About one in three adults aged 50 to 75 years have not been tested for colorectal cancer as recommended by the United States Preventive Services Task Force (USPSTF), according to a new Vital Signs report from the Centers for Disease Control and Prevention (CDC). Despite research that shows colorectal cancer screening tests save lives, screening rates remain too low.
“There are more than 20 million adults in this country who haven’t had any recommended screening for colorectal cancer and who may therefore get cancer and die from a preventable tragedy,” said CDC Director Tom Frieden, MD, MPH. “Screening for colorectal cancer is effective and can save your life.”
Colorectal cancer is the second leading cancer killer among men and women in the United States, after lung cancer. Screening tests can prevent cancer or detect it at an early stage, when treatment can be highly effective. Adults aged 50 years and older should get tested with one or a combination of these screening tests:
• Fecal occult blood test (FOBT) or fecal immunochemical test (FIT) done at home every year;
• Flexible sigmoidoscopy, done every five years, with FOBT/FIT done every three years;
• Colonoscopy done every 10 years.
A colonoscopy can detect cancer early, and it can find precancerous polyps so they can be removed before they turn into cancer. An FOBT/FIT is a simple at-home test that can detect cancer early by identifying blood in the stool, a possible sign of cancer. People are not always offered a choice of colorectal cancer tests, but studies have shown that people who are able to choose the test they prefer are more likely to get the test done.
CDC researchers reviewed colorectal cancer screening data from CDC’s 2012 Behavioral Risk Factor Surveillance System to estimate the percentage of people aged 50 to 75 years who reported getting screened as recommended by type of test.
Major Findings
• Among adults who were screened as recommended, colonoscopy was by far the most common screening test (62%). Use of the other USPSTF-recommended tests was much lower: FOBT (10%), and flexible sigmoidoscopy in combination with FOBT/FIT (less than 1%).
• The highest percentage of adults who were up-to-date with colorectal cancer screening was in Massachusetts (76%).
• The percentage of people screened for colorectal cancer using the FOBT within one year was more than twice as high in California (20%) when compared with most states.
• Blacks and whites had similar screening rates, but a higher percentage of blacks across all income and education levels used FOBT.
The authors noted that increasing use of all tests may increase screening rates. Furthermore, research shows that more people may get tested if health care providers used an organized approach to identify people who need to be screened: contact them at their home or community setting; advise them of each test; and carefully monitor to make sure they complete their test.
CDC provides funding to 25 states and four tribal organizations across the United States to help increase colorectal cancer screening rates among men and women aged 50 years and older through organized screening methods. Through the Affordable Care Act, more Americans will have access to health coverage and preventive services like colorectal cancer screening tests. The tests will be available at no additional cost. Visit Healthcare.gov or call 1-800-318-2596 (TTY/TDD 1-855-889-4325) to learn more.
Women vaccinated with one dose of a human papillomavirus (HPV) vaccine had antibodies against the viruses that remained stable in their blood for four years, suggesting that a single dose of vaccine may be sufficient to generate long-term immune responses and protection against new HPV infections, and ultimately cervical cancer, according to a study published in Cancer Prevention Research.
“The latest Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention on vaccination coverage indicates that in 2012, only 53.8% of girls between 13 and 17 years old initiated HPV vaccination, and only 33.4% of them received all three doses,” said Mahboobeh Safaeian, PhD, an investigator in the Division of Cancer Epidemiology and Genetics at the National Cancer Institute (NCI) in Bethesda, Maryland.
“We wanted to evaluate whether two doses, or even one dose, of the HPV 16/18 L1 VLP vaccine [Cervarix] could induce a robust and sustainable response by the immune system,” she added. “We found that both HPV 16 and HPV 18 antibody levels in women who received one dose remained stable four years after vaccination. Our findings challenge previous dogma that protein subunit vaccines require multiple doses to generate long-lived responses.”
Data for this study are from the NCI-funded phase III clinical trial to test the efficacy of Cervarix in women from Costa Rica. About 20% of the women in the study received fewer than three doses of the vaccine, not by design.
The researchers looked for the presence of an immune response to the vaccine (measured by antibody levels) in blood samples drawn from 78, 192, and 120 women who received one, two, and three doses of the vaccine, respectively, and compared the results with data from 113 women who did not receive vaccination but had antibodies against the viruses in their blood because they were infected with HPV in the past.
They found that 100% of the women in all three groups had antibodies against HPV 16 and 18 in their blood for up to four years. Antibody levels were comparable for women receiving two doses six months apart and those receiving the full three doses.
The researchers also found that while antibody levels among women who received one dose were lower than among those who received the full three doses, the levels appeared stable, suggesting that these are lasting responses. In addition, the levels of antibodies in women from the one- and two-dose groups were five to 24 times higher than the levels of antibodies in women who did not receive vaccination, but had prior HPV infection.
“Our findings suggest promise for simplified vaccine administration schedules that might be cheaper, simpler, and more likely to be implemented around the world,” said Safaeian. “Vaccination with two doses, or even one dose, could simplify the logistics and reduce the cost of vaccination, which could be especially important in the developing world, where more than 85% of cervical cancers occur, and where cervical cancer is one of the most common causes of cancer-related deaths.”
In some parts of the world, including Chile and British Columbia, two doses of HPV vaccine is now the recommended vaccination program, according to Safaeian. But for a single HPV dose, “while our findings are quite intriguing and show promise, additional data are needed before policy guidelines can be changed,” she clarified. “For instance, it is important to note that persistence of antibody responses after a single dose has not been evaluated for Gardasil, the quadrivalent HPV vaccine that is more widely used in the United States and many other countries.”
In my work as a radiologist, every day I see a whole lot of poop, well, actually images of poop. One of the most common emergency room patient complaints is abdominal pain and, too often, particularly in children, the cause is simply constipation. This is evident on imaging studies, and I believe this is a symptom of a much larger problem, our Standard American Diet, which is generally very high in animal-based foods and processed foods, and quite low in plant-based whole foods (e.g., fruits, leafy vegetables, and whole grains).
Unfortunately, constipation is just the beginning for many of these youngsters. Here are just a few of the problems they are likely to encounter later in life without significant dietary changes:
Hemorrhoids. These are vascular structures in the anal canal that help with stool control. They become pathological when swollen. They are composed of arterio-venous channels and connective tissue. Internal hemorrhoids usually present with painless rectal bleeding, whereas external hemorrhoids may be asymptomatic or, if thrombosed, may cause significant pain and swelling related to the anus region. Factors that increase intra-abdominal pressure (e.g., chronic constipation) contribute to hemorrhoids.
Diverticulosis/Diverticulitis. Diverticulosis refers to diverticula in the colon, which are outpocketings of the colonic mucosa and submucosal, through weaknesses of muscle layers in the colon wall. These are more common in the sigmoid colon, which is a common place for increased pressure (e.g., chronic constipation) and are uncommon before the age of 40. Diverticulosis often results in painless rectal bleeding. Diverticulitis results when one of these diverticula becomes inflamed, may cause pain and fever, and can be complicated by abscesses, which occasionally require drainage procedures or surgery.
Colorectal Cancer. Cancer is an uncontrolled cell growth, which in this case occurs in the colon or rectum. Symptoms of colorectal cancer typically include rectal bleeding and anemia, which are sometimes associated with weight loss, pain, and changes in bowel habits. Results of The China Study showed that high fiber intake (e.g., plant-based whole foods) was consistently associated with lower rates of cancers of the rectum and colon.1,2
Constipation and hemorrhoids used to be personal issues for me. However, since adopting a whole food, plant-based diet, neither has been a problem and I sincerely doubt they ever will be. I consider myself fortunate that I did not progress to diverticulitis or colorectal cancer before making my dietary changes.
It is noteworthy that recent studies seem to suggest that the environment within our colon may be a predictor of our risk of many chronic diseases. A chronic failure to expeditiously eliminate waste/toxins through our bowel seems to have reverberating consequences throughout our body. Furthermore, it has been my anecdotal observation over the last 15 years as a practicing radiologist that adults in whom I diagnose constipation on imaging studies are much more likely to have cancers (e.g., breast, prostate, and colorectal) and visible atherosclerotic disease.
Yet, relatively few dollars are spent on research and education related to the benefits of a plant-based diet to promote colon health. Instead, like other cancers—including breast and prostate—most expenditure in the United States is toward screenings for early detection and implementing treatment regimens following diagnosis. Why do we not place more value on nutritional prevention in our US health system? Why do we generally prefer only to diagnose/screen and to treat?
As health care professionals, we can and should educate our patients and encourage them with regard to plant-based foods as the most comprehensive and effective way to prevent the diseases that result in most American deaths. By starting with our children, we can give them each an opportunity for a healthier, longer, and more productive life, free of many chronic diseases.
References
1. Li JY, Liu BQ, Li GY, et al. Atlas of cancer mortality in the People’s Republic of China. An aid for cancer control and research. Int J Epidemiol. 1981 Jun;10(2):127-33.
2. Junshi C, Campbell TC, Junyao L, Peto R, eds. Diet, Life-style and Mortality in China: A Study of the Characteristics of 65 Chinese Counties. Oxford, UK; Ithaca, NY; Beijing, PRC: Oxford University Press; Cornell University Press; Peoples’s Medical Publishing House; 1990.
New cancer recommendations made by a National Cancer Institute (NCI) working group could reduce unnecessary treatment by eliminating the fear factor linked with some early-stage cancers. However, there is a need for diagnostic tests that can recognize whether these early conditions could become life-threatening, states an analyst with research and consulting firm GlobalData.
The NCI scientists recommended that words like cancer, neoplasia, and carcinoma should be removed from premalignant conditions in order to reduce the incidences of over diagnosis and to prevent patients from undergoing irrelevant surgery, radiation, or drug treatment.
“The implementation of this recommendation will help make patients and physicians more comfortable with refraining from unnecessarily treating benign disease,” says Cheryl S. Gradziel, PhD, oncology analyst with GlobalData. “The term cancer and its synonyms are alarming, which leads patients to strongly believe that premalignant conditions such as ductal carcinoma in situ or high-grade prostatic intraepithelial neoplasia should be treated aggressively, when this is often not the case.”
As people become more aware and screening for many common cancers increases, more tumors are being treated at early stages. But, those screenings have resulted in more frequent diagnoses of abnormalities that would never become life-threatening, which is what the NCI is trying to minimize by redefining the terms surrounding cancer.
In order to reduce the excessive treatment of low-risk diagnoses, GlobalData’s analyst argues for the importance of investing in tests that could determine early on if a condition will become malignant or not.
“There is ample market opportunity for such tests, and their approval and subsequent adoption will have the greatest impact towards reducing the overdiagnosis and overtreatment of cancers in the US,” says Gradziel.
The taller a postmenopausal woman is, the greater her risk for developing cancer, according to a study published in Cancer Epidemiology, Biomarkers & Prevention.
Height was linked to cancers of the breast, colon, endometrium, kidney, ovary, rectum, and thyroid, as well as to multiple myeloma and melanoma, and these associations did not change even after adjusting for factors known to influence these cancers, in this study of 20,928 postmenopausal women, identified from a large cohort of 144,701 women recruited to the Women’s Health Initiative (WHI).
“We were surprised at the number of cancer sites that were positively associated with height. In this data set, more cancers are associated with height than were associated with body mass index,” said Geoffrey Kabat, PhD, senior epidemiologist in the Department of Epidemiology and Population Health at Albert Einstein College of Medicine of Yeshiva University in New York. “Ultimately, cancer is a result of processes having to do with growth, so it makes sense that hormones or other growth factors that influence height may also influence cancer risk.”
Some genetic variations associated with height are also linked to cancer risk, and more studies are needed to better understand how these height-related genetic variations predispose some men and women to cancer, according to the study’s authors.
Kabat and colleagues used data from the WHI, a large, multicenter study that recruited postmenopausal women between the ages 50 and 79, between 1993 and 1998. At study entry, the women answered questions about physical activity, and their height and weight were measured.
The researchers identified 20,928 women who had been diagnosed with one or more invasive cancers during the follow-up of 12 years. To study the effect of height, they accounted for many factors influencing cancers, including age, weight, education, smoking habits, alcohol consumption, and hormone therapy.
They found that for every 10-centimeter (3.94 inches) increase in height, there was a 13% increase in risk of developing any cancer. Among specific cancers, there was a 13% to 17% increase in the risk of getting melanoma and cancers of the breast, ovary, endometrium, and colon. There was a 23% to 29% increase in the risk of developing cancers of the kidney, rectum, thyroid, and blood.
Of the 19 cancers studied, none showed a negative association with height.
Because the ability to screen for certain cancers could have influenced the results, the researchers added the participants’ mammography, Pap, and colorectal cancer screening histories to the analyses and found the results remained unchanged.
“Although it is not a modifiable risk factor, the association of height with a number of cancer sites suggests that exposures in early life, including nutrition, play a role in influencing a person’s risk of cancer,” said Kabat. “There is currently a great deal of interest in early-life events that influence health in adulthood. Our study fits with this area.”
