Exact Sciences Corp announced the introduction of a new home test, Cologuard®, for the detection of colon polyps and colon cancer. The test will be first offered to patients through the Mayo Clinic, whose researchers helped develop the new screening technology.
Cologuard® is designed to detect DNA alternations and blood released from cancerous and precancerous colon lesions. The test requires a prescription and express mail access. The Cologuard® kit is mailed to the patient who completes the test at home, and then is mailed back to a laboratory for processing. The patient should receive the results within two weeks. Patients who have a positive (abnormal) test result will require follow up colonoscopy.
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MedicalResearch.com Interview with:Frank van Hees, MSc
Researcher, Department of Public Health, Erasmus MC
Rotterdam, The Netherlands
Medical Research: What are the main findings of the study?Answer: Many U.S. elderly are screened for colorectal cancer more frequently than recommended: One in every five elderly with a negative screening colonoscopy result undergoes another screening colonoscopy within 5 years’ time instead of after the recommended 10 years. Moreover, one in every four elderly with a negative screening colonoscopy result at age 75 or older receives yet another screening colonoscopy at an even more advanced age. Our study shows that, in average risk individuals, these practices are not only a waste of scarce health care resources: often they are also associated with a balance among benefits, burden, and harms that is unfavorable for those being screened.
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MedicalResearch.com Interview with:Øyvind Holme, MD
Department of Medicine, Sorlandet Hospital Kristiansand, Kristiansand, Norway
Institute of Health and Society, University of Oslo, Oslo, Norway
Departments of Epidemiology and Biostatistics, Harvard School of Public Health,
Harvard-MIT Division of Health Sciences and Technology
Boston, Massachusetts
Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
Medical Research: What are the main findings of the study?Dr. Holme: In this population-based trial, we found that once-only flexible sigmoidoscopy screening in asymptomatic 50-64 year old individuals reduces colorectal cancer mortality by 27% and colorectal cancer incidence by 20% after 11 years of follow-up. We found that the incidence reduction is as great in 50-54 year old individuals as in 55-64 old individuals. Addition of a once-only fecal occult blood test to flexible sigmoidoscopy did not lead to a larger reduction in colorectal cancer incidence or mortality compared to flexible sigmoidoscopy screening alone.
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MedicalResearch.com Interview with: Kaspar Truninger, MD, FMH
Gastroenterology and Internal Medicine
Langenthal, Switzerland
MedicalResearch: What are the main findings of the study?Dr. Truninger: In our study, we investigated the effect of lifestyle exposure on DNA methylation. We measured genome-wide promoter CpG methylation in 1092 normal colon biopsies from 546 healthy females. We observed that fewer CpGs acquired age-dependent methylation in users of aspirin and hormonal replacement therapy compared with nonusers, whereas more CpGs were affected in smokers and individuals with a body mass index > 25 compared with nonsmokers and less obese females. Half of the CpGs showing age-dependent methylation gain were hypermethylated in tissue of colorectal cancer. These loci gained methylation with a higher rate and were particularly susceptible to lifestyle exposure compared to age-only methylated CpGs. In addition, these CpGs were enriched for polycomb regions. Finally, all effects were different according to the anatomic location along the colon.
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MedicalResearch.com Interview with:Frank van Hees MSc
Erasmus University Medical Center
Rotterdam, the Netherlands and
Ann G. Zauber PhD
Memorial Sloan Kettering Cancer Center, New York
MedicalResearch: What are the main findings of the study?Answer:The main finding of our study is that colorectal cancer screening of individuals without previous screening is worthwhile well beyond age 75, which is the recommended age to stop screening in individuals with an adequate screening history. The exact age up to which screening should be considered in unscreened elderly depends on an individual's health status: in healthy individuals screening remains worthwhile up to age 86, whereas in individuals with a severe illness, such as heart failure, screening remains worthwhile up to age 80. (more…)
MedicalResearch.com Interview InvitationDorna Jafari, M.D. and
Michael J Stamos, MD
Professor of Surgery
John E. Connolly Chair,
Department of Surgery
University of California, Irvine
Orange, CA 92868
MedicalResearch.com: What are the main findings of the study?Answer: Surgeons are faced with an aging population and data regarding outcomes is rare given that many studies preclude the elderly from the study population. Therefore, it is difficult to accurately discuss risk of surgical resection given the lack of data. Therefore we aimed to report the national trends and outcomes of colorectal cancer treatment in the elderly population.
We demonstrated that the majority of resections are performed in patients >65yeras old. There is a trend towards a decrease in incidence of colorectal resection and a decrease in rate of mortality during 2001-2010. However, the unique physiological changes associated with aging contribute to increase morbidity and morality as demonstrated by our findings. In fact patients >85 years have a 472% increase in risk-adjusted mortality during a hospital admission compared to younger patients. However, despite the substantially higher mortality and morbidity associated with age, there has been a marked improvement in surgical outcomes in the elderly population.
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MedicalResearch.com Interview with:M.S. Reimers, MD PhD Student
and
Dr. Jan Liefers MD
Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
MedicalResearch.com: What are the main findings of the study?Answer: Aspirin use was associated with an improved survival, as we have published before when investigating this cohort (Bastiaannet et al, Brit J Cancer 2012/ Reimers et al. J Am Geriatr Soc. 2012. In this study we have focused on investigating which patients will benefit from aspirin treatment by investigating some tumor markers, such as PTGS2 expression, HLA class I expression and PIK3CA mutation status. Interestingly, only patients with HLA class I expression on their tumor membrane will benefit from aspirin treatment and have a better outcome. We raise the hypothesize that aspirin inhibits platelet aggregation to circulating tumors cells. By interfering with this process, the metastatic potential of these circulating tumour cells is inhibited, thereby preventing metastasis and colon cancer death.HLA class I expression might be needed for signalling between platelets and circulating tumor cells. If this hypothesis is confirmed by others or in vitro studies, than this might explain the finding that aspirin seems not only beneficial as an adjuvant therapy for colorectal cancer patients, but also for patients with other malignancies (oesophagus, breast, etc). Interestingly, preliminary findings from our team investigating aspirin use in oesophageal cancer also showed that aspirin use in these tumors was associated with an improved survival.
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MedicalResearch.com Interview Invitation with:Dr. Thomas Imperiale MD
Professor of Medicine, Indiana University School of Medicine
Research Scientist, Indiana University Center for Health Services and Outcomes Research
Research Scientist, Center for Health Services Research, Regenstrief Institute, Inc.
Core Investigator, VA HSR&D Center for Health Information and Communication
MedicalResearch.com: What are the main findings of the study?Dr. Imperiale: The main findings are the performance characteristics of the multi-target test (sensitivity of 92.3%, specificity of 86.6%) and its performance as compared with the commercial FIT: more sensitive for colorectal cancer and advanced precancerous polyps, but less specific.
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MedicalResearch.com Interview with:Sameer Saini MD
Veterans Affairs Center for Clinical Management Research,
VA Ann Arbor Healthcare System
Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
MedicalResearch.com: What are the main findings of the study?Dr. Saini: The way that quality measures are defined can have important implications for how care is actually delivered. Current colorectal cancer screening quality measures use age to identify screen-eligible patients, encouraging screening in patients between 50 and 75 years of age. But they do not explicitly incorporate health status. In this context, our study had two main findings.
First, by focusing on age alone, we are not screening everyone who is likely to benefit. Specifically, many healthy people over 75 years of age (who are outside the target age range of the quality measure) may benefit from screening, but the current measure does not encourage screening in this population, leading to low screening use.
Second, some people who are NOT likely to benefit are being screened unnecessarily, like those with serious health problems. For example, people between ages 70-75 with serious health problems (who have limited life expectancy) are unlikely to benefit from screening, and may even be harmed by it. But the current quality measure encourages screening in such individuals due to their age, yielding relatively high screening rates. If the system focused on age and health status (rather than age alone), screening use would be more aligned with screening benefit, and we would have better health outcomes.
MedicalResearch.com Interview with:Jiyoung Ahn, PhD
Assistant Professor of Epidemiology
Department of Population Health
NYU School of Medicine
New York, NY 10016
MedicalResearch.com: What are the main findings of the study?Dr. Ahn: Before we did our research, it was suspected that gut bacteria were related to colorectal cancer. We, for the first time, found colorectal cancer patients have a different gut bacteria composition than healthy subjects.
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MedicalResearch.com Interview with: Chia-Hung Kao, MD
Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taiwan.
MedicalResearch.com: What are the main findings of the study?Answer: Colonic diverticular disease and colorectal cancer shared certain characteristics. Some previous studies aimed to identify their epidemiological correlation. However, their results were discrepant and insufficiently strong to draw firm conclusion. In our nationwide population-based retrospective cohort study, we found that the previously diagnosed colonic diverticular disease is not associated with an elevated risk of colorectal cancer after the first year of a diagnosis of colonic diverticular disease (adjusted HR, 0.96). The increased risk in the first year may be due to misclassification and screening effect.
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MedicalResearch.com Interview with:Li-Shu Wang, PhD
Department of Medicine, Medical College of Wisconsin,
Milwaukee, WisconsinMedicalResearch.com: What are the main findings of the study?Answer:Ulcerative colitis (UC) is frequently an intermediate step to colon cancer. The interleukin-10 knock-out (KO) mouse is a genetic model of this progression. We have now shown that KO mice fed 5% black raspberries (BRBs) had significantly less colonic ulceration as compared to KO mice that consumed the control diet. Dysfunction of the Wnt signaling pathway is a key event in UC-associated colon carcinogenesis. We investigated the effects of BRBs on the Wnt pathway and found that the BRB-fed KO mice exhibited significantly decreased promoter methylation of Wnt antagonists and a significantly lower level of β-catenin nuclear translocation. Our results suggest that BRBs inhibit colonic ulceration partly through inhibiting aberrant epigenetic events that dysregulate Wnt signaling.
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MedicalResearch.com Interview with: James Murphy, M.D.
Assistant Professor, Department of Radiation Medicine and Applied Sciences, Center for Advanced Radiotherapy Technologies ,UC San Diego Moores Cancer Center
La Jolla, CA 92093
MedicalResearch.com: What are the main findings of the study?Dr. Murphy: This study evaluated racial disparity in metastatic colorectal cancer. In a large population-based cohort we found of over 11,000 patients we found that black patients were less likely to be seen in consultation by a cancer specialist, and were less likely to receive treatment with chemotherapy, surgery, or radiation. Furthermore, we found that this disparity in treatment accounted for a substantial portion of the race-based differences between black and white patients.
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MedicalResearch.com Interview with: Aasma Shaukat, M.D., M.P.H.
Dept. of Medicine
GI Division, MMC 36
University of Minnesota
Minneapolis, MN 55455
MedicalResearch.com: What are the main findings of the study?Dr. Shaukat: The study showed that screening for colon cancer using stool cards
consistently reduces risk of death from colon cancer by one-third through
thirty years. The benefit of screening in larger in men compared to women,
and for women the benefit seems to start at age 60. However, screening did
not make people live longer. (more…)
Dr. Bettina Scholtka Universität Potsdam
Institut für Ernährungswissenschaft
Abt. Ernährungstoxikologie
Arthur-Scheunert-Allee 114-116
14558 Nuthetal, Germany.
MedicalResearch.com: What are the main findings of the study?Answer: The extremely high sensitivity of the WTB-HRM technique allows to find
very low amounts of different types of colon cancer initiating gene
mutations even in stool samples of patients. The method is able to
find the expected mutations as well as unknown mutations. So, by
applying WTB-HRM to a panel of especially selected marker genes, it is
possible to detect cancer precursors in feces before they progress
into a malignant stage.
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MedicalResearch.com Interview with: Paul C. Schroy III, M.D., M.P.H.
Professor of Medicine, Boston University School of Medicine
Director of Clinical Research, GI...
Computed tomographic colonography (CTC), also known as virtual colonoscopy, administered without laxatives is as accurate as conventional colonoscopy in detecting...
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Exact Sciences Corp announced the introduction of a new home test, Cologuard®, for the detection of colon polyps and colon cancer. The test will be first offered to patients through the Mayo Clinic, whose researchers helped develop the new screening technology.
Cologuard® is designed to detect DNA alternations and blood released from cancerous and precancerous colon lesions. The test requires a prescription and express mail access. The Cologuard® kit is mailed to the patient who completes the test at home, and then is mailed back to a laboratory for processing. The patient should receive the results within two weeks. Patients who have a positive (abnormal) test result will require follow up colonoscopy.
(more…)
