Author Interviews, Cancer Research, CDC, Colon Cancer, Race/Ethnic Diversity / 06.12.2017

MedicalResearch.com Interview with: Dr. Arica White PhD MPH Division of Cancer Prevention and Control CDC MedicalResearch.com: What is the likelihood of reaching the 80% CRC screening rate goal by next year? Response: As of 2016, 67% of adults age 50-75 years reported being up-to-date with colorectal cancer screening. The 80% by 2018 initiative represented an aspirational goal that public health, non-profit, and community-based organizations will continue to strive for regardless of the outcome in 2018. (more…)
AACR, Alzheimer's - Dementia, Author Interviews, Cancer Research, Cognitive Issues, Colon Cancer, UCSF / 24.10.2017

MedicalResearch.com Interview with: Yingjia Chen, M.Sc, MPH, Ph.D. Postdoctoral Fellow University of California, San Francisco  MedicalResearch.com: What is the background for this study? Response: Both colon cancer and dementia are prevalent among the elderly and have a high risk of co-occurrence. Previous studies found that patients with dementia were treated less aggressively. In this study, we hypothesized that presence of pre-existing dementia was associated with worse survival for stage III colon cancer patients, and that post-operative chemotherapy was on the causal pathway. (more…)
Author Interviews, Cancer Research, Colon Cancer, Race/Ethnic Diversity / 08.08.2017

MedicalResearch.com Interview with: Rebecca Siegel, MPH Strategic Director, Surveillance Information Services American Cancer Society, Inc. 250 Williams St. Atlanta, GA 30303 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Colorectal cancer (CRC) incidence rates have been increasing in people under 55 since at least the mid-1990s, despite rapid declines in older age groups. We analyzed mortality data covering over 99% of the US population and found that death rates for CRC in adults under 55 have been increasing over the past decade of data (2004-2014) by 1% per year, in contrast to rapid declines in previous years. This indicates that the increase in incidence is not solely increased detection due to more colonoscopy use, but a true increase in disease occurrence that is of sufficient magnitude to outweigh improvements in survival because of better treatment for colorectal cancer. The second major finding was that the rise in death rates was confined to whites, among whom death rates rose by 1.4% per year, for an overall increase of 14%. In blacks, the colorectal cancer death rate declined slowly during the entire study period (1970-2014). This racial disparity is consistent with incidence, but in contrast to trends for major risk factors for CRC, like obesity, which has increased across all racial and ethnic groups. This means that the obesity epidemic is probably not wholly responsible for the increase in disease. Third major finding was that CRC death rates are increasing in people in their early 50s, for whom screening has been recommended for decades. This was particularly surprising since CRC screening has a two-fold impact on death rates by both preventing cancer and detecting it early when treatment is more effective. Rising death rates in this age group likely reflects lower screening rates in ages 50-54 than 55+ -- 46% vs 67% in 2015, probably because of delayed initiation of screening. (more…)
Author Interviews, Colon Cancer / 13.07.2017

MedicalResearch.com Interview with: Dr.Yi Xu PhD Center for Infectious and Inflammatory Diseases Institute of Biosciences and Technology Department of Microbiology and Microbial Genetics, University of Texas Health Science Center Texas A&M Health Science Center College Station, Texas MedicalResearch.com: What is the background for this study? Response: Colorectal cancer is fairly treatable when caught early with regular screenings, but it is still the second-leading cause of cancer-related deaths in American men and the third-leading cause in women. Researchers at Texas A&M have found that a subspecies of the bacterium Streptococcus gallolyticus appears to actively promote the development of colorectal cancer, which could lead to potential treatment strategies. Their findings are published in the journal PLOS Pathogens. Scientists have known for some time that people infected with S. gallolyticus are more likely to have colorectal cancer. “This association was well established in the clinical literature,” said Yi Xu, PhD, associate professor at the Texas A&M Institute of Biosciences and Technology and principal investigator of the study. However, it was unclear if that relationship was cause or effect—that the bacteria promote cancer development—or if S. gallolyticus simply grows easily in the environment that the tumor cells provide.  (more…)
Author Interviews, Biomarkers, Colon Cancer, JAMA / 19.06.2017

MedicalResearch.com Interview with: Anastasia Katsoula, MD MSc Aristotle University of Thessaloniki Greece  MedicalResearch.com: What is the background for this study? Response: Early detection of colorectal cancer (CRC) has proven to be effective in reduction of cancer-related mortality. Fecal immunochemical testing (FIT) has been recently advocated for population-based screening for CRC in average-risk individuals due to its high accuracy and potential for adherence, based on results from previous systematic reviews and meta-analyses in average-risk populations. However, the potential role of FIT for screening of subjects at increased risk for CRC has not yet been elucidated, hence colonoscopy is currently the only recommended screening option for subjects at increased risk of CRC. We performed a systematic review and meta-analysis to explore the diagnostic accuracy of FIT for CRC or advanced neoplasia (AN) in patientswith personal or familial history of CRC, using colonoscopy as the reference standard. (more…)
ASCO, Author Interviews, Colon Cancer, Exercise - Fitness, Nutrition, UCSF / 06.06.2017

MedicalResearch.com Interview with: Dr. Erin Van Blarigan, ScD Assistant Professor, Department of Epidemiology and Biostatistics UC San Francisco MedicalResearch.com: What is the background for this study? Response: There are over 1.3 million colorectal cancer survivors in the United States. Cancer survivors often seek guidance on what they can do to lower their risk of cancer recurrence and death. In response to patient interest and the need for improved survivorship care, the American Cancer Society (ACS) published guidelines on nutrition and physical activity for cancer survivors. The guidelines are to: 1) achieve and maintain a healthy body weight; 2) engage in regular physical activity; and 3) achieve a dietary pattern that is high in vegetables, fruits, and whole grains. (more…)
Annals Internal Medicine, Author Interviews, Cancer Research, Colon Cancer, Race/Ethnic Diversity / 24.05.2017

MedicalResearch.com Interview with: Stacey Fedewa PhD Strategic Director, Risk Factors & Screening Surveillance American Cancer Society, Inc. Atlanta, GA 30303 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Screening for colorectal cancer is effective in reducing incidence and mortality by detecting precancerous lesions or cancer at more curable stages. But colorectal cancers can still develop in screened populations, some are missed at the time of screening; others can develop between recommended screenings. Patterns of risk for interval colorectal cancer, defined as cancers that develop after a negative result on colonoscopy, by race/ethnicity are not well known. The risk for blacks was of interest to us because colorectal incidence and mortality rates in blacks are the highest among any race or ethnicity in the United States. We were also interested to see if quality of colonoscopy, measured by physician’s polyp detection rate, could account for differences. (more…)
Author Interviews, Colon Cancer / 08.03.2017

MedicalResearch.com Interview with: Rebecca L. Siegel, MPH Surveillance and Health Services Research American Cancer Society Atlanta, GA  MedicalResearch.com: What are the main findings? Response: It was known that colorectal cancer incidence rates are declining rapidly in people 50 years and older, but curiously increasing in people younger than 50 years. For a more comprehensive understanding of incidence patterns, we examined CRC incidence trends by 5-year age group and year of birth using age-period cohort analysis. This modeling technique helps enhance the understanding of disease trends by disentangling factors that influence all ages (period effects) from those that vary by generation (birth cohort effects). In incidence data for almost 500,000  colorectal cancer patients during 1974-2013, we found both period and cohort effects. However, the period effects were dwarfed by the cohort effects. The age-specific risk of colorectal cancer declined during the first half of the 20thcentury, but has increased for subsequent generations since around 1950, such that those born in 1990 have twice the risk of colon cancer and 4 times the risk of rectal cancer compared to people born in 1950. Said another way, someone in their 20s today is 4 times more likely to be diagnosed with rectal cancer than someone who was in their 20s in 1970. The risk for contemporary generations has escalated back to that of people born circa 1890. (more…)
ASCO, Author Interviews, Cancer Research, Colon Cancer, Genetic Research, Journal Clinical Oncology / 01.02.2017

MedicalResearch.com Interview with: Matthew B Yurgelun, M.D Instructor in Medicine, Harvard Medical School Dana-Farber Cancer Institute MedicalResearch.com: What is the background for this study? What are the main findings? Response: It has long been known that hereditary factors play a key role in colorectal cancer risk. It is currently well-established that approximately 3% of all colorectal cancers arise in the setting of Lynch syndrome, a relatively common inherited syndrome that markedly increases one’s lifetime risk of colorectal cancer, as well as cancers of the uterus, ovaries, stomach, small intestine, urinary tract, pancreas, and other malignancies. Current standard-of-care in the field is to test all colorectal cancer specimens for mismatch repair deficiency, which is a very reliable means of screening for Lynch syndrome. The prevalence of other hereditary syndromes among patients with colorectal cancer has not been known, though other such factors have been presumed to be quite rare. (more…)
Author Interviews, Cancer Research, Colon Cancer / 27.01.2017

MedicalResearch.com Interview with: Dr. Mark Prince MD USMD Health System Arlington, TX 76017 MedicalResearch.com: What is the background for this study? Response: This 12-month retrospective study conducted to determine the screening compliance rates for a noninvasive multitarget stool DNA (mt-sDNA) screening test (Cologuard) for colon cancer among a cohort of nearly 400 average-risk Medicare patients who had previously not complied with recommended screening. These were patients who had never had a colonoscopy, had been more than ten years since last colonoscopy, or had been more than one year since last stool testing for occult blood. (more…)
Author Interviews, Cancer Research, Colon Cancer, JAMA, Surgical Research / 25.01.2017

MedicalResearch.com Interview with: Kangmin Zhu, PhD, MD John P. Murtha Cancer Center, Walter Reed National Military Medical Center Professor at the Uniformed Services University of the Health Sciences in the Department of Preventive Medicine and Biostatistics Bethesda, Maryland MedicalResearch.com: What is the background for this study? Response: An article published on JAMA Surgery in 2015 showed more utilization of chemotherapy among young colon cancer patients.  To demonstrate the study findings, we analyzed the data from the Department of Defense healthcare system, in which all members have the same level of access to medical care and therefore the potential effects of insurance status and types on research results can be reduced. MedicalResearch.com: What are the main findings? Response: The main findings were that young and middle-aged colon cancer patients were 2 to 8 times more likely to receive postoperative chemotherapy and 2.5 times more likely to receive multiagent regimens, compared with their counterparts aged 65 to 75 years.  However, no matched survival benefits were observed for the young and middle-aged among patients who received surgery and postoperative chemotherapy. (more…)
Author Interviews, Cancer Research, Colon Cancer, Genetic Research / 17.12.2016

MedicalResearch.com Interview with: Heather Hampel, MS, LGC Associate Director, Division of Human Genetics Associate Director, Biospecimen Research Professor, Internal Medicine Licensed Genetic Counselor The Ohio State University Comprehensive Cancer Center Columbus, OH 43221 MedicalResearch.com: What is the background for this study? What are the main findings? Response: This study was part of the Ohio Colorectal Cancer Prevention Initiative, a statewide study being conducted at 50 hospitals that includes universal tumor screening for Lynch syndrome. For the subset of 450 colorectal cancer patients diagnosed under age 50, we performed multi-gene cancer panel testing regardless of the results of their tumor screening for Lynch syndrome since early age of diagnosis is a red flag that a cancer might be hereditary. (more…)
Author Interviews, Colon Cancer, JAMA / 03.12.2016

MedicalResearch.com Interview with: David Lieberman MD Professor of Medicine Chief, Division of Gastroenterology and Hepatology Oregon Health and Science University Portland, OR 97239 MedicalResearch.com: What is the background for this study? What are the main findings? Response: New guidelines for colorectal cancer (CRC) screening from the USPSTF were published in June 2016. They recommended any of 8 different screening programs. The purpose of this review was to highlight elements not included in the USPSTF report: 1. Elements of informed decision making associated with each program 2. Quality metrics for each program 3. Recommendations for higher than average risk individuals (more…)
Author Interviews, Colon Cancer, Gout, NYU, Rheumatology / 20.11.2016

MedicalResearch.com Interview with: Michael Pillinger, MD Professor of Medicine and Biochemistry and Molecular Pharmacology NYU School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: We are interested in the co-morbidities of gout and the fact that gout is accompanied by multiple cardiovascular, renal and other events. The implications of gout for cancer are less clear, but the basic biology suggests that either: 1) the acute and chronic inflammation of gout could contribute to a pro-cancer environment; 2) the anti-oxidant effects of urate could have anti-cancer properties; 3) the ability of uric acid to serve as a "danger signal" released from dying cells (potentially including cancer cells" could promote anti-cancer immunity. The clinical literature is murky at best. (more…)
Author Interviews, Colon Cancer, JAMA / 30.10.2016

MedicalResearch.com Interview with: Fausto Petrelli, MD Oncology Unit, Oncology Department Treviglio ,Italy MedicalResearch.com: What is the background for this study? What are the main findings? Response: This meta-analysis evaluated if side (excluding rectum site) represents an independent prognostic factor for survival in patients with stages 1-4 colon cancer. This variable is in fact associated with an adverse outcome with a reduced risk of death by 20% if patients are affected by a left colon cancer compared to those with right colon cancers. Implications are enormous: for prognosis first but also for follow-up, stratification into clinical trials and treatment (for both medical and surgical therapies). The power of the study is relevant: it enclosed 66 studies with more than 1 million of patients retrospectively or prospectively analyzed for survival according to common variables known to be prognostic in colorectal cancer (age, sex, stage, race, adjuvant CT..etc) in multivariate analysis. Side is significantly associated with survival independent of other covariates analyzed. The question of the side is old and partially known, but no study systematically explored the published literature to confirm this suggestion. Recent large randomized trials in metastatic disease showed different results according to the site of disease with right colon cancers usually less responsive to anti-EGFR treatment due to a different molecular behavior and conversely left colon cancers which attained the greater benefit from cetuximab and panitumumab due to less BRAF mutations in their tissue. Also, a less extensive and radical lymphadenectomy in right-sided cancers, without a complete mesocolon excision during surgery, could hamper their cure rate, as our colorectal surgeon's team lead by Prof. Giovanni Sgroi and Luca Turati MD, suggested in the discussion. It is also well known the leads term bias with a later diagnosis of right cancers due to clinical and anatomic reasons. (more…)
Annals Internal Medicine, Author Interviews, Brigham & Women's - Harvard, Colon Cancer, Geriatrics / 27.09.2016

MedicalResearch.com Interview with: Xabier Garcia-De-Albeniz MD PhD Research Associate Department of Epidemiology Harvard T.H. Chan School of Public Health Mongan Institute for Health Policy Massachusetts General Hospital MedicalResearch.com: What is the background for this study? Response: Randomized controlled trials are considered the gold standard to inform health care delivery. Unfortunately, no randomized controlled trials of screening colonoscopy have been completed. Ongoing trials exclude persons aged 75 or older, and will not have mature results before 2025. However, healthy persons older than 75 may live long enough to benefit from colorectal cancer (CRC) screening. The Medicare program reimburses screening colonoscopy without an upper age limit since the year 2001. We used the extensive experience of Medicare beneficiaries to evaluate the effectiveness and safety of screening colonoscopy. (more…)
Author Interviews, Biomarkers, Colon Cancer, Science / 11.07.2016

MedicalResearch.com Interview with: Jeanne Tie MBChB, FRACP, MD Division of Systems Biology and Personalised Medicine, Walter and Eliza Hall Institute of Medical Research Department of Medical Oncology, Western Health, St Albans, Victoria, Australia. Department of Medical Oncology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne Parkville, Victoria, Australia MedicalResearch.com: What is the background for this study? What are the main findings? Response: This study investigated the ability of circulating tumor DNA (ctDNA) in detecting residual microscopic cancer after surgery with curative intent in patients with stage II colon cancer. Although the majority of patients with stage II colon cancer are cured by surgery alone, our ability to accurately predict the risk of cancer relapse based on current clinical and pathological criteria is imprecise. Population-based study indicated that adjuvant chemotherapy is given to up to 40% of stage II colon cancer patients, meaning that we are over-treating a significant number of patients with cytotoxic therapy. A better indicator of residual disease and recurrence would be very useful clinically. The current study collected tumor and blood samples from 230 patients with stage II colorectal cancer. A personalised assay was then designed to detect patient-specific tumor DNA in the plasma samples collected four to ten weeks after surgery. The presence of ctDNA (positive test) in the post-operative blood sample predicted recurrence in 100% of patients, while the relapse rate is only 10% in those with negative ctDNA test. We have also shown that the ctDNA test is a better predictor of recurrence than the standard clinic-pathological criteria. (more…)
Author Interviews, Colon Cancer, Cost of Health Care, Gastrointestinal Disease, Vanderbilt / 06.07.2016

MedicalResearch.com Interview with: Erica R. H. Sutton, MD Assistant Professor Department of Surgery, General Vanderbilt MedicalResearch.com: What is the background for this study? What are the main findings? Response: Colorectal cancer is one of the most preventable diseases that we face; however, despite the great strides that we have made in the realm of early detection, many people still do not undergo screenings. We sought to increase the availability of screenings to those in our community who are at high risk for colorectal cancer and uninsured by providing free colonoscopies to them and to examine the cost-effectiveness of this intervention. Over a 12-month period, 682 uninsured people underwent screening colonoscopies, and 9 cancers were detected. Compared to the Surveillance, Epidemiology, and End Results (SEER) registry, our patient population included more early-stage cancers, and our program was found to be cost-neutral. (more…)
Author Interviews, Colon Cancer, Geriatrics, Kaiser Permanente, NIH / 27.06.2016

MedicalResearch.com Interview with: Carrie N. Klabunde, PhD Office of Disease Prevention Office of the Director NIH Rockville MD MedicalResearch.com: What is the background for this study? What are the main findings? Response: Many studies of colorectal cancer screening focus on adults 50-75 years of age; few specifically look at screening in the elderly. We wanted to examine colorectal cancer screening use, including follow-up diagnostic testing for those with abnormal fecal blood screening tests, in adults 65 years of age and older. We also wanted to assess whether screening use in this population is influenced more by elderly individual’s chronological age, or their health status (called comorbidity in our study). The study was conducted in three large, integrated healthcare systems: Kaiser Permanente in Northern California and Southern California, and Group Health in Washington state and Idaho. We examined data on nearly 850,000 patients aged 65-89. (more…)
Author Interviews, Colon Cancer, JAMA / 16.06.2016

MedicalResearch.com Interview with: Jennifer S. Lin, MD, MCR, FACP Director, Kaiser Permanente Research Affiliates Evidence-based Practice Center Investigator, The Center for Health Research, Kaiser Permanente Northwest Portland, OR 97227 MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Lin: Our systematic review was commissioned by the USPSTF, in tandem with a separate modeling exercise, to help update their 2008 colorectal cancer screening recommendations. Since the previous recommendation, there has been a wealth of new evidence, including more evidence on the long-term effectiveness of flexible sigmoidoscopy for reducing colorectal cancer mortality, the screening accuracy and decreasing radiation exposure from CT colonography, and the screening accuracy for a number FDA-approved stool tests using fecal immunochemical testing (FIT). While we have large, well-designed RCTs demonstrating that screening for colorectal cancer using flexible sigmoidoscopy and older generation stool testing reduces colorectal cancer mortality, these screening tests are no longer widely used in the United States. Well-designed diagnostic accuracy studies of screening colonoscopy, CT colonography, and various stool based tests using FIT demonstrate adequate sensitivity and specificity to detect adenomas and/or colorectal cancer, making each of them viable screening options. However, each screening option has potential harms associated with their use, particularly those allowing for direct visualization of the colon. Colonoscopy harms include perforations and major bleeding events. CT colonography requires exposure to radiation; and CT colonography not uncommonly results in detection of extra-colonic findings which necessitate additional diagnostic follow-up which may result in a benefit or harm. (more…)
Author Interviews, Cancer Research, Colon Cancer, Genetic Research / 14.05.2016

MedicalResearch.com Interview with: Dr. Geoffrey Liu, MD MSC Princess Margaret Hospital/Ontario Cancer Institute University of Toronto Toronto, Ontario Canada MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Liu: Cetuximab is a monoclonal antibody therapy used in metastatic colorectal cancer patients when other chemotherapy options have been exhausted. Currently, the only useful biomarker to determine whether metastatic colorectal cancer patients will benefit from the drug, cetuximab, is whether patients carry a RAS mutation in their tumours. We evaluated additional biomarkers using samples from a Phase III clinical trial led by the Canadian Cancer Trials Group and the Australasian Gastrointestinal Trials Group. Our study identified a germline, heritable biomarker, a FCGR2A polymorphism, that further identifies an additional subgroup of patients who would benefit most from receiving cetuximab. This is important because the drug does have toxicity and is expensive to use; patients who are found not to likely benefit from this drug can go on quickly to try other agents, including participation in clinical trials. (more…)
Annals Internal Medicine, Author Interviews, Biomarkers, Colon Cancer, Kaiser Permanente / 27.01.2016

MedicalResearch.com Interview with: Douglas A. Corley, MD, PhD Gastroenterologist and Research Scientist III Division of Research Kaiser Permanente Oakland, CA  Medical Research: What is the background for this study? What are the main findings? Dr. Corley: Colorectal cancer is a leading cause of cancer death in the United States, so understanding how cancer screening tests for this cancer are used and if they are effective is extremely important. There are two commonly used tests for colorectal cancer screening in the United States: colonoscopy and fecal immunochemical tests (also known as "FIT"). Colonoscopy requires a bowel preparation to clean you out and is invasive but, if normal, it is done infrequently (every ten years). FIT is simple to do at home but, to be most effective, needs to be done every year. This has the advantage of potentially picking up cancers that grow between tests. There are few studies that have looked at how well FIT picks up cancers when used year after year. If a test picks up most cancers, it is said to be very "sensitive" for picking up cancer. Most studies only looked at 1 or 2 years of use for how well FITdetected cancers. It is possible that the first year of use may "clear out" most of the easily detectable cancers and that FIT might not work as well in subsequent years. This very large study over several years at Kaisier Permanente, where we use both colonoscopy and FIT for colorectal cancer screening, looked at whether FIT worked as well at detecting cancer in years 3 and 4 as it did the first time someone used it. We found that the sensitivity was highest in the first year, likely from clearing out cancers that were there for a while and easily detected, but that in subsequent years the sensitivity, though 5-10% lower, remained high. Also, most people who started with FIT continued doing it, suggesting that it is both feasible and effective for colorectal cancer screening. (more…)
Author Interviews, Brigham & Women's - Harvard, Colon Cancer, Dermatology, Nature, Testosterone / 14.01.2016

More on Colon Cancer on MedicalResearch.com MedicalResearch.com Interview with: Dr. Nana Keum, PhD Department of Nutrition Harvard T.H. Chan School of Public Health Boston, MA Medical Research: What is the background for this study? What are the main findings? Dr. Keum: Male pattern baldness, the most common type of hair loss in men, is positively associated with androgens as well as IGF-1 and insulin, all of which are implicated in pathogenesis of colorectal neoplasia.  Therefore, it is biologically plausible that male pattern baldness, as a marker of underlying aberration in the regulation of the aforementioned hormones, may be associated with colorectal neoplasia.  In our study that examined the relationship between five male hair pattern at age 45 years (no-baldness, frontal-only-baldness, frontal-plus-mild-vertex-baldness, frontal-plus-moderate-vertex-baldness, and frontal-plus-severe-vertex-baldness) and the risk of colorectal adenoma and cancer, we found that frontal-only-baldness and frontal-plus-mild-vertex-baldness were associated with approximately 30% increased risk of colon cancer relative to no-baldness.  Frontal-only-baldness was also positively associated with colorectal adenoma. (more…)
Author Interviews, BMJ, Colon Cancer, Gastrointestinal Disease / 13.12.2015

MedicalResearch.com Interview with: Dr Franco Radaelli Division of Digestive Endoscopy and Gastroenterology Valduce Hospital Como, Italy  Medical Research: What is the background for this study? Dr. Radaelli: Split regimens of bowel preparation are strongly recommended by European and American Guidelines as they have been associated with a higher level of colon cleansing. However, there is still uncertainty on whether the higher level of cleansing associated with a split regimen also results in a higher proportion of subjects with at least one adenoma (adenoma detection rate, ADR), that represents by far a more relevant quality indicator than the level of cleansing itself. On this background, we designed a randomized investigator-blinded controlled trial to evaluate whether a “split regimen” of low-volume 2-L PEG-ascorbate solution was superior to the traditional “full dose, the day before regimen” in terms of ADR. Differently from other studies on bowel preparation, we considered adenoma detection rate  instead of the level of colon cleansing, the primary study end-point, and we designed the sample size accordingly. A precise estimation of the sample size was facilitated by including an homogeneous population of asymptomatic subjects undergoing first colonoscopy after positive-FIT within CRC organized screening program. Besides, ADR represents a very solid end-point due to the very low inter-pathology variability in the differential diagnosis between neoplastic and non-neoplastic lesions, while the assessment of the level of cleansing is hampered by unavoidable degree of subjectivity and higher degree of inter-operator variability. (more…)
Author Interviews, Colon Cancer, Cost of Health Care, Health Care Systems, Outcomes & Safety, Surgical Research / 06.12.2015

MedicalResearch.com Interview with: Johannes Govaert MD Department of Surgery Leiden University Medical Center Leiden, The Netherlands Medical Research: What is the background for this study? Dr. Govaert: The Value Based Health Care agenda ofPprof. Porter (Harvard Business School) suggests that focus in healthcare should shift from reducing costs to improving quality: where quality of healthcare improves, cost reduction will follow. One of the cornerstones of potential cost reduction, as mentioned by Porter, could be availability of key clinical data on processes and outcomes of care. Despite the important societal and economical role the healthcare system fulfils, it still lags behind when it comes to standardised reporting processes. With the introduction of the Dutch Surgical Colorectal Audit (DSCA) in 2009, robust quality information became available enabling monitoring, evaluation and improvement of surgical colorectal cancer care in the Netherlands. Since the introduction of the DSCA postoperative morbidity and mortality declined. Primary aim of this study was to investigate whether improving quality of surgical colorectal cancer care, by using a national quality improvement initiative, leads to a reduction of hospital costs. Detailed clinical data was obtained from the 2010-2012 population-based Dutch Surgical Colorectal Audit. Costs at patient-level were measured uniformly in all 29 participating hospitals and based on Time-Driven Activity-Based Costing. Medical Research: What are the main findings? Dr. Govaert: Over three consecutive years (2010-2012) severe complications and mortality after colorectal cancer surgery respectively declined with 20% and 29%. Simultaneously, costs during primary admission decreased with 9% without increase in costs within the first 90 days after discharge. Moreover, an inverse relationship (at hospital level) between severe complication rate and hospital costs was identified among the 29 participating hospitals. Hospitals with increasing severe complication rates (between 2010 and 2012) were associated with increasing costs whereas hospitals with declining severe complication rates were associated with cost reduction. (more…)
AACR, Author Interviews, CDC, Colon Cancer, Race/Ethnic Diversity / 18.11.2015

MedicalResearch.com Interview with: Hannah K. Weir, PhD, MSc Senior Epidemiologist CDC Medical Research: What is the background for this study? What are the main findings? Dr. Weir: Colorectal cancer (CRC) is one of the leading causes of cancer related deaths in the United States. We know that the risk of dying from colorectal cancer  is not the same across all communities – people living in poorer communities have a higher risk of dying from colorectal cancer than people living in wealthier, better educated communities. In this study, we estimated the number of potentially avoidable CRC deaths between 2008 and 2012 in poorer communities.  Then we estimated the value of lost productivity that resulted from these deaths. Lost productivity includes the value of future lost salaries, wages, and the value to household activities such as cooking, cleaning, and child care. We focused on the age group 50 to 74 years because this is the age group where routine CRC screening is recommended. We estimated that more than 14,000 CRC deaths in poorer communities could have been avoided and that these CRC deaths resulted in a nearly $6.5 billion dollars loss in productivity. This is tragic - for the person who died, their family and for their community. This loss in productivity contributes to the economic burden of these already disadvantaged communities. (more…)
AACR, Author Interviews, Biomarkers, Chemotherapy, Colon Cancer, MD Anderson / 10.11.2015

MedicalResearch.com Interview with: Van K. Morris,  M.D. Assistant Professor, GI Medical Oncology University of Texas – M.D. Anderson Cancer Center Houston, TX 77030  Medical Research: What is the background for this study? What are the main findings? Dr. Van K Morris: BRAF V600E mutations are associated with poor clinical outcomes for patients with metastatic colorectal cancer.  Patients were enrolled in a phase I clinical trial with the BRAF inhibitor vemurafenib, the anti-EGFR antibody cetuximab, and irinotecan.  Blood  samples were collected every two weeks with each dose, and plasma was analyzed for changes in the fraction of mutant BRAF V600E allele relative to wild-type BRAF allele with time.  Trends in circulating free DNA (cfDNA) changes were compared with radiographic changes by RECIST 1.1 criteria to examine this technique as a marker for response to therapy. For patients who had a response radiographically, drastic reductions in the BRAF V600E allele fraction were observed even after two weeks of starting therapy, well before the first restaging scan.  Patients who did not have responses radiographically had less  dramatic changes relative to baseline in the BRAF V600E allele fraction.  This technique analyzing cfDNA from plasma was validated using two different approaches – digital droplet PCR and next-generation sequencing by Guardant Health.  Sequencing of cfDNA was also compared in pretreatment and post-progression samples, and novel mutations in MEK1 and GNAS were observed uniquely in post-progression samples. (more…)