Bang the Drum....Read This!!!!

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Bang the Drum....Read This!!!!

Postby Guest » Wed Mar 08, 2006 12:50 pm

Most Americans still skip colon cancer screening By Anne Harding

NEW YORK (Reuters Health) - Three out of four Americans aged 50 to 70 aren't getting regular colon cancer screening, according to a survey sponsored by the maker of a new screening test for the disease.

Colon cancer is currently the second leading cancer killer in the United States, with 60,000 Americans expected to die from the disease this year.

The American Cancer Society recommends that everyone get a colonoscopy to test for colon cancer at age 50. But 26 percent of the 1,200 people surveyed said their doctor had never discussed colon cancer screening with them, and 24 percent said they didn't get screened because they had no symptoms of the disease. Twenty-eight percent said they didn't want to have a colonoscopy.

Dr. David Stein, director of education for the Colon Cancer Foundation and the chief of the division of colorectal surgery at Drexel University College of Medicine in Philadelphia, points out that this test isn't something most people are comfortable chatting about around the water cooler, despite efforts by Katie Couric and others to raise awareness of the need for colon cancer screening. "The stigma of a colonoscopy is pretty significant," he told Reuters Health.

However, if a person with no family history of the disease has a colonoscopy at 50, the doctor performing the test is able to review the entire colon, and no problems are found, he or she doesn't need to have the test again for 10 years, Stein added. "At 50 you can go get it done and you're good 'til 60," he said.

The survey, conducted by Harris Interactive, was sponsored by EXACT Sciences Corp., a Marlborough, Massachusetts-based company that makes a new non-invasive test that screens for colon cancer by looking for cancer-related DNA in the stool.

Stool DNA tests, which can be done at home, have a roughly 60 percent rate of detection, and rarely yield false-positive results. "When it does detect something, it's pretty accurate," Stein said.

Such non-invasive tests are better than nothing for people who refuse to have colonoscopies, according to Stein, who notes that the American Cancer Society advises people who refuse colonoscopies to have some other type of colon cancer screening test.

The worst thing about a colonoscopy is not the test itself, which is usually performed with some sort of anesthesia, it's the preparation beforehand, Stein noted, in which a person takes laxatives and, in some cases, enemas to clear the bowel. Virtual colonoscopy, in which a CAT scan or MRI is used to scan the bowel, still requires the colon-clearing prep, Stein said, while its effectiveness remains controversial and insurance does not cover it.

Despite the prep's unpleasantness, Stein adds, it's a small price to pay for a test that can be lifesaving. "In the big picture it's a no-brainer."

Ron50
Posts: 699
Joined: Fri Feb 10, 2006 7:04 pm

early detection

Postby Ron50 » Wed Mar 08, 2006 3:45 pm

I have no doubt that the statistics are very similar for Australia. I know from my circle of friends the most common reaction is "They stick a camera WHERE? NO WAY." The other trouble is The medical profession ,and I'm talking G.P's ,follow the path of least resistence ,suspect the lesser ,not the worst. An example was my diagnosis . I told my doctor that I thought I may have a tumour,supported by the fact that I had a swelling in lower left quadrant. I was told I was too fat and the swelling was a partial hernia . Would she do a test ,NO. Changed doctors dx irritable bowel then some 9 mos later a loose loop of bowel ,by this time I was suffering classic cc symptoms. I insisted on a scope a month later,it was granted reluctantly ,to ease my paranoia. I didn't get out of hospital for two weeks . It was an aggressive stage 3 tumour into 6 lymph glands plus the colon was almost closed and I was so close to gangrene and peritonotis it wasn't funny .My GI suggested that untreated I may have been dead in as little as a week. The moral of the story is that we are in control of our own health ,if you seriously suspect a problem get it checked out Ron.

ASTEPHENS33
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Joined: Wed Dec 14, 2005 10:04 pm
Location: Seattle, Washington
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More on Colon Screening

Postby ASTEPHENS33 » Wed Mar 08, 2006 7:19 pm

The following is a discussion that came from another forum I participate in. I do not know the privacy feelings about indicating other sources (which is why I am not crediting the author directly, but do not want to plagerize either.) I thought this was very informative and insightful that I wanted to share it, however.

Decisions about when to begin screening are made a an organization called the US Preventive Services Task Force (USPSTF) in collaboration with a number of organizations, including the American Cancer Society and organizations of oncologists and gastroenterologists. They balance benefits and risks in recommending guidelines for various screening tests and other preventive health measures. They chose 50 as the point to begin screening for people of average risk because over 90% of cases occur after that. The average age of onset is 65. I know of no evidence that more cases are being found younger than 50 or that the average age is decreasing.

The problem to my mind is not that screening starts too late, but that the
prevention and early detection message is not complete. Screening is only a part of it. In addition, people and their doctors need to be assessing risk and testing those of higher risk with colonoscopy earlier and more often. Also, everyone should know the symptoms of colorectal cancer and insist on colonoscopy evaluation of those symptoms.

It is not enough to pat someone on the bottom and assure them that no one gets colorectal cancer when they are young. It seems like a no brainer just to test everyone earlier. If we did that then we wouldn't need to worry about high risk or misdiagnosing symptoms. Or would we?

Screening isn't risk free. There will be 3 serious complications for every
1000 colonoscopies, some life-threatening. Those complication figures have held up pretty consistently. A death rate from all colonoscopies is
estimated at 1 per 20,000 patients, but this includes patients with symptoms who may have a higher risk than those undergoing screening colonoscopy. Screening other than colonoscopy must be followed up with colonoscopy including false positives for FOBT -- so there is still risk even for smearing a bit of feces on a card.

In addition, by switching screening attention and resources from those of
highest risk (older adults, those with personal or family histories of
polyps or cancer, inherited cancers, inflammatory bowel disease) to those of lower risk (adults under age 50), we may actually increase the number of deaths from colorectal cancer.

David Lieberman MD is well-known for his work in screening colonoscopy with Veterans Administration populations. In an article in the American Journal of Gastroenterology he discusses changes in screening recommendations based on sex, gender, and ethnicity. Studies show that women's risk at age 55 is about the same as a man's risk at 50. African-Americans have a higher risk for an earlier diagnosis. Should women be screened later? Blacks earlier? While Lieberman worries about making an already complex message even more complicated, he believes that assessing risk more individually would use resources better and might get people to accept screening if they saw it based on individual risk. He writes:

"However, we have limited national resources that can be used for CRC
screening, and should use them wisely. Performing screening in very low-risk individuals uses resources that should be reserved for higher-risk
individuals. Choosing the right test, at the right time, should be a critical element of screening."

You can read the entire text of his article at:

http://tinyurl.com/l53bw

If you would like to know more about how the USPSTF decided on screening recommendations, you can read the full text (free) of their report in the Annals of Internal Medicine when they reviewed and revised their recommendations in 2002.

http://www.annals.org/cgi/reprint/137/2/132.pdf

Bottom line: Screening is only part of the message. Besides screening at
age 50, we should be assessing everyone's risk and choosing the right time to begin screening, the right interval for testing, and the right test.
Everyone should know the symptoms of colorectal cancer and have those
symptoms evaluated with colonoscopy.

This March let's be sure the message is complete:

Screen folks of average risk at 50.
Know your risk and be screened based on that risk.
Know the symptoms of colorectal cancer and insist on evaluating them with colonoscopy.


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