NEW YORK (WABC) — Scientists are making advances in genetic testing for colon cancer.

Frank Garritano never thought he would be diagnosed with colon cancer ever let alone at the age of 40. A marathon runner and restaurant owner in Orangeburg, New York, Frank got the diagnosis just days after celebrating his daughter Isabella’s first birthday

“Physically I felt great. I was running 30 miles a week,” he said.

Colon cancer can affect anyone. That’s why a colonoscopy is recommended for everyone over 50, but scientists are getting better at figuring out who may be most at risk.

“This work is all about who needs to be screened before age 50? Who needs to be screened earlier and perhaps more often?” Dr. Thomas Weber said.

Dr. Weber, a surgical oncologist at SUNY Downstate, says that by working with researchers around the world, they have discovered genetic mutations or clues in the dna.

“There are currently over 12,000 reports of mismatched repeari genes associated with early onset colorectal cancer,” he said.

So it’s not black and white. Just because you have the genetic mutations doesn’t mean you’ll get colon cancer, but with more research it’s becoming more and more targeted

Dr. Weber says if you have the most concerning genetic changes known to date, your lifetime risk of colon cancer is up to 80-percent. So if you have a strong family history of colon cancer, ask your doctor to see a genetic counselor to see if genetic testing is worth it for you.

Frank learned he has one dna mutation and hopes this information will help his family get screened earlier. After a year of surgeries and chemotherapy he says he takes nothing for granted.

“The fact that we’re all sitting here together means everything is perfect,” Garritano laughed.

He is running again. This weekend he will be joining thousands of other runners and walkers in central park for the 9th annual New York Colon Cancer Challenge. It’s on Sunday, April 1st starting at 9:00 a.m. WABC-TV is the proud sponsor of the event. So far they’ve raised almost half a million dollars for colon cancer research.

ONLINE:
The Collaborative Group of the Americas on Inherited Colorectal Cancer: http://www.cgaicc.com/

Colon Cancer Challenge Quiz: http://abclocal.go.com/wabc/feature?section=resources/lifestyle_community/community&id=8589624

WABC Informational Page: http://abclocal.go.com/wabc/story?section=resources/lifestyle_community/community&id=8568932

David Paul Morris/Bloomberg News

A new study shows that patients are far less likely to undergo screening for colon cancer if their doctors recommend only colonoscopy, rather than offering other screening options.

The research suggests that offering patients at risk more choices might help increase the rate of testing for a disease that has long been associated with low screening rates. Survival rates for colorectal cancer are high when the disease is found early and treated, but nationwide, screening for the disease lags far behind that for breast and cervical cancers. Health authorities recommend that everyone be screened for colon cancer after the age of 50, or sooner in those who have additional risk factors, like a family history of the disease.

Colonoscopies are widely considered the gold standard when it comes to screening, but many patients fear the procedure and the bowel-cleansing preparation it requires, and many skip the test. Doctors rarely tell patients they have other options, like the fecal occult blood test, which is less accurate at detecting cancer but is far less invasive, requiring only that patients collect a tiny stool sample to be tested for traces of blood.

In the new study, published in Archives of Internal Medicine, researchers looked at what happened when roughly 1,000 people at moderate risk for colorectal cancer in the San Francisco area were given one of three screening options. In one group, doctors recommended only colonoscopy. In another, they offered their patients only a fecal occult blood test, requiring a stool sample. And in the third, they discussed with their patients both tests and gave them the option of choosing either one.

At the end of the study, the contrast among the groups was stark. When offered only colonoscopy, 38 percent of patients went through with screening. But nearly double the number of people went through with screening in the other groups – 67 percent of people in the group offered stool tests, and 69 percent in the group that was offered both options. The researchers noted, importantly, that a positive stool test was followed up by a colonoscopy to complete the screening.

Historically, most gastroenterologists prefer to offer only colonoscopies because they feel the other tests are inferior, but it is clear that many people would rather forgo screening altogether than undergo a colonoscopy, said the lead author of the study, Dr. John M. Inadomi, a professor and chief of the division of gastroenterology at the University of Washington. “I think what this shows is that patient preferences should be identified, because that’s the way you’re going to increase adherence to colon cancer screening,” he said.

“No matter how effective we believe a colonoscopy is,” he added, “if a patient doesn’t do it, then it’s not doing anything for them.”

Health authorities say that as many as 60 percent of deaths from colorectal cancer could be prevented if everyone over 50 were screened regularly. And yet according to a large nationwide study in 2005, the most recent figures available, only half of adults over 50 reported that they had undergone a colonoscopy in the previous decade or a stool test with a home kit in the previous year. Screening rates are especially low among members of racial and ethnic minorities.

In the current study, roughly 60 percent of participants had completed screening after a year. Latinos had the highest rates of completion, at 63 percent, followed by Asians, at 61 percent. White patients were most likely to choose colonoscopy, whereas nonwhites showed a strong preference for the noninvasive stool test.

In an accompanying editorial, Dr. Theodore R. Levin, a gastroenterologist at Kaiser Permanente Medical Center in California, said the idea of a “preferred” screening test should not mean what doctors prefer, but what both doctors and their individual patients want.

“Many patients prefer to have a stool testing option, and including that option results in more patients being screened,” he wrote.

Click here to watch video.

By Kerry Grens

NEW YORK | Mon Apr 23, 2012 4:46pm EDT

NEW YORK (Reuters Health) – Colonoscopy has become an increasingly popular method of screening for colon cancer while the rate of at-home stool testing has dropped off, according to a new study.

The findings, published in the journal Cancer, are primarily driven by a trend among people above the poverty line preferring colonoscopy; poor people still choose at-home testing as frequently as they did a decade ago.

Dr. Chyke Doubeni, a professor at the University of Massachusetts Medical School who was not involved in the study, said the results demonstrate that in order to raise screening rates in lower socioeconomic-status groups, all types of colon cancers tests should be encouraged.

“Health care providers need to give patients options for screening, not just colonoscopy for everybody,” Doubeni told Reuters Health.

Colonoscopy is an invasive procedure that uses a camera called an endoscope to look for signs of cancer within the colon and rectum.

The U.S. Preventive Services Task Force (USPSTF), a government-backed advisory group, recommends that people should start getting screened for colon cancer beginning at age 50.

But the USPSTF doesn’t endorse any particular type of test over the others — it recommends screening either with a colonoscopy every 10 years, with another invasive test called a sigmoidoscopy every five years or using an annual at-home test called a fecal occult blood test.

The home-based test looks for signs of blood in the stool. If the test comes back positive, a colonoscopy is then recommended to determine whether a person has cancerous growths in the intestine.

According to the American Cancer Society, a person’s risk of developing colon cancer over their lifetime is about one in 20.

Previous studies have shown that although colon cancer screening rates have increased over the past decade, people in lower socioeconomic-status groups are less likely to be screened in general.

Priti Brandi, the study’s lead author and a researcher at the American Cancer Society, said her group wanted to see whether people’s preferences for either type of test have changed over time — understanding that could help doctors and public health policymakers focus their efforts toward increasing cancer screening, she explained.

Brandi’s team analyzed data from thousands of adults 50 to 64 years old, across the U.S., who responded to the National Health Survey.

The survey questioned 6,000 people in 2000, nearly 6,700 people in 2005 and about 5,000 people in 2008.

Over the entire study period, the number of people who did an at-home fecal occult blood test dropped by about six percentage points.

When Brandi grouped survey participants by income and education levels, she found the biggest changes in use of the at-home test among those with higher education and income levels.

Home-based cancer screening dropped from 19 percent in 2000 to 10 percent in 2008 among people with a college degree, for example.

Similarly, in 2000, 17 percent of people who earned four times the poverty level (roughly $92,000 per year for a family of four in 2012) got an at-home test, compared with just 10 percent in 2008.

For people with low incomes or low education levels, at-home screening levels remained stable over the years at around seven to nine percent.

While at-home testing was declining, the endoscopic tests — colonoscopy or sigmoidoscopy — were becoming more popular among those with higher incomes and educations.

Thirty-five percent of people with the highest incomes had an endoscopic screen in 2000, compared with 56 percent in 2008.

In contrast, 23 percent of participants below the poverty line underwent a colonoscopy or sigmoidoscopy in 2000, compared with 29 percent in 2008.

Brandi says one likely explanation for the slower uptake of endoscopic screening methods among the poorer groups is cost.

“Lower socioeconomic groups are significantly less likely to have health insurance and more likely to have barriers in terms of paying for — even if they are covered — more expensive procedures like colonoscopy,” she told Reuters Health.

A colonoscopy can cost upwards of two thousand dollars, compared to several dollars for a home-based fecal occult blood test.

Even if people have insurance, they might have a co-pay for the exam.

“It’s not all about costs,” Doubeni said, however, “it’s about a system of care, it’s about resources, it’s about access to care and cultural differences.”

Doubeni said physicians need to be sensitive to the fact that some patients might prefer one test over another.

“Because these all have similar benefit, the focus should be on maximizing the number of people screened one way or another. Patient preferences are important here,” Dr. Virginia Moyer, chair of the USPSTF, agreed in an email to Reuters Health.

Indeed, a recent study found that colon cancer screening rates shot up when patients got to choose which type of test they would have. (See Reuters Health story of April 9, 2012.)

“A lot of physicians in the United States, they don’t even think about stool testing. They’re not doing a good enough job of laying out options for patients,” said Dr. Joshua Fenton, a professor at the University of California, Davis, who was not involved in the new study.

He said that encouraging home-based stool testing might be the easiest way to increase screening rates in lower socioeconomic-status individuals who don’t have ready access to colonoscopy.

SOURCE: bit.ly/IVwt2u Cancer, online March 20, 2012.

House Ways and Means Chairman Brian White doubts the effectiveness of anti-smoking TV commercials funded by the agency, including one running now that features teens and the ghostly “Gray Man” of Pawleys Island, and believes the money would be better spent on detecting cancer.

“Most every one of us has had someone in the family affected,” White, R-Anderson, said about what prompted the legislation.
Redirecting the money can save lives through a permanent funding source. Legislators previously funded cancer screening with one-time money but haven’t done so for the last two years, White said.
Legislators made the $5 million designation as part of the 2010 law that increased South Carolina’s state cigarette taxes for the first time in 33 years. State taxes rose by 50 cents per pack, to 57 cents, in July 2010. The tax ranks 42nd nationwide, with the nationwide average at $1.46 per pack.

The bulk of that additional revenue goes toward Medicaid.

The executive director of the South Carolina Tobacco Collaborative was at a conference Wednesday and could not be reached.

DHEC discontinued its colorectal screening program amid state budget cuts.

The state-funded SCOPE program, which stands for Screening Colonoscopies on People Everywhere, provided 1,113 colonoscopies to poor, uninsured residents between 45 and 64 years old during the 2009 and 2010 fiscal years; seven cancers were diagnosed and up to 34 cases of colorectal cancer were prevented, according to the agency.

DHEC’s breast and cervical cancer program, called Best Chance Network, receives $3.2 million from the Centers for Disease Control and Prevention for screening.

Since its 1991 creation through December, the program has screened 90,800 South Carolina women for breast and cervical cancer, providing nearly 140,000 mammograms and 178,000 clinical breast exams. Nearly 21,000 follow-up visits resulted in the detection of 46 early forms of breast cancer, and 299 cases of cancer, according to the agency.

Those services are provided to uninsured, low-income women between 47 and 64 years old.

By Durado Brooks, MD, MPH

Imagine that you dropped your car off at a service station for what you thought was a free oil change. You return an hour later to be informed that while the service was underway a small problem was found and repaired (with no input from you), and you now owe $250. How would you take this news? This is the predicament that a number of people face every day due to an oversight in existing Medicare regulations.

Colorectal cancer remains the third leading cause of cancer death in the U.S. Screening is inarguably one of the most effective tools in our fight against the disease, since colorectal cancer screening not only helps find cancer in early, more treatable stages, but can actually prevent cancer altogether. Detection of precancerous polyps is a frequent occurrence during screening exams, occurring in approximately 15% of colonoscopies performed on women, and in up to a quarter of procedures in men. Removing these growths has contributed significantly to the steady fall in colorectal cancer cases and deaths over the past 15 years. Colorectal cancer screening has also been proven to be highly cost-effective.

An important provision of the Patient Protection and Affordable Care Act makes a number of proven preventive services, including colonoscopy screenings, available at no cost to Medicare beneficiaries. However, if a polyp is found and removed during the course of a routine colonoscopy, the procedure is no longer coded as a screening exam, but is reclassified as a therapeutic procedure – at which point the patient becomes responsible for a payment. This fee can range as high as $200, an amount that can be difficult to afford for seniors living on a fixed income. A substantial body of evidence demonstrates that lack of insurance coverage and other financial barriers are associated with lower rates of cancer screening. At a time when 4 out of 10 at-risk individuals are not getting screened for colorectal cancer, we should be doing everything possible to eliminate these barriers and increase utilization of this health-preserving and life-saving technology.

Fortunately there may soon be a solution to this vexing problem. The ‘Removing Barriers to Colorectal Cancer Screening Act of 2012’ (H.R. 4120), sponsored by U.S. Representative Charlie Dent (R-PA), would close this loophole and eliminate the possibility of unexpected costs for Medicare beneficiaries receiving a screening colonoscopy, even if a polyp ends up being removed during the procedure. The American Cancer Society Cancer Action Network (ACS CAN) has teamed with a host of organizations involved in the fight against colorectal cancer to support of this legislation. Your legislators need to know that you too are concerned about this barrier to high quality healthcare, so please call or write your elected representatives and encourage them to get behind (pun intended) this important piece of legislation.

Dr. Brooks has served as the director of prostate and colorectal cancers at the American Cancer Society’s National Home Office since 2000. In this role he is involved in creating and implementing strategies to improve the prevention and early detection of prostate and colorectal cancers, and is engaged in a number of the Society’s disparities-reductions efforts.

After graduating from the Ohio State University and the Wright State University School of Medicine, Dr. Brooks practiced primary care internal medicine in community health centers, initially in Ohio and later in his current hometown of Dallas, TX. Prior to joining the ACS he was awarded a Commonwealth Fund/Harvard University Fellowship and earned his MPH degree at the Harvard School of Public Health.

It’s worth mentioning that pages 80-88 highlight colorectal screening as a case example for the potential for integration.  The Roundtable is discussed, and there are many other suggestions.

Many thanks to Dr. James Hotz of the National Association of Community Health Centers for his work on this report.

The competition is now open and will close on April 5th.  See the email below for details, including application guidelines.

Samples of Blue Star use can be submitted to Mary Doroshenk at nccrt@cancer.org by April 30, 2012 with “Blue Star Challenge” in the subject line.  Last year’s winners were so creative, inspiring, beautiful and energizing that this year, we will be setting aside time at the NCCRT annual meeting on November 29th and 30th for winners to present their work.  We will also cover the cost of travel and lodging for the presenters to the NCCRT annual meeting (one person per winning entry).

Thank you for your continued support in the fight against this preventable, treatable and beatable disease and for your support of the NCCRT.  Please feel free to contact me with any questions or suggestions.

Legislation Would Increase Access to Colon Cancer Screenings and Treatments for the Medically Underserved

Colon Cancer Awareness Month in March is a Reminder of the Importance of
Screening and Early Detection

WASHINGTON – March 1, 2012 – Critical legislation introduced recently in the U.S. House of Representatives would ensure that cost is not a barrier for Medicare beneficiaries to access lifesaving colon cancer screenings.

The ‘Removing Barriers to Colorectal Cancer Screening Act of 2012’ (H.R. 4120), sponsored by U.S. Representative Charlie Dent (R-PA), would eliminate cost sharing for Medicare beneficiaries receiving a colonoscopy, even if a polyp is removed. Under current Medicare policy routine colonoscopies are considered a free preventive service; however, cost sharing is required if a polyp is removed during the routine colonoscopy. Colonoscopies have been shown to prevent colon cancer, but this cost may serve as a barrier for some people seeking to get the screening, since a patient won’t find out whether a precancerous polyp or other abnormality needed to be removed until after the procedure is complete. The risk of any cost-sharing can be a deterrent from getting the screening.

“I commend Representative Dent for this important effort to ensure that everyone has access to life saving cancer screenings, without regard to their ability to pay,” said Christopher W. Hansen, president of the American Cancer Society Cancer Action Network (ACS CAN). “Too many Americans are going without lifesaving screenings because they cannot afford it. We urge Congress to help stop a cancer that can be prevented in many cases.”

In addition to this legislation, another bill sponsored by U.S. Senators Joe Lieberman (I-CT) and Kay Bailey Hutchison (R-TX) and U.S. Representatives Kay Granger (R-TX) and James McGovern (D-MA), introduced in 2011, would create a national program run by the Centers for Disease Control and Prevention (CDC) to provide grants to states for screening low-income individuals who cannot afford to get tested. The program would bridge the gap for men and women who are within the recommended age for colon cancer screening but may not be able to access the new benefits under the Affordable Care Act.

The screening program created by this legislation would be modeled after the successful National Breast and Cervical Cancer Early Detection Program, a CDC-run national program which offers lifesaving cancer screenings to low-income and medically underserved women and provides a gateway to treatment through Medicaid. Since 1990, more than 10 million screening exams have been performed through the program for four million women, resulting in the detection of more than 50,000 cases of breast cancer and saving an untold number of lives. The American Cancer Society and ACS CAN have been steadfast supporters of the program since its inception over 20 years ago.

“Colon cancer has a five-year survival rate of over 90 percent when diagnosed early, but a survival rate of only 12 percent when diagnosed late,” said Rob Kugler, chair of ACS CAN’s board of directors. “Colon cancer screening has been proven to prevent cancer through the detection and removal of premalignant polyps. The programs created by these pieces of legislation would help to save lives, prevent suffering and reduce the cost burden of colon cancer on our country.”

Also known as colorectal cancer, colon cancer is the third most commonly diagnosed cancer and the third leading cause of cancer deaths in both men and women. An estimated 143,460 new cases of colorectal cancer will be diagnosed in the U.S. in 2012, and 51,690 colorectal cancer deaths are estimated to occur in the same year.

African-American men and women are disproportionately affected by this disease, having higher colon cancer incidence and mortality rates than whites. Economic disparities play a significant role in these statistics, as being uninsured or underinsured often hinders access to colon cancer screening tests, which would detect the disease at an earlier, more treatable stage.

ACS CAN, the nonprofit, nonpartisan advocacy affiliate of the American Cancer Society, supports evidence-based policy and legislative solutions designed to eliminate cancer as a major health problem. ACS CAN works to encourage elected officials and candidates to make cancer a top national priority. ACS CAN gives ordinary people extraordinary power to fight cancer with the training and tools they need to make their voices heard. For more information, visit www.acscan.org.

FOR MORE INFORMATION, CONTACT:
Christina Saull or Steven Weiss
American Cancer Society Cancer Action Network
Phone: (202) 585-3250 or (202) 661-5711
Email: Christina.Saull@cancer.org or Steve.Weiss@cancer.org