortality as determined by geospatial analyses. The study population included Hispanic men and non-Hispanic white and black men. . Chi-square test helped determine variances in patient- and county-level characteristics between men in hotspot counties and in non-hotspot counties. Survival was estimated based on the date of diagnosis and the date of the last follow-up appointment or death.

The study identified 232 counties as EAO-CRC hotspots— a majority were located in the South, at a vast 92% or 214 of the 232 hotspot counties. The remaining 8%, or 18 of the 232 counties, were located in the Midwest. Although the average age of men diagnosed with EAO-CRC was 42.73 years, age was not a significant differential among men in the individual hotspot counties.

Men living in hotspot areas were more likely to be:

  • Non-Hispanic black
  • Less likely to be Hispanic
  • Less likely to be married or have a domestic partner

Men residing in these areas were also more likely to be diagnosed with metastatic CRC than men living in other areas.

Hotspot counties commonly shared the following characteristics compared to other counties:

  • Higher poverty rates
  • Higher rates of adult obesity
  • More physical inactivity along
  • Fewer exercise opportunities
  • Limited access to healthy foods
  • Lower college completion rates
  • Higher adult smoking rates
  • Higher uninsured rates
  • Fewer primary care physicians
  • Increased rurality
  • More violent crimes

Overall, men residing in these hotspot areas had a lower CRC survival rate than those in non-hotspot counties. Specifically, men diagnosed with EAO-CRC who lived in hotspots had a 24% increased risk of CRC-specific death than those in non-hotspot areas. Smoking was identified as a major cause of EAO-CRC mortality in hotspots, as EAO-CRC patients in these areas who smoked had a 12% higher rate of mortality than men who did not.

Implications

CRC hotspots in the U.S. tended to be associated with risk factors related to high levels of poverty. Potential explanations for these hotspots could be inadequate access to health care, a knowledge gap on CRC risks and symptoms, and high uninsured rates. The results of the study emphasize the need for increased education on symptoms, preventative measures, and treatments of CRC, especially in hotspot areas.

The article says: Study participants were NH-White, NH-Black, and Hispanic adults or adolescents aged 15-49 at primary CRC diagnosis. A total of 32,447 men in the SEER database were diagnosed with EOCRC from 1999-2016,

Brittney Waldrop 32, female, patient

How did you discover your diagnosis? How old were you at the time? Did you have symptoms? 

I was 31 years young when diagnosed. I went in for my first ever colonoscopy and they found one polyp that was cancerous. I had symptoms for about 5 years, but they were unfortunately overlooked by many doctors. I experienced extreme exhaustion; I could drink 8 cups of coffee a day and still go to sleep! I also occasionally had bloody stools, but they were bright red instead of the black they tell you to look for. Doctors kept saying that it was just hemorrhoids but didn’t look into it any further. If they did, maybe I wouldn’t be stage 4 at this point! It could’ve been caught sooner!

 

Did you have any prior knowledge about colon cancer before you were diagnosed? For instance, did you know about the symptoms and factors that lead to a higher risk of CRC? Did you know your family history?

I did not know anything and I do not have a family history of colon cancer.

 

Has your experience impacted your lifestyle? If so, what are some changes you’ve made?

Yes, it made me realize that life is short, and to live each day to the fullest! I’m weaker than I used to be, so I’ve been slowly trying to build my strength back up as well. 

 

It’s great that you’ve been taking the steps to regain your strength! Is there anything specific that you’ve been doing for this?

I have been walking, riding my stationary bike, reading my daily religion book, stretching and taking wheatgrass shots daily!

 

Is there someone or something that you have leaned on for support during this time?

Facebook support groups, my family & friends, and the hospital that I received care from.

 

What advice would you give to others who are experiencing the same situation as you?

Breathe, it’s going to be okay!

 

For more information related to colon cancer contact us today: www.coloncancerfoundation.org

A new law passed during the Indiana General Assembly’s 2020 session now requires insurance companies to cover colonoscopies at age 45 instead of the previously recommended 50. The law comes two years after the American Cancer Society modified their guidelines for colon cancer screenings.

In a study published in 2017 by the Journal of the National Cancer Institute, researchers found that from the mid-1980s through 2013, colorectal cancer incidence rates in adults age 55 years and older were declining while incidence rates for adults between the ages of 20 and 49 were increasing. It is speculated that the increase in colorectal cancer incidents in young adults is attributed to the fact that screenings were previously not recommended for those under 50.

Implications

It is estimated that there will be around 104,000 newly diagnosed cases of colon cancer and around 43,000 new cases of rectal cancer in the United States in 2020. Almost 18,000 of these cases are estimated to be diagnosed in adults younger than 50. The American Cancer Society estimates that among these numbers, 3,410 will be Indiana residents. Inspired by these statistics, the new Indiana law allows for cases to be diagnosed at an earlier age since screenings are now covered for those 45 years and older. Rep. Brad Barrett, who drafted the law, emphasized its benefits by explaining that insurance costs could potentially decrease if people are diagnosed at an early stage since “the cost of treatment will be less than if it had been caught at a later stage.” The five-year survival rate for colorectal cancer that has been detected early is 90%.

At the virtual American Society of Clinical Oncology (ASCO) annual meeting in May/June 2020, promising results from the interim analysis of phase 3 data from the KEYNOTE-177 trial were presented during the plenary session. First-line treatment of a subset of patients with metastatic colorectal cancer (mCRC) with the immunotherapy drug pembrolizumab doubled the median progression-free survival (PFS) compared to patients treated with standard-of-care chemotherapy. This has now led to an FDA approval for the drug.

Trial Results

KEYNOTE-177 was designed as a global, multicenter, open-label, active-controlled, randomized trial that compared treatment of 307 previously untreated patients with microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) mCRC. Mismatch repair is an inherent property of cells that allows them to correct DNA replication errors, and dMMR cell lack this process, resulting in mutations in the DNA. dMMR cells with alterations in short, repetitive DNA sequences are called MSI-H.  Patients were randomized to receive first-line pembrolizumab alone at 200 mg every 3 weeks for up to 2 years or investigator’s choice chemotherapy: FOLFOX (fluorouracil [5-FU], leucovorin, and oxaliplatin) or FOLFIRI (5-FU, leucovorin, and irinotecan) every 2 weeks, with or without bevacizumab or cetuximab.

This was a crossover trial, meaning patients on chemotherapy could cross over to receive pembrolizumab for up to 35 cycles if their disease had progressed. Primary end points were PFS and overall survival (OS); objective response rate (ORR) was the secondary endpoint.

Median PFS was 16.5 months in the pembrolizumab group and 8.2 months in the chemotherapy group. Pembrolizumab showed a 40% reduction in the risk of disease progression (P=0.0002); PFS rates were 55% vs 37% for pembrolizumab vs chemotherapy, respectively, at 12 months, and 48% vs 19%, respectively, at 24 months. ORR were 43.8% and 33.1%, respectively. While the median duration of response was 10.6 months for chemotherapy (2.8-37.5 months), it had not been reached with pembrolizumab (2.3-41.4 months). Complete responses were achieved in 11.1% and 3.9% patients receiving pembrolizumab vs chemotherapy, partial responses were achieved in 32.7% vs 29.2%, respectively.

Only 22% of patients in the pembrolizumab arm had treatment-related adverse events (TRAEs) compared to 66% in the chemotherapy arm. One TRAE death was reported in the chemotherapy arm.

The study is ongoing and OS data are expected to be presented at a later time.

FDA Approval

The above results have led to the FDA approval of pembrolizumab in previously untreated patients with MSI-H/dMMR mCRC. Importantly, this is the first immunotherapy to receive FDA-approval as first line of care in this patient population.

You can help significantly decrease your chances of colorectal cancer through proactive action related to your diet.

Maintaining a Healthy Weight Helps Prevent Colon Cancer

One of the best things you can do is to get yourself to a healthy weight and maintain it within a designated range. By maintaining a healthy weight you won’t just be proactively protecting yourself from colon cancer, you’ll also be making an investment in your overall health.

What to Eat to Beat Colon Cancer and Help Prevent it

Some of the best foods to be eating to lower your chances of contracting colon cancer include, chicken, fish, fruits, and whole grains.

Foods that you should avoid eating in excess include red meats and anything that is rich in refined sugars.

The Link Between Obesity and Colon Cancer

A strong link has been identified between obesity and colon cancer. Diet choices have a profound impact on how susceptible you are to contracting colon cancer.

It’s important to remember that making healthy choices with what you eat and how much affects much more than your susceptibility to contracting colon cancer. Your diet affects your overall health. It’s also important to remember that portion size is just as important as the food that you choose to eat. You can eat red meat without increasing your chance of getting colon cancer if you do it in moderation.

Someone who enjoys a steak every couple of weeks or so for dinner with a salad is not going to have a particularly high risk of getting colon cancer. Conversely, someone who eats steak, pork, sausage, and bacon in large quantities every single day or even every other day, will greatly increase their chances of having colon cancer.

Eating red meats in small amounts and in limited frequency is perfectly fine. No one needs to be panicking about eating a steak every now and again. No matter what you eat, your portion size is vital. Larger portion sizes are unhealthy and will put weight on fast.

You shouldn’t commit to a healthy diet just to decrease your chances of contracting colon cancer, you should want to eat healthy to feel better about yourself and increase your overall health. If you exercise and maintain a healthy diet, you won’t just be limiting your chances of getting colon cancer. You will feel better, and eliminate your susceptibility to countless other health problems.

How Does a Poor Diet Increase Your Chances of Contracting Colon Cancer?

Some of you might be wondering exactly how a poor diet increases your chances of contracting colon cancer. Obviously foods that are rich in fats aren’t good for you, but why does such delicious food have to make you more susceptible to such a horrible disease?

Studies have shown that when mice were fed a diet consisting of foods that were high in fats, they exhibited aggressive cell growth of stem-like cells that encourage mutation. This aggressive cell growth is typically coupled with the development of cancerous tumors along the intestine.

The unfortunate mice who were tested offer us invaluable insights into the factors that affect one’s chances of developing colon cancer. Their sacrifice, while trivial compared to the totality of scientific inquiry, is significant and it can save lives, human lives.

Further Recommendations

With so much information out there on the internet, it can be difficult to distinguish genuinely useful information from inaccurate drivel. For example, fiber supplements and antioxidant vitamins do not reduce one’s chances of having colon cancer, nor does it affect polyps.

Calcium, on the other hand, does have an effect on polyps and helps reduce polyp recurrence. Another thing that can help you is regular exercise. If you’re going to make the effort to maintain a healthy diet, you should double down and add exercise to the mix.

By exercising, eating healthy, and consuming the recommended amount of calcium, you can reduce your chances of contracting colon cancer significantly. Although these lifestyle changes can give you much better odds, it’s still imperative that you schedule regular screenings. If you aren’t being screened for colon cancer, you can still contract if and all of your efforts will be for naught, especially if it isn’t detected early on, hence the importance of regular screenings.

 

 

 

 

 

Many therapies have been proposed in the continuous fight against colon cancer. Some of these therapies have proven to be more effective than others. One of the more promising therapies for treating colon cancer is immunotherapy. It is a much more holistic approach than many other treatment methods and helps the patient’s body fight cancer on its own. Here is what you should know about the benefits and challenges of treating colon cancer with immunotherapy.

In 2019, an estimated 100,000 of new cases of colon cancer emerged. Numbers like that might not seem like a lot, but when you start looking at the big picture, say, 100,000 cases of colon cancer per year, you can see a trend of 1,000,000 cases in ten years. One hundred thousand might seem trivial, but a million people is like the population of a small country, and when you look at the mortality rates, the picture gets even more interesting.

This is why colon cancer awareness is so important. Do yourself and your loved ones a favor and start talking about your family history and get screened. Prevention is crucial, and being proactive is the key to prevention. One of the best things you can do for yourself aside from committing to regular screenings is to learn more about the most effective treatments. One of the most intriguing treatment methodologies to date is immunotherapy.

What to Know About colon Cancer Prevention and Immunotherapy

Most immunotherapy methodologies focus on leveraging the patient’s own body to actively seek out, identify, and destroy cancer cells. It works by empowering your own immune system and helping it root out any cancer cells before they cause you any more trouble.

Immunotherapy has displayed impressive success rates when used to treat certain types of cancer including a type of lung cancer and skin cancer. Less is known about immunotherapy’s potential to combat colon cancer.

For those who are afflicted with colon cancer, immunotherapy shows the most promise to patients who exhibit something called mismatch repair deficiency. Patients with mismatch repair deficiency are prone to abnormal rates of mutations including the types of cells that contribute to colon cancer.

This serves to highlight the importance of knowing more about your genetics. Some people are afraid to investigate their genetic predisposition because of the fear of actually being predisposed. No one wants to hear that they are genetically susceptible to contracting colon cancer. As difficult to hear as it may be, information is your best friend in these situations. If you’re genetically predisposed to getting colon cancer, you can focus on prevention to decrease your chances of contracting the disease.

Is Immunotherapy Right for You?

One thing that you should know about immunotherapy is that it’s widely considered to be the last line of defense, or offense, depending on how you look at it. Chemotherapy and surgery are the two most commonly used treatment options. They are used at both to combat colon cancer in both the early and late stages of the disease. It’s only when both surgery and chemotherapy have failed that immunotherapy comes into play.

When colon cancer is caught relatively early, surgery has a fairly high success rate as a treatment. When other treatments have failed, immunotherapy is typically used. There is a lot to learn about immunotherapy and a lot more developments underway. One day, immunotherapy may be considered to be a much more promising treatment.