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02/03/2012 - 14:26

Did You Know? Screening Guidelines Updated

If any of your relatives have been diagnosed with colorectal cancer, you may qualify for a screening colonoscopy before the usual 50 years of age.

In 2009 changes were made as to when to begin screening in family members. Age 60 is a key factor for determining when screening should be moved up to and earlier age or when to to more frequently.

1. Single first degree relative (mother, father, brother, sister) with colorectal cancer or advanced precancerous adenoma (based on the size and histology of the polyp) diagnosed at age < 60 years. Begin at age 40 or ten years earlier than the age of the patient when they developed colon cancer. These patients should be followed with colonoscopy every 5 years.

2. Single first degree relative (mother, father, brother, sister) with colorectal cancer or advanced precancerous adenoma (based on the size and histology of the polyp ) diagnosed at age ≥ 60 years.Recommended screening: Same as average risk (colonoscopy every 10 years beginning at age 50 years).

3. Single first degree with colorectal cancer or advanced adenoma diagnosed at age < 60 years or two first degree relatives with colorectal cancer or advanced adenomas.Recommended screening: colonoscopy every 5 years beginning at age 40 or 10 years younger than age at diagnosis of the youngest affected relative.

12/02/2011 - 08:47

Give Yourself the Gift of Health

The holiday season and weight gain seem to go hand in hand. Between Thanksgiving, office buffets, Christmas parties, eggnog and a plethora of cookies, it’s no wonder that the average American gains at least two pounds between the end of November and the beginning of January. All of the rich food and sweets add up and take a toll on our bodies; it’s actually surprising that the average weight gain isn’t higher. In my office, for example, there are some great bakers that often feel the need to share their latest sugary masterpieces with the rest of the staff. With that being said, gaining less than five pounds this holiday season will be difficult.

I’m a good example of someone who knows the facts about disease prevention and its relationship to a healthy BMI (body mass index) and still, I let myself gain a few throughout the course of the holiday season. It seems difficult to turn down seconds and frosting covered cookies but we have to remain vigilant and make sure that we exercise restraint and exercise our bodies. Gaining a few pounds and stopping your regular gym routine can be a slippery slope.

A recent blog titled, “Americans Are Fat, And Expected to Get Much Fatter” says that if we stay on our current trajectory, “83% of men will be overweight or obese by 2020. Women are right behind them, with 72% projected to be overweight or obese by then.”

Colorectal cancer is influenced by a variety of risk factors including age, family history, history of Inflammatory Bowel Disease (IBD), and last but not least, lack of exercise and excess weight. Obesity is associated with increased risk of polyps and CRC, so every effort needs to be made to ‘watch it.’

No one wants to be the bearer of bad news, just as no one wants to be told they are obese. Yale psychologist and researcher, Rebecca Puhl, recently performed a poll and found that, 'only one-third of doctor's surveyed say they talk to patients about losing weight.' This is interesting news considering how much our body weight impacts the likelihood of contracting heart disease, diabetes, and certain cancers. Maybe it is time for Americans to take responsibility for themselves and push the plate away.

10/10/2011 - 07:24

Avoiding Health Care to Limit Spending?

The gravity of the situation cannot be understated. Americans are facing tough financial times. Every morning we wake to news reports stating that unemployment rates are high and home ownership rates are declining, both of which are very alarming. Across the board we are cutting out what we consider to be extras, and only spending on money on the essentials. Unfortunately, this means that many Americans are neglecting their health and recommended preventative screenings.

Kaiser Family Foundation (KFF) polled Americans and issued a Health Security Update due to worries that average Americans are having problems paying their medical bills; the poll results also indicate that nearly half of the participants have taken some sort of action in the past year –such as skipping recommended tests or treatments- to limit their health spending. Non-compliance with prescriptions and doctor recommendations is costly so these findings should raise red flags all over the place.

Ben Franklin once said, ”an ounce of prevention is worth a pound of cure.” This statement rings true when it comes to colorectal cancer screening because the co-pay for a screening colonoscopy is only a small fraction of the price that a patient would pay for cancer treatment. Never mind the lost time at work and the suffering they would endure from a late-stage diagnosis. Colorectal cancer, the second leading cause of cancer deaths behind lung cancer, is largely preventable and can be beatable if caught early. If a patient thinks that they are making a fiscally sound decision when they avoid CRC screening, they are wrong.

08/25/2011 - 11:33

Exercise Helps Prevent and Beat Cancer

Over the weekend I participated in the LiveStrong Philadelphia Challenge with 5,100 other athletes. Together we raised more than $2.6million with donations from 30,000+ donors. One hundred percent of the money raised at the event will go toward the Lance Armstrong Foundation (LAF) programs aiming to improve the experience of having cancer. I was very proud to wear my PreventingColorectalCancer.Org jersey, and on the back I had printed, “My legs hurt and it’s not the hills. We’re kicking cancer’s butt!”

I am an avid bicyclist and I have always been a fan of Lance Armstrong; and I feel empathy for those fighting cancer,so I am a huge fan of his foundation. A glance at the website shows patient navigation tools, survivorship best practices, worldwide anti-stigma campaigns, clinical trial match-making services, and community forums such as ‘Planet Cancer’ for young adults. In a similar vein, the LAF supports educational efforts to try and prevent cancer and teach people how to live healthful lives; I’m grateful for their efforts because more and more studies continue to prove the assertion that exercise not only reduces your risk of getting cancer but also helps your chance of survival once diagnosed.

In 2000, I remember reading Lance Armstrong’s book, It’s Not About the Bike, in it he said that even in his darkest days he would get on the stationary cycle and spin his legs. He kept telling himself, “If I’m riding I’m alive.” Ever since then there have been legions of followers, the LiveStrong army as they call themselves) who do the same and feel good because they know that they are doing their best to strengthen themselves for a battle against cancer. Now new evidence has been published in England and WebMD Health News that confirms Lance’s theory.

The report, "Move More: Physical activity the underrated 'wonder drug,’ “from Macmillan Cancer Support in the U.K., says ‘that 150 minutes of moderate intensity activity per week, the amount recommended by the U.K.'s four chief medical officers, is the minimum amount required to see the benefits.

Moderate intensity activity includes exercise such as cycling and very brisk walking, but also household tasks such as heavy cleaning and mowing the lawn.

The report presents four key findings:

Breast cancer patients' risk of recurrence and of dying from the disease can be reduced by up to 40% by doing 150 minutes of moderate intensity activity per week.

Bowel cancer patients' risk of recurrence and dying from the disease can be reduced by up to 50% by doing significant amounts of physical activity; this means about six hours of moderate intensity physical activity per week.

Prostate cancer patients' risk of dying from the disease can be reduced by up to 30% by doing the recommended 150 minutes of moderate intensity physical activity.

After treatment, all cancer patients can reduce their risk of side effects from cancer and its treatment, including fatigue, depression, osteoporosis, and heart disease, by doing the recommended levels of physical activity.’

I think the takeaway message from both Lance Armstrong and these studies is the same: Live strong and you’ll live long.

08/16/2011 - 13:51

Confronting Colorectal Cancer at a Young Age

Imagine thinking that one second you have your whole life ahead of you, and then the next finding out you might die at an early age. This is a reality that confronts many of the younger patients newly diagnosed with colorectal cancer (CRC), especially those under 40.

Often times, young adults with this form of cancer are diagnosed in the later stages of the disease since routine colonoscopies are not performed on people under 40 years of age. Even if a younger person is exhibiting all the key symptoms of colorectal cancer, doctors still may not think that the symptoms could be caused by cancer and may neglect to perform this test.

Cancer, although not as prevalent as it is in older age groups, is still a killer in the younger generations. The fact that younger people are diagnosed in the later (and more fatal) stages of the disease needs to be acknowledged and more specialists are a necessity.

Cancer is the fourth leading cause of death in young adults. Although rare, colorectal cancer rates continue increasing in young adults between the ages of 20 and 34. There is a direct correlation between increased survival rates and the speed in recognizing the disease and treating it.

According to a report from the National Cancer Institute, “Even as cancer survival rates continued to improve in adults of middle age and older, the survival rates for people ages 15 to 39 has not risen substantially in more than two decades.”

Doctors often overlook these key symptoms of colorectal cancer in the younger demographics, and neglect to perform a test that would be routine if the patient was of an older age. This is a serious problem that has been overlooked for too long. More research is needed to understand why colorectal cancer rates are on the rise among young adults.

Causes of colorectal cancer in young adults:

· Polyps are the primary source of colorectal cancer. Practically every case of CRC begins as a polyp that gradually grows bigger over time, eventually turning into cancer. Colon polyps are an unusual growth on the mucous membrane or inside lining of the colon.

· Genetics are another factor when it comes to colorectal cancer. Genetic factors have a bigger role in younger cancer patients than in older patients. There are two known hereditary syndromes that cause colorectal cancer:

o Familia Adenomatous (FAP): Usually starts out as pre-cancerous polyps in the colon -- affected people have a 100 percent chance of developing colon cancer.

o Non-Polyposis Colorectal Cancer (HNPCC): This is the gene that gives individuals an 80 percent chance of developing colon cancer.

· Lifestyle can greatly impact a person’s likelihood of developing colorectal cancer. Too much of a bad thing, or too little of the good things, can contribute to CRC. For example, eating too much red meat or too few vegetables can lead to a colorectal cancer diagnosis. Keeping a healthy and well balanced diet is important in prevention. Factors such as smoking, excessive consumption of alcohol, lack of exercise, and obesity have also been thought to contribute to CRC.

Colorectal cancer is frightening news for anyone, especially someone embarking on life’s journey. People diagnosed with the disease can find support by connecting with others who are also dealing with the disease as well as reaching out to friends and family.

The more information that is available and publicized about colorectal cancer, the more awareness levels will be raised. Anyone can be diagnosed with colorectal cancer and everyone should be made aware of it. Publicizing the need for early detection will -- hopefully -- reduce misdiagnosis and fatalities from this form of cancer.

Stephanie Carneal, a senior at Indian Creek Upper School in Crownsville, MD, is a Schooner Healthcare Services intern.

05/11/2011 - 13:36

Frustration

Despite reading every day about the high (and rising) cost of health care I find myself frustrated and perplexed that the things I attempt to do to bring costs down and take care of my patients in a cost effective manner are often either blocked, ignored, prolonged or impossible to initiate. I will give you but four simple examples. I run a very large Gastroenterology group with multiple outpatient centers. We recently built an eighth center in Northwest Atlanta, adjacent to one of the largest hospitals in the state. Despite AAAHC and Medicare Certification we have been open 15 months and are still awaiting a contract from one of the two largest insurers in the state. The contract is EXACTLY the same as we have at our other seven sites and we have had those open for up to fifteen years. Endless paper work, months till we can get a reply to requests, errors in the contract and no sense of urgency results in our doctors doing cases every day in the hospital facility which charges patients from 300 to 1000 percent more than our facility!! In the past year this has probably cost that provider millions of dollars….but not to worry…they raised their premiums an average of 15% so they report record earnings.

Another example is infusion of a drug called Infliximab which we have continued to do in our offices for patients with Inflammatory Bowel Disease. Because of razor thin margins using this expensive drug, many of my colleagues have started sending these patients to the hospitals for treatment, which averages about every 8 weeks. How do the insurers respond…naturally they cut my fees. So now we can send the patients to the hospitals that receive between $12,000-18,000 per infusion in Atlanta and up to $30,000 plus per treatment in other parts of the country. In office payment is usually less than $3500. Same drug, same dose, same patient, four to tenfold difference. Cost to Blue Cross if we stop infusing: over 10 million a year. But not to worry they raised our insurance rates 18%.

If you are not exacerbated yet, my favorite waste of time, resources and money is ‘double’ procedures. Medicare has long taken a posture of only paying half for a second procedure done the same day. Therefore most commercial insurers follow that policy. What do doctors do…we do the cases on two separate days. Twice the time off work, two facility and anesthetic fees, loss of productivity. I have tried to explain to Congressmen, Medical Directors, insurance company executives, how much money could be saved by paying fairly for both procedures even if done the same day. Deaf ears.

Finally the most irrational part of health care is that if you go to the hospital, Emergency Room or even some doctor’s office and you have no insurance or a high deductible (catastrophic policy) you pay the highest price. If you go to buy a car, furniture, a personal service (such as construction) and can pay cash do you get the worst price? No…only in health care do you get the most perverse result. Cash is not king, it is a ticket to get ‘ripped’ off.

So I read about how much health care costs but I see tens, if not hundreds of millions of dollars, thrown away every year on things that make no sense and are easily changed. However record earnings, double digit insurance rate raises (30 percent or more in California), multi-million dollar salaries for insurance executives and hospital administrators, doctors who don’t worry about costs, all coalesce to suppress any real desire for change. So I remain perplexed…and frustrated as we travel down the road to ???

03/30/2011 - 12:59

The Importance of a Quality Screening

To recognize March as Colorectal Cancer Awareness Month, events held across the U.S. this past month have drawn attention to the importance of being screened, but also to the value of high-quality screening. During my participation in the Prevent Cancer Foundation’s Dialog for Action® conference, I learned that not all screenings are created equally.

For those undergoing the gold standard colonoscopy screenings, there are several important patient responsibilities. First and foremost, it is vital to adhere carefully to prep directions. Having quality bowel prep is essential to the effectiveness of screening and poor bowel prep is a major impediment to the effectiveness of colonoscopy. Inadequate bowel prep can lead to a need for premature termination of the examination prior to full cecal intubation.

Cecal intubation is defined as passage of the colonoscope tip to a point proximal to the ileocecal valve so that the entire cecal caput, including the medial wall of the cecum between the ileocecal valve and appendiceal orifice, is visible (ASGE definition). The need for cecal intubation is based on the persistent finding that a substantial fraction of colorectal neoplasms are located in the proximal colon, including the cecum. Visualization of this area is paramount to the prevention of colon cancer, so it’s commonly accepted that doctors should strive for 90% or higher cecal intubation.

The National Colorectal Cancer Roundtable is working on an initiative to create an accreditation program that would take into consideration quality measures such as cecal intubation, adenoma detection rate and withdrawal time. The accreditation would serve as a report card that provides clarification to patients and referring physicians as to which doctors and facilities are truly providing quality colonoscopies.

Another consideration while planning for a colonoscopy is to ask your doctor the type of sedation he or she offers and who will be administering the drug. Recent studies indicate there are many merits to receiving propofol administered by an anesthesiologist or a certified registered nurse anesthetist. There is less clinical multi-tasking and more of the gastroenterologist’s attention being paid to the colonoscopy.

Make sure you make the most of the screening by receiving quality care, adhering to prep instructions and ask to be sedated with propofol so you improve your polyp detection rate and bounce back quickly.

02/18/2011 - 08:53

Do what you can to raise awareness of CRC

I’ve been working for Preventing Colorectal Cancer.Org for nearly three years. You might think that my skin would be tougher by now but that’s not the case. Over the years I have met patients and survivors that share their stories and make me cry. Some of them haven’t survived and that makes me cry more. Once I noticed on Facebook that someone I met last year at an advocacy event is no longer online; I googled for her name and found an obituary. It’s just not fair. I don’t have this disease and no one in my family has been affected but I can tell you that I hate colorectal cancer.

There’s no need for colorectal cancer to be the third most commonly diagnosed cancer and second leading cause of cancer deaths. It is one of the most preventable types of cancer. People need to know the screening guidelines, act quickly when they notice a change of bowel habit, and get screened regularly once they have turned 50. If you don’t give the polyps a chance to turn into cancer, you don’t get cancer. There are –of course- the infrequent diagnoses of youngsters with no family history of CRC that baffle doctors and family, but the majority of cases could be caught with early preventative screenings.

Once you have been touched by this disease you want to scream from the top of your lungs: ‘Everyone, go get a colonoscopy!’ But, that’s unreasonable and I doubt that if I gave it a try people will listen to the crazy redhead screaming in the streets. Here is what I’m going to do instead: Raise awareness. I’ve started by updating our website with new events in the ‘Get Involved’ section of the site. I plan on taking part in grassroots advocacy activities on Capitol Hill in March. I’ve also registered for a LiveStrong event in Philadelphia August 20-21. If anyone wants to join me for a century ride (100 miles of lovely rolling countryside) I started a team called ‘Sail On’. You’re welcome to join by visiting http://www.livestrong.org/Take-Action/Team-LIVESTRONG-Events and register to be on my team. I think I’ll wear a blue jersey with a catchy ‘care for your colon’ sort of message. Or maybe I’ll wear the screening guidelines emblazoned on my back. Who knows? I’m open to suggestions!

If you can’t make it to Philadelphia in August, please do your best in any way you can to help spread the message that a cancer prevented is better than a cancer cured.

11/16/2010 - 09:19

Why do we need more CRC legislation?

November 16, 2010

The future looks bright for The Colorectal Cancer Prevention, Early Detection and Treatment Act sponsored by Representative Granger(R-TX). The bill did not pass during the 109^th or 110^th Congress; however it did get dozens of co-sponsors. During the past year, the bill was overshadowed by healthcare reform and elections so we now look forward to the 112^th Congress and the trend towards tightening the federal purse-strings to push the bill (which will get a new number assigned in January). It’s fair to say that the chances of getting the Bill introduced, sent to committee and passed are pretty good because it truly is both a life-saver and money-saver.

Why do Americans need this bill if the Patient Protection and Affordable Care Act (PPACA) creates easy access to screening? Despite all the increased screening offered by healthcare reform a safety net is necessary for populations such as those not yet 50, or with a higher risk due to ethnicity and family history. Low-income adults at high-risk, uninsured individuals and people with ‘grandfathered’ insurance coverage may not have CRC screening coverage either. Currently over 7 million people between the ages of 50-64 would qualify for the cancer screening program established by the Colorectal Cancer Prevention, Early Detection and Treatment Act.

When you estimate the cost of screening 7 million people you may think that it’s a hugely expensive program; however, when you take into consideration the cost savings associated with early diagnosis versus late diagnosis you see how this bill could pique the interest of even the most fiscally conservative politician. A study by the Lewin Group says the cost savings has been estimated to be in the billions of dollars. It’s a very easy concept: prevention and early diagnosis is low cost; treating advanced stages of cancer is expensive. As the new Congress convenes, PCC.Org will keep you posted regarding the bill numbers and how anyone can voice their support to legislators.

09/24/2010 - 11:27

Today is a milestone... sort of

The Patient Protection and Affordable Care Act (PPACA), often referred to as ‘health reform’, is a step in the right direction. Today is the first day that all new health insurance policies are required to cover preventative services, including colorectal cancer screening, without imposing cost-sharing requirements on patients. However, the same issue of preventative vs. therapeutic still exists because if, during a colonoscopy, a pre-cancerous polyp is found and removed the procedure is often no longer deemed to be preventative and becomes a therapeutic surgical procedure so the patient would be responsible for cost-sharing. The PPACA allows health plans and insurers the freedom to impose cost-sharing requirements -such as meeting a deductible or copayments- if, during a colonoscopy, a precancerous polyp is found and removed.

A press release(http://www.beckersasc.com/gastroenterology-and-endoscopy/asge-and-colorectal-cancer-coalition-praise-affordable-care-act-provision-for-colorectal-screening-coverage.html?sms_ss=email )in Becker’s ASC Review raises two good points. First of all, the PPACA only addresses ‘new’ health insurance policies. How about people like me that already have health insurance plans? As the press release states, ‘… (we) hope that existing plans will also adopt this new cost-sharing policy to maintain equity in care.’

My second concern is that many people might not realize that having coverage for screening does not also mean coverage for a polypectomy. If you undergo a screening colonoscopy and expect it to be free of charge, you will be sorely disappointed to find out that your bill may be several hundred dollars because your gastroenterologistfound and removed a polyp. It absolutely doesn’t make sense to penalize a responsible citizen who is taking action to prevent a costly illness, and yet this is the fact of the matter. The risk of incurring a large cost is a deterrent to patients who wish to have a colonoscopy, the gold standard in CRC screening.

In sum, the PPACA is presumably going to lead to more screenings but it’s also going to lead to many dis-satisfied patients in gastroenterologist offices all over the country unless health plans decide to eliminate the cost-sharing associated with polypectomies.

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