The anticipated draft recommendation from the U.S. Preventive Task Force Services (USPSTF) is here…and it brought forth great news for the colorectal cancer (CRC) community. This independent panel of experts has proposed lowering CRC screening age for average-risk adults from 50 to 45 years.

The B grade recommendation means private insurance plans must cover this preventive service without the individual paying anything out-of-pocket (no copayment, coinsurance, or deductible). A key provision of the Affordable Care Act is that private health insurance plans must cover preventive health care services recommended by expert medical bodies without cost-sharing.

Members of CCF’s Medical Advisory Council welcomed this recommendation.

Judy Yee, MD, FACR Chair of Radiology at the Albert Einstein College of Medicine and Montefiore Medical Center, said, “The new USPSTF draft guidelines will help to increase screening in patients younger than 50. Specifically, for individuals between the ages of 45-49, the B rating by the USPSTF indicates that colorectal cancer screening must be covered by private health plans.” Dr. Yee is a proponent of providing patients the option of validated screening tests such as CT colonography (virtual colonoscopy). “CT colonography is a structural exam, like colonoscopy, and can find polyps before they turn in to cancer, which is an advantage over the stool-based tests. Knowing about all the options is important and ultimately the best test is the one that actually gets done.”

Kimmie Ng, MD, MPH, Director of the Young-Onset Colorectal Cancer Center and Co-Director of the Colon and Rectal Cancer Center, Dana-Farber Cancer Institute, told CCF, “45 is the new 50!” Dr. Ng strongly believes that the revised screening age recommendation “is hugely impactful, will change standard of care in preventive medicine, and lead to insurance coverage of screening for people starting at age 45. However, research must continue into what the underlying causes of young-onset colorectal cancer are, as this new guideline will not benefit the many patients who are diagnosed younger than 45.”

Cindy Borassi, Interim President of the CCF, said, “The Colon Cancer Foundation applauds the USPSTF for taking a step in the right direction by lowering the screening-age recommendation for CRC screening. With early-age onset colon cancer a growing concern in both the U.S. and globally, initiating screening at 45 years instead of 50 among individuals with an average risk of CRC will lead to earlier diagnosis, potentially before the disease progresses to an advanced stage, which can dramatically improve patient outcomes. This is a significant boost to our foundation’s promise of raising awareness of the importance of early detection of CRC.”

A study published in JAMA Network Open earlier this year that analyzed CRC incidence in 1-year age increments found a steep rise in incidence among people in their early 50s, reflecting the large number of CRCs detected during first screening, which would be at the existing recommendation of 50 years. The proposed recommendation by USPSTF, once finalized, will help diagnose these early-onset cases much before they progress to an advanced stage.

It is important to remember that these are draft recommendations and the USPSTF is inviting stakeholders to provide comments till November 23, 2020. It is imperative that the CRC community prepare to spread the message on early screening within the population and primary care centers once the final recommendation is released early next year.

USPSTF has proposed lowering the screening age for CRC to 45! Lend your support and send in your comments directly to USPSTF by November 23.

Send Your Comment to USPSTF

 

As the nation moves towards a new era of inclusivity and diversity, the American Society of Clinical Oncology (ASCO)’s fourth annual survey sheds light on racial inequality and other issues that influence cancer screening and health care access amidst the COVID-19 pandemic.

ASCO’s National Cancer Opinion Survey is a largely accessible national representative survey conducted by The Harris Poll. The 2020 survey, conducted virtually from July 21st to September 8th, revealed that 4,012 U.S. adults aged 18 and older are suffering or have suffered from cancer in 2020 alone. ASCO President Lori Pierce, MD, FASTRO, FASCO said that “this survey assesses Americans’ perceptions of a wide range of cancer prevention and care issues during a most turbulent time in our country,” with the goal of addressing these needs within the context of access to cancer screening.

In line with the national racial equality crisis, and the Black Lives Matter Movement, this year’s survey placed a focus on understanding whether race can affect health care access. The survey found that 59% of Americans are aware of racial disparities impacting the care a person receives, with a majority of these views belonging to those in racial and ethnic minorities.

Figure 1: The Impact of Racism on Health Care Access. ASCO’s National Cancer Opinion Survey found that the majority of racial minorities (including Blacks, Hispanics, and Asians) argue that racism impacts the care an individual receives.

71% of respondents belonging to the Black ethnic group believe that they are less likely to receive the same quality of cancer care as Caucasians, while only 47% of Caucasians seem to agree with this belief. This large divide between the opinions of the two groups potentially stems from the fact that Caucasians aren’t overtly subjected to racial discrimination when it comes to their health care rights and quality of care, and they may subconsciously choose to believe that it does not exist. It could also be due to the lack of adequate information surrounding the extent of racial disparities within health care. This unconscious ignorance seen within the large majority of the American population needs to be resolved so that the nation can move forward to incorporate racial equality in cancer health care access.

Another prominent issue that ASCO has raised is the unequal distribution of good health care insurance within the population—56% of Americans argue that the type of health care insurance influences the likelihood of cancer survival. Additionally, despite increasing evidence showing worsened cancer prognosis in racial minorities, particularly for those belonging to the Black minority, fewer than 1 in 5 (19%) Americans actively believe that race impacts cancer survival, with Hispanic and Black respondents holding these views more than Whites.  Dr. Pierce argues that “racism undermines public health,” significantly affecting those suffering from cancer. She also states that “for almost every cancer, Black Americans fare worse than other racial groups” and that “now is the time to address the systemic issue of health inequity that negatively impact the health of Blacks and other people of color.”

 

Another surprising discovery from 2020’s National Cancer Opinion Survey is that a hefty two-thirds of Americans have either delayed or avoided their cancer screenings due to fear surrounding the COVID-19 pandemic. While pushing cancer screenings for a couple of months is not necessarily life-threatening, ASCO’s Chief Medical Officer Richard L. Schilsky, MD, FACP, FSCT, FASCO, is concerned that “a significant number of Americans might stop getting preventative care for long periods of time or altogether,” inevitably causing a drastic surge in cancer-associated morbidity and mortality. Though screenings may seem subjectively avoidable during a global pandemic, cancer can be well managed through screening—data shows that a majority of cancer-related deaths could be prevented with early screening and diagnostic measures.

Figure 2: Incorporation of Cancer Prevention Behaviors into Routine life. The National Cancer Opinion Survey conducted by ASCO consistently reports that a large proportion of the population do not include cancer prevention behaviors (usage of sunblock, healthy weight, and limited alcohol consumption) into their daily schedules.

Simultaneous to increased delays in cancer screenings, previous ASCO National Cancer Opinion surveys have also reported that most Americans are not incorporating cancer prevention behaviors into their regular schedules. For instance, less than half of the respondents use sunblock, maintain a healthy weight, or limit alcohol consumption, thereby increasing their cancer risk. While these cancer prevention steps may not seem that important in light of the current global situation, they are vital to reducing an individual’s risk of developing cancer. Therefore, researchers, oncologists, medical doctors, and other health care professionals strongly recommend incorporating these behaviors into daily routines.

To conclude, this year’s National Cancer Opinion Survey conducted by ASCO uncovers several issues within the American health care system, namely unequal access to cancer screenings due to racial disparities, cancer screening denial, and fear of developing COVID-19. In light of recent events and unprecedented circumstances, researchers and health care professionals now more than ever argue that it is imperative to proactively find solutions to these issues to better transform the future of the American health care system.

The U.S. Preventive Services Task Force (USPSTF)—which is made up of an independent expert physician panel who recommend preventive care guidelines—has proposed initiating colorectal cancer (CRC) screening at 45 years for average-risk adults. This is a B grade recommendation. Screening for those between 50 and 75 years remains an A grade recommendation and screening for the 76 to 85 age group is a C grade recommendation.

An A grade recommendation means there is high certainty of a substantial net benefit, a B grade recommendation means that there is a high certainty of a moderate net benefit or a moderate certainty of a moderate net benefit, and a C grade recommendation means the service should be offered based on professional judgement and an individual patient’s situation because there is a moderate certainty of a small net benefit.

Task Force chair Alex Krist, MD, MPH, said, “Unfortunately, not enough people in the U.S. receive this effective preventive service that has been proven to save lives. We hope that this recommendation to screen people ages 45 to 75 for colorectal cancer will encourage more screening and reduce people’s risk of dying from this disease.” The Task Force has particularly recognized the disproportionately high number of CRC incidence and mortality among Black Americans and has urged physicians to offer this screening to their Black patients starting 45 years.

Both direct visualization (colonoscopy, CT colonography, flexible sigmoidoscopy, and flexible sigmoidoscopy with FIT) and stool-based tests (HSgFOBT, FIT, and sDNA-FIT) are included in the screening recommendation.

The draft recommendation is open for public comment till November 23.

A study conducted by researchers in Japan found that cigarette smoking may increase the risk of colorectal cancer (CRC) incidence in a Japanese population While smoking has been associated with an increased risk of CRC among Western populations, it has not been investigated as a risk factor in Asian populations prior to this study, according to the authors.

 

Statistics show that 60% of CRC cases occur in developed countries and CRC incidence continues to increase rapidly in Asia. Specifically, Japan experienced an increase in cases from 1978 to 1993 and has remained stable since then but is still among the top 10 countries with the highest incidence of CRC. A separate Japanese study found a gender-based difference in CRC incidence, with men being more susceptible to rectal cancer and women being more susceptible to colon cancer:

 

Colon cancer:

  • Men: 65.7%
  • Women: 75.4%

Rectal cancer:

  • Men: 34.3%
  • Women: 27.0%

 

It is hypothesized that environmental and lifestyle factors, such as smoking, can increase the risk of CRC. In Japan, for instance, 80% of men and 20% of women were smokers in the 1950s. However, a significant reduction was observed in smoking rates by 2017: only 32% of men and 9% of women were smokers. The age-standardized CRC incidence rate was 22.2 in 1978 and 38.9 in 2018.

 

Tobacco use can cause many different cancers, including mouth, larynx, lung, kidney, liver, and many more . In 2014, the U.S. Surgeon General’s report added CRC to the list of tobacco-related cancers. However, there are some issues with this:

  • Evidence supporting the claim that the use of tobacco is associated with the development of colon cancer has been derived mainly from Western populations while data from Asian populations are conflicting. More research is needed on this association in Asian populations.
  • Meta-analysis by geographic region did not find a significant association between smoking and CRC in Asian studies

The Japanese study aimed to investigate the correlation of smoking and CRC incidence in Asian populations.

 

Researchers used original data from major cohort studies performed by the Research Group for the Development and Evaluation of Cancer Prevention Strategies in Japan. The following criteria  were used when examining these studies for this analysis:

 

  • Population-based cohort studies conducted in Japan
  • Studies initiated between the mid-1980s and mid-1990s
  • Studies with more than 30,000 participants
  • Studies that acquired information on health-related lifestyles
  • Studies that followed the incidence of CRC

 

A self-administered questionnaire at the baseline survey determined if each participant was a smoker and classified them into one of three groups: never smoker, former smoker, or current smoker. Participants were followed-up for CRC incidence from the baseline study until the date of CRC diagnosis, migration out of the study area, death or the end of follow-up, whichever was first. The end of the follow-up period was between December 31, 1992 and December 31, 2014.

 

The study found that men who were ever, current or former smokers had a statistically significant higher risk of CRC than never smokers. Ever and current smoking increased the risk of both colon and rectal cancer, while former smokers had an increased risk of colon cancer.

Women who were ever, current or former smokers did not have an increased risk of CRC, but a significantly greater risk of distal colon cancer. Women who were heavily exposed to smoking had an increased risk of CRC.

 

Colon cancer is one of the most preventable diseases through screening methods and avoiding risk factors such as smoking , obesity, and poor diet. The American Cancer Society recommends getting screened at age 45 or younger if you have a family history of CRC.

Although a colon cancer screening might not sound like the most exciting thing in the world, it is still extremely important. There are far more reasons why you absolutely should commit to regular colon cancer screenings, than reasons not to. Here is an overview of the many compelling reasons why colon cancer screenings are something that you should be a priority.

The Benefits of Colon Cancer Screenings

Colon cancer treatment has come a long way over the years as continuous advancements have made it much more manageable when it’s caught early on. The key to beating colon cancer is knowing whether you have it or not as early as reasonably possible. By agreeing to colon cancer screenings on a regular basis, you can stay on top of things so that if you contract it, you’ll have the vantage ground of prescience.

Preventing colon cancer is of utmost importance because it plays such a key role in beating the disease.

They Are Easy to Perform and There Is Very Little Risk

One of the most commonly used forms of colon cancer screening is a colonoscopy. These procedures are relatively easy to perform with a very low risk of any adverse effects. Overall, the benefits of having a colonoscopy at regular intervals are much more favorable than the consequences of neglecting your screenings. It is recommended that people who are considered to be at average risk of contracting the disease should have a colonoscopy every 10 years starting at age 50.

It’s one of the rites of passage to middle age, and it’s nothing to worry about. Colon cancer screenings help to keep you healthy and safe by ensuring early detection.

You Owe it to Yourself and to Your Family

When it comes down to it, you owe it not only to yourself but also to your family to get screened for colon cancer. One of the most painful situations is one in which there is nothing that could have been done to prevent a potentially fatal disease. In these situations, when no amount of effort could possibly help it leaves families feeling helpless as they watch their loved one struggle in vain.

More painful still, however, are the cases in which the disease could have been prevented quite easily and wasn’t. It’s far better to undergo the mild discomfort and inconveniences of colon cancer screenings than to hope for the best and wind up hearing that you have only a few months to live. In these cases, loved ones can be unforgiving as they seek to place blame on someone in their grief. They will hold you at fault which only adds salt to the wound as no one will ever be harder on you in such a situation than yourself.

Let’s face it, no one knows exactly how much time on this Earth they will be blessed with, but by going to your colon cancer screening tests, you will gain precious knowledge that could save your life.

Does Your Family Have a History of Colon Cancer?

Folks who are considered to be of average risk of contracting colon cancer are encouraged to have a colonoscopy every 10 years or so. If however, someone in your family had colon or rectal cancer, you will be considered to be at a higher risk and will need more frequent screenings.

You should know that if someone in your family had colon cancer, it does not automatically mean that you will succumb to the same disease. Although you will certainly have a higher chance of contracting colon cancer at some point, as long as you’ve been going to your screenings you will be able to catch it early and defeat it much more easily.

For those of you who have had a family member with colon cancer, screening tests like colonoscopies are your safeguard against the disease. Don’t look at a colonoscopy as something to dread, look at it as a way to protect yourself instead.

On the surface, you might be thinking that you can’t afford to have regular colon cancer screenings. Fortunately, colon cancer screenings are exempt from co-pays under the Affordable Care Act.

 

 

 

Numerous challenges present themselves when a patient chooses to get screened for colorectal cancer (CRC), but we know very little about why patients may opt-out of getting screened. 

A survey mailed to 660 patients aged 50-75 years old from the Virginia Ambulatory Care Outcome Research Network practices in June-July 2005 posed an open-ended question regarding what the most important barrier to CRC screening might be. Approximately 74% of the individuals who responded noted fear as the most important barrier to CRC screening. According to Nagelhout et al, one of the most common patient-reported barriers is fear, which was observed among 27.6% of responders. Other reasons included:

  • absence of physician advice
  • lack of time, lack of awareness
  • limited information

Patients’ outlook toward the screening procedure and the uncertainties surrounding it seemed to influence their decision to not get screened. Many individuals in the recommended CRC screening age range either lack awareness about why they need to get tested or they believe they don’t need to be screened because they feel ‘fine’.

Fear and anxiety concerning CRC screening is equally prevalent across different racial and ethnic groups. A series of studies suggest fear to serve as the most common barrier in CRC screening. Many patients expressed concern about getting infected with AIDS as a result of a medical device being inserted into their rectum. Several were reluctant to participate due to fear of anticipated pain, while others felt apprehensive about the preparation needed prior to a colonoscopy. Patients also expressed concern about being diagnosed with cancer after getting screened, fear of complications during the screening, and having an overall fear of getting a medical test done.

A significant gender-based difference has also been identified with respect to CRC screening. Women are far more likely to list fear as a barrier primarily due to negative past experiences pertaining to sexual abuse.

Health care providers need to gain a better understanding of barriers from the patient’s perspective, including psychological barriers, as well as what can be done to eliminate them. As noted by Jones et al, patients believe the motivation to overcome fears relies on how passionately physicians advocate for CRC screening. Patients felt that physicians should reiterate and express the importance of CRC screening while remaining empathetic. Above all, physicians need to be mindful that many patients may need to reach a level of comfort before they agree to be screened.

 

The Colon Cancer Foundation (CCF) has been invited to present a poster at the 24th Annual Meeting of the Collaborative Group of the Americas on Inherited Gastrointestinal Cancer. The event will be held virtually, November 14-15, 2020.

CCF will be presenting findings from its Early-Age Onset Colorectal Cancer Virtual Summit, held in April 2020, where researchers and cancer care providers shared their experiences with colorectal cancer (CRC)—particularly early-age onset CRC—care during the early days of the COVID-19 pandemic. With more than 323 attendees, presenters focused on changes in screening and surveillance policies, modifying oncological and surgical care, and using alternative care delivery models such a telehealth, among other things, due to the pandemic. Discussions also touched upon the importance of the emotional well-being of clinical care providers.

Be on a lookout for the full meeting report, which will be released on the CCF website in November.

Colon cancer and rectal cancer, commonly grouped together as colorectal cancer (CRC), is on the rise among individuals under the age of 50, with the most notable increase observed amongst individuals aged 20-39 years, according to the American Cancer Society.

Recently, award-winning actor and “Black Panther” star, Chadwick Boseman, lost his 4-year long battle to colon cancer at age 43. Boseman’s tragic death provides an opportunity to convey the urgent message of how colon cancer can impact a young person’s health, even if they are younger than the suggested screening age for those at average risk–usually 50 years.

Colon and rectal cancer remain the third most commonly diagnosed cancer in the U.S., and the fourth most commonly diagnosed cancer globally. In 2020, an estimated one million lives will be lost to CRC across the globe.

The main difference between colon cancer and rectal cancer is the location of the cancerous lesion(s). The last 12 centimeters of the large intestine is identified as the rectum, while the rest of the large intestine is classified as the colon. Differentiating between the two requires the help of a doctor and advanced imaging technology. Identifying whether a person has colon or rectal cancer is also important to identify the treatment strategy needed to fight the cancer.

Colon cancer has about a 2% risk of recurrence. Rectal cancer, on the other hand, has about a 20% chance of recurrence due to the absence of a protective layer called the serosa that exists in the colon. Rectal cancer even poses a greater risk of spreading to surrounding organs—a process known as metastasis. Metasis can complicate treatment as the cancerous cells break away from the original tumor and travel to other areas in the body, most commonly the liver. This process will also advance the cancer to stage IV, the most aggressive stage.

Recent trends indicating the steepest increase in incidence rates amongst younger age groups means young adults should pay careful attention to their gastrointestinal health. Though older age and aging are risk factors for CRC, colon and rectal cancers can both be attributed to varying lifestyle influences including diet, exercise, and alcohol consumption. Specifically, a low-fat diet high in fiber, fruits, and vegetables is best recommended for reducing the onset of colon and rectal cancer. Additionally, a colonoscopy is best recommended for identifying colon and rectal cancer and is often called the “gold standard,” due to the ability to prevent 90% of CRCs.

Most importantly, visit a doctor if any of the following symptoms occur as they may be a sign of CRC:

  • Sudden or unexpected weight loss
  • Abnormal bowel movements that last for more than a few days
  • Bloody or dark stools
  • Cramping or pain in the abdomen
  • Weakness or fatigue

Prevention and detection are simultaneous in most cases, which is why it is important to “check your butt” as early as you can!

 

When reading about colon and rectal cancer, it can quickly become confusing as to which one is which and what the difference between them is. It becomes even more difficult to understand when you throw colorectal cancer into the mix. So what is the difference between all of these terms? Are there different screening and treatment methods for each of them? You’re about to find out, here is the definitive guide on the differences between colon and rectal cancer.

How to Distinguish Colon Cancer From Rectal Cancer and Vice Versa

Many references make the difference between colon and rectal cancer sound complicated and hard to identify, but in reality, they are quite distinct. Although both diseases share many common factors, there is a primary distinction that can be used to tell them apart. That distinction is the exact location in which the cancer began. If the origin point of the cancer is in the rectum, then it is considered to be rectal cancer and referred to as such. If on the other hand, the point of origin is farther up the large intestine, it will be designated as colon cancer.

It might seem strange to think of it in this way, but it’s important to note that the rectum comprises the last 12 centimeters of the colon. The rectum and the large intestine while separate, are still essentially parts of the same organ. As such, they are very much connected so if cancer starts in the rectum, it will inevitably spread throughout the rest of your colon if it’s not detected on time and properly treated.

So what about colorectal cancer? Is that a type of colon cancer or rectal cancer. Truth be told, it is neither and it is both. Colorectal cancer is a broad term that can be used to refer to both colon and rectal cancer. Although colon and rectal cancer are not the exact same disease, they are still referred to as colorectal cancer as a group.

What Are the Symptoms

Both colon and rectal cancer share several common symptoms that are remarkably similar. If you’re experiencing any of these symptoms, it’s imperative that you tell your Doctor and schedule a thorough screening test like a colonoscopy.

Seeing red, black. Dark-colored spots in your stool are a potential symptom of colon and or rectal cancer. Any of these colors, when present in stool can indicate that there is blood in the stool which is something that you should tell your Doctor about right away.

Constipation, diarrhea, gas, stomach pain are also potential warning signs that you should tell your Doctor about especially when accompanied by fatigue.

Treatment for Colorectal Cancer

When it comes to treating colon cancer versus rectal cancer there are some important differences that are worth noting. Although these types of cancers are similar, the treatment strategy is somewhat unique.

Rectal cancer is considered more dangerous because of its proximity to neighboring organs. To that effect, rectal cancer treatments typically start off with chemotherapy or targeted radiation.

Colon cancer, on the other hand, is generally treated by performing surgery. Although the treatment for colon cancer usually starts with surgery it is often necessary to follow up with chemotherapy to eradicate the disease more thoroughly.

Although the treatments for colon and rectal cancer may differ, the fact that preventative screenings are key to early detection remains the same. By screening for them both, colon and rectal cancer will be easier to fight when you have the strategic advantage of early detection.

The Big Picture

There you have it, whether you’re medically interested in it or if you’re trying to win an argument on the subject at dinner, you now know the exact difference between colon and rectal cancer. In all seriousness, it really is important that you learn the difference early on so that if you suspect that you have one or the other, you won’t lose time reading information that pertains to the wrong one.

When it comes to any type of cancer be it colon, rectal, or any other type of cancer, preventative screenings are crucial. The more aggressively you screen for it, the less likely it is that you will have much or any trouble defeating it should you receive a diagnosis.

Names and semantics aside, colon, rectal, and colorectal cancer can be defeated, especially when you are screening for them. Preventative screenings are your best defense against any of these cancers and can buy you decades of life that would otherwise have been lost unnecessarily to the disease. Instead of letting colorectal cancer sneak up on you, turn the tables and sneak up on it instead with preventative screenings!

 

 

 

Recent findings in a study published by American Association for Cancer Research (AACR) suggest that the presence of periodontal disease is associated with a slightly higher risk of developing colorectal precursor lesions, which include serrated polyps and adenomas.

Data on tooth loss and periodontal disease was obtained from the Nurses’ Health Study (1992-2002) and the Health Professionals Follow-up Study (1992-2010). 17,904 women and 24,582 men were included in the sample size of the study. Data regarding polyp diagnosis was obtained through self-reported questionnaires and later confirmed through medical records. The data were also adjusted for smoking and other related risk factors that lead to periodontal disease and colorectal cancer. The study found that:

  • Individuals with periodontal disease had about a 17% increased risk of developing serrated polyps
  • Individuals with periodontal disease had about an 11% increased risk of developing conventional adenomas
  • Individuals who have lost four or more teeth presented a 20% increased risk of developing serrated polyps

Though the research furthers scientific understanding of the interaction of oral health and gut health, additional research is needed to explore the extent of the correlation and how this influences the risk of colorectal cancer for a definitive conclusion. A previous study published by the International Journal of Cancer suggests that the correlation between periodontal disease and carcinogenesis in the gut may be attributed to the increase in systemic inflammation, thus increasing immune dysregulation and affecting gut microbiota. The study also mentions that positive associations between periodontal disease and other forms of cancers such as lung, breast, and pancreatic cancer have been reported.

Colorectal cancer is largely preventable given that precursor lesions can be detected and removed. Individuals should regularly monitor their oral health and speak to their medical providers about family history regarding periodontal disease and colorectal cancer to prevent early onset of colorectal cancer.