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Health & Medicine for Senior Citizens

Removal of Polyps by Colonoscopy Cuts Colon Cancer Deaths in Half

Removal of these lesions resulted in a 53 percent reduction in colorectal cancer mortality: Memorial Sloan-Kettering Cancer Center - see video, Medicare coverage, about colonoscopy

Feb. 23, 2012 - For the first time, a new study has shown that removing polyps by colonoscopy not only prevents colorectal cancer from developing, but also prevents deaths from the disease. Patients in the study were evaluated for up to 23 years after having the procedure, providing the longest follow-up results to date.

The collaborative study, led by researchers at Memorial Sloan-Kettering Cancer Center, will be published in the February 23, 2012 issue of The New England Journal of Medicine.

 

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“Our findings provide strong reassurance that there is a long-term benefit to removing these polyps and support continued recommendations of screening colonoscopy in people over age 50,” said the study’s lead author Ann G. Zauber, PhD, a biostatistician at Memorial Sloan-Kettering.

Tumor-like growths called adenomatous polyps are the most common abnormality found during colonoscopy screening and have the potential to become cancerous.

Previous research from these investigators showed that removal of these polyps prevented colorectal cancer but it was not known whether the cancers prevented were potentially lethal. This study assessed whether removal of adenomatous polyps reduced colorectal cancer mortality — a finding that would indicate that the polyps removed had the potential to progress and cause cancer death.

Researchers evaluated the long-term results of 2,602 patients enrolled in the National Polyp Study (NPS, the largest study of its kind) who had precancerous polyps removed during colonoscopy.

They found that the detection and removal of these lesions resulted in a 53 percent reduction in colorectal cancer mortality compared to that of the deaths expected in the general population of comparable size, age, and gender.

Furthermore, patients who had adenomatous polyps removed also had the same low death rate from colorectal cancer for up to 10 years after the procedure compared to a control group of people in whom no such polyps were detected.

Link to  Video on Colonoscopy,

NIH Senior Health

Colonoscopy is a procedure that lets your doctor look inside your entire large intestine. It uses an instrument called a colonoscope, or scope for short. Scopes have a tiny camera attached to a long, thin tube. The procedure lets your doctor see things such as inflamed tissue, abnormal growths, and ulcers.

Your doctor may recommend a colonoscopy for a number of reasons:

   ● To look for early signs of cancer in the colon and rectum

   ● To look for causes of unexplained changes in bowel habits

   ● To evaluate symptoms like abdominal pain, rectal bleeding, and weight loss

Your doctor can also remove polyps from your colon during a colonoscopy.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases (More MedlinePlus)

Read about Medicare coverage and more about Colorectal Screening below news report.

“The magnitude of reduction in mortality seen after this procedure is likely due to high-quality colonoscopy performed by well-trained, experienced gastroenterologists,” said the study’s senior author Sidney J. Winawer, MD, a gastroenterologist at Memorial Sloan-Kettering and Principal Investigator of the NPS.

“Randomized controlled trials of screening colonoscopy in the general population underway in the US and Europe will in 10 to 15 years provide further evidence for this potentially powerful cancer prevention approach,” added Dr. Winawer, an internationally recognized leader in the prevention of digestive cancers who is credited with introducing colonoscopy as a key component of national guidelines for colorectal cancer screening in the United States and worldwide.

The National Cancer Institute estimates that in 2011 more than 100,000 new cases of colon cancer and almost 40,000 cases of rectal cancer were diagnosed, and that more than 49,000 people died from colon and rectal cancer combined.

The multi-institutional study included experts from various disciplines, including endoscopists, radiologists, pathologists, and epidemiologists. Researchers from the following institutions contributed to the study: Boston University School of Medicine (MA), Erasmus Medical Center (Netherlands), Minneapolis Veterans Administration (MN), Valley Presbyterian Hospital (CA), Cedars Sinai Medical Center (CA), Medical College of Wisconsin (WI), and Mount Sinai Medical Center (NY).

The work was supported by the National Cancer Institute, The Society of Memorial Sloan-Kettering Cancer Center Fund, the Tavel-Reznik Fund, and the Cantor Colon Cancer Fund.

Source: Memorial Sloan-Kettering Cancer Center

Medicare on Colon Cancer Screenings (Colorectal)

How often is it covered?

  • Fecal Occult Blood Test: Once every 12 months.
  • Flexible Sigmoidoscopy: Generally, once every 48 months, or 120 months after a previous screening colonoscopy for people not at high risk.
  • Screening Colonoscopy: Generally once every 120 months (once every 24 months if you're at high risk), or 48 months after a previous flexible sigmoidoscopy.
  • Barium Enema: Your doctor can decide to use this test instead of a flexible sigmoidoscopy or colonoscopy. This test is covered every 24 months if you are at high risk for colorectal cancer and every 48 months if you aren't at high risk.

You're at high risk if you have any of the following risk factors:

  • A close relative (sibling, parent, or child) who has had colorectal cancer or an adenomatous polyp (a type of polyp that could become cancerous)
  • A family history of familial adenomatous polyposis (this involves multiple adenomatous polyps, often in the hundreds, and carries a very high risk of colon cancer)
  • A family history of hereditary nonpolyposis colorectal cancer (a type of colorectal cancer that runs in families and tends to cause cancer at a relatively young age - under 45 years)
  • A personal history of adenomatous polyps
  • A personal history of colorectal cancer
  • A personal history of inflammatory bowel disease, including Crohn's Disease and ulcerative colitis

Who’s eligible?

All people with Medicare are eligible for a screening colonoscopy. All other colorectal screenings are available to people with Medicare age 50 and older.

Your costs in Original Medicare

  • You pay nothing for the fecal occult blood test. You pay nothing for the flexible sigmoidoscopy or screening colonoscopy, if your doctor accepts assignment.
  • For barium enemas, you pay 20% of the Medicare-approved amount for the doctor's services. The Part B deductible doesn't apply. If it's done in a hospital outpatient setting, you pay a copayment.

Colorectal Cancer Resources

 

 

Background on Colorectal Screening

By American Society for Gastrointestinal Endoscopy (ASGE)

Colorectal Cancer Screening

Facts About Colorectal Cancer
Colorectal cancer (CRC), often referred to as colon cancer, develops in the colon or the rectum (known as the large bowel or large intestine). The colon and rectum are parts of the digestive system, which is also called the gastrointestinal (GI) tract. The digestive system processes food for energy and eliminates solid waste. CRC usually develops slowly over many years. Most colorectal cancer begins as a noncancerous (benign) adenoma or polyp (abnormal growth) that develops on the lining of the colon or rectum. Polyps can be removed to significantly reduce cancer risk. Colonoscopy plays an important role in colorectal cancer prevention because precancerous polyps can be detected and removed during the same exam when they are discovered.

·        CRC is the third-leading cause of death from cancer in the United States for men and women. It is the third most commonly diagnosed cancer in the United States (excluding skin cancers).

·        More than 140,000 people in the United States are diagnosed with colorectal cancer each year, and over 50,000 die because of it annually.

·        The majority of CRC can be prevented with proper screening, early detection and removal of adenomatous polyps. Screening helps prevent CRC by finding precancerous polyps so they can be removed before they turn into cancer.

·        Only about 50 percent of adults who should have colonoscopies comply with recommended guidelines. More than 60 percent of Americans aged 50 or older, approximately 42 million people, have not utilized any screening method for CRC.

·        Exercise and eating healthy foods such as vegetables and fruits can help decrease the risk of colorectal cancer.

·        As of November 2010, there is no federal law requiring all insurers to cover the cost of preventative CRC screenings. However, the recent enactment of the Affordable Care Act requires coverage of CRC screenings for certain populations depending on individual’s insurance plan. So far only 30 states have passed laws requiring coverage for screening of CRC-a cancer causing 50,000 deaths per year. In contrast, 50 states have passed legislation requiring coverage of screening for breast cancer-a cancer causing 40,000 deaths per year. Additional efforts to improve colorectal cancer screening are needed. Medicare covers colonoscopy once every ten years for those 65 and over at average risk.

·        The incidence of CRC and the death rate from the disease has dropped for the past 15 years. Scientists believe that the decrease is probably because polyps are being found and removed by colonoscopy before becoming cancer. Also, CRC is being found earlier when it is easier to cure, and treatments for cancer once it has occurred have improved. There are approximately one million CRC survivors in the United States, and that number is growing.

·        The five-year survival rate for people with CRC discovered early is greater than 90 percent. But only 39 percent of CRCs are found at that early stage. Five-year survival rapidly declines when the cancer has spread to nearby organs or lymph nodes.

·        Individuals who have a family member (parent, brother or sister, or child) with colorectal cancer or polyps are at increased risk for developing the disease themselves and may need to undergo more aggressive screening starting at a younger age. Individuals who have more than one family member with colorectal cancer or with other types of cancers may be at even higher risk.

Symptoms of CRC
Certain symptoms might indicate this cancer:

·        blood in the stool

·        narrower than normal stools

·        unexplained abdominal pain

·        unexplained change in bowel habits

·        unexplained anemia

If you experience any of these symptoms, talk with your physician. CRC can also occur without symptoms, family history, or any predisposing conditions such as inflammatory bowel disease. When a patient is being evaluated for symptoms, this is NOT considered screening but diagnostic evaluation. The term screening is reserved for healthy, asymptomatic patients.

SCREENING RECOMMENDATIONS FOR THOSE AT AVERAGE RISK:
Beginning at age 50, both men and women at average risk for developing CRC should have a colonoscopy every 10 years. The risk of developing CRC increases with age, with more than 90 percent of cases occurring in persons aged 50 or older.

Men and women should begin screening earlier and more often if they have any of the following CRC risk factors: a family history of CRC or polyps, a known family history of inherited CRC syndromes, a personal history of CRC, or a personal history of chronic inflammatory bowel disease (ulcerative colitis or Crohn's Disease).

People with risk factors for CRC or family history of CRC should talk with a gastroenterologist about screening at an earlier age and find out how often they need to be screened. Read ASGE’s colorectal cancer screening guidelines.

There are several screening methods which have different abilities to detect or prevent CRC: stool blood test known as Fecal Occult Blood Test (FOBT) or Fecal Immunochemical Test (FIT), flexible sigmoidoscopy, colonoscopy, CT colonography, barium enema with air contrast, and stool DNA testing. Tests which mainly detect cancer include FOBT and stool DNA. Tests which mainly detect polyps or cancer include colonoscopy, flexible sigmoidoscopy, CT colonography and barium enema. Colonoscopy is considered the gold standard of colorectal cancer screening methods for its ability to view the entire colon and both detect and remove polyps during the same procedure.

Patients should speak with their physician about the screening method that is best for them. To learn more about CRC prevention and available screening options, log on to ASGE’s colorectal cancer awareness Web site www.screen4coloncancer.org.

DIET AND LIFESTYLE:
There are no foods that directly cause colorectal cancer. However, studies of different populations have identified associations that may affect your risk of developing colorectal cancer. Smoking clearly increases the risk of colorectal cancer and other cancers. Studies have shown a slight increased risk of developing colorectal cancer among individuals with higher red meat or non-dairy (meat-associated) fat intake. Studies have also shown that getting an adequate amount of calcium and vitamin D in the diet or from supplements can reduce the risk of polyps and cancer. Use of aspirin and NSAIDs (such as celecoxib and sulindac) has been proven to decrease the risk of colorectal polyps. There may be a decreased risk of colorectal cancer in patients taking aspirin. However, the use of these agents is reserved for individuals at high risk for colorectal polyps and cancer.

Ongoing studies evaluating the role of vitamins and other natural products are underway to examine their role in colorectal cancer prevention. Few studies, though, have been able to show that modifying lifestyle reduces the risk of colorectal polyps or cancer. Nonetheless, lifestyle modifications such as reducing dietary fat, increasing fruits and vegetables, ensuring adequate vitamin and micro-nutrient intake, and exercise, may improve general health.

Regardless of your dietary and lifestyle habits, screening for colorectal polyps is the key in preventing colorectal cancer.

WHAT AFRICAN-AMERICANS SHOULD KNOW ABOUT CRC:
Although all men and women are at risk for CRC, some people are at higher risk for the disease because of age, lifestyle or personal and family medical history. According to studies, African-Americans are at a higher risk for the disease than other populations. Starting at age 50, everyone should begin routine screening tests. Research shows that African-Americans are being diagnosed at a younger average age than other people. Therefore, some experts suggest that African-Americans should begin their screening at age 45.

·        The incidence of CRC is higher among African-Americans than any other population group in the United States.

·        Death rates from CRC are higher among African-Americans than any other population group in the United States.

·        There is evidence that African-Americans are less likely than Caucasians to get screening tests for CRC.

·        African-Americans are less likely than Caucasians to have colorectal polyps detected at a time when they can easily be removed.

·        African-Americans are more likely to be diagnosed with CRC in advanced stages when there are fewer treatment options available. They are less likely to live five or more years after being diagnosed with CRC than other populations.

·        There may be genetic factors that contribute to the higher incidence of CRC among some African-Americans.

·        African-American women have the same chance of getting CRC as men, and are more likely to die of CRC than are women of any other ethnic or racial group.

·        African-American patients are more likely to have polyps deeper in the colon (on the right side of the colon).

WHAT HISPANICS SHOULD KNOW ABOUT CRC:

·        Hispanic Americans are less likely to get screened for the disease than either Caucasians or African-Americans.

For more information about colorectal cancer prevention or to find a qualified doctor in your area, visit ASGE's colorectal cancer awareness Web site at www.screen4coloncancer.org

Reviewed November 2010

Click here to current version and updates.

 

 

 

 

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