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Sensitivity of Double Fecal Immunochemical Testing for Detection of Colorectal Cancer

Fecal immunochemical testing (FIT) is a commonly used method for screening and diagnosis of colorectal cancer (CRC) in patients who are exhibiting typical signs and symptoms of the disease. FIT testing is widely used in preventing CRC as test kits can be mailed to patients to collect the sample and shipped back for laboratory analysis. This allows patients who may be ambivalent about more invasive testing to engage in a safe and effective preventative method in the comfort of their home. This form of testing, while an effective way of assessing and prioritizing patients with the highest risk, exhibits low levels of sensitivity (approximately 87%). 

Double FIT More Sensitive

In order to improve the sensitivity levels of FIT assessments, researchers from Scotland conducted two sequential, prospective cohort studies to measure and compare the sensitivity levels of both single and double FIT. Following a general practitioner referral, patients selected for the study were shipped either one or two FIT kits depending on their assigned study group, and results were analyzed following kit return. 

In the single FIT cohort, assessments were able to detect the presence of CRC with 84.1% sensitivity and advanced colorectal neoplasia with 64.4% sensitivity. These results were significantly lower than the sensitivity levels of the double FIT strategy, with this strategy being able to detect colorectal cancer with 96.6% sensitivity. Double FIT testing was also able to significantly improve detection of advanced colorectal neoplasia, with this strategy detecting disease at 81.6% sensitivity. 

This research reveals that double FIT may be an effective way to increase the accuracy of preventative testing measures, especially in symptomatic populations. 

While double FIT testing can provide increased accuracy and sensitivity when screening for CRC, obtaining two FIT submissions from patients is more difficult than obtaining a single test result. In this specific study, 22% of patients in the double FIT cohort only returned a single test, which reveals that this strategy may require innovative follow-up methods. 

A 2017 study by researchers within a hospital system in Texas found that mailed outreach literature and free testing kits increased rates of preventative screening measures, including FIT completion. In order to ensure that double FIT is an effective strategy, hospitals and clinics can develop and mail out literature that invites and encourages patients to complete two consecutive FIT’s tests. Other strategies could include social media, email, and notifications in patient portals.

 

Emma Edwards is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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Fundraisers and Other Awareness Campaigns: Supporting the CRC Cause

By Parker Lynch

Image credit: Mary Pahlke from Pixabay

Every year, The Great Plains Colon Cancer Task Force holds a bike ride event called the “Rollin’ to Colon” to raise money and awareness towards colon cancer research within the state of Nebraska. This year, the 15th annual event was held on the morning of June 11th, and was open to riders of all experience levels and ages. 

Ten, twenty, thirty, and 53-mile routes were available to the public as well as virtual riders, who wanted to contribute to the cause from their stationary bikes at home. Every year, all proceeds from the event go towards bringing awareness to colon cancer prevention and early detection.

Fundraising for CRC: Why is it Important?

This organization is one of many that host fantastic events to support the colorectal cancer (CRC) cause. Despite the numerous array of fundraising endeavors that already exist, more can always be done to support the continuous research and development behind CRC preventative measures as well as treatment options for patients. When someone hosts a fundraiser for CRC, they are not just making monetary contributions, they are raising awareness, and in turn, saving lives. 

According to Marcline St-Germain, the operations manager for the Colon Cancer Foundation (CCF), “It’s not just about raising money. We are letting our community know about colon cancer, and that it’s not just an old man’s disease. In fact, many young people don’t know that they’re at risk themselves, and this is something that we are trying to change through fundraising events. Through these events, we’re trying to teach the community that CRC still exists, and people need to be aware of it.” 

The CCF gets creative when coming up with ways to bring CRC awareness to communities all across the U.S. The Rollin’ Colon, a pink, 20-foot long inflatable tunnel, is used as a fun and educational visual that provides important health information to those who experience it. While “walking through the colon”, people are able to learn about the signs and symptoms of CRC; they will see giant polyps, ulcerative colitis, Crohn’s disease, and the different stages of CRC. Organizations are able to request The Rollin’ Colon, which will then be shipped to them to have at their own events and/or fundraisers.

CCF also hosts the Colon Cancer Challenge, an annual event in March (perfectly lining up with Colorectal Cancer Awareness Month). This challenge gives individuals the opportunity to run/walk a 5K or walk a mile. The funds raised through this challenge are used to support CRC prevention through various measures: supporting advocacy efforts, public awareness, research, and screening.

Whether it be on an individual or company-wide level, anyone has the opportunity to start their own fundraiser to support CCF. Regardless of whether or not one has a personal connection to the colorectal community, fundraising endeavors are vital to keeping the mission alive; they are also fun, collaborative events that bring communities and people together. These fundraisers that are held for CCF as well as the donations that individuals make (regardless of how large or small they may be), have an immense impacts on the CRC community. Not only do they support the patients and their families, but they give CCF the opportunity to continue to spread preventative awareness through educational endeavors, such as sending out The Rollin’ Colon to other events.

According to Ms. St.-Germain, “Fundraising is the backbone of our foundation. Without fundraising we wouldn’t be here.”

Donate to CCF today! 

Parker Lynch is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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Colonoscopy Reminders Increase Screening Rates Among High-Risk Individuals

By Deepthi Nishi Velamuri


Colorectal cancer (CRC) is a significant health concern, particularly for those with a family history of the disease. Unfortunately, many existing screening programs overlook this high-risk group. However, a recent study conducted at the University of California Los Angeles (UCLA) has introduced an innovative intervention aimed at improving CRC screening rates in individuals with a family history of CRC. 

The study was presented at Digestive Disease Week 2023.

A Game-Changing Intervention

The researchers at UCLA conducted a study within their large academic health center that already had a screening program for average-risk individuals. They aimed to engage individuals with a family history of CRC who were resistant to screening and determine the effectiveness of the intervention in increasing colonoscopies ordered, scheduled, and completed.

Study participants were divided into two groups:

  1. Group 1 received reminders to schedule a colonoscopy. The attending doctors also received a reminder.
  2. Group 2 received reminders along with educational materials on CRC risk and the colonoscopy procedure, as did their doctors.

Promising Results and Implications

The study included 150 patients, evenly divided between the two groups. The primary outcome showed that both groups had similar rates of completed colonoscopies. However, both groups experienced a significant increase in the number of colonoscopies ordered, scheduled, and completed.

The multicomponent intervention successfully engaged high-risk individuals who had been hesitant about CRC screening. The combination of reminders for doctors and patients proved effective in increasing screening rates. Surprisingly, the additional educational materials did not significantly impact outcomes, suggesting that they may not be necessary in future interventions.

The study’s findings offer hope for improving CRC prevention and control in high-risk individuals with a family history of the disease. By refining and expanding this intervention, we can raise screening rates, detect CRC at an early stage, and potentially save lives.

Take Action

Regular screening is crucial for early detection of CRC. If you have a family history of CRC or are overdue for screening, consult your healthcare provider to discuss the best screening options for you. Together, we can fight CRC and make a meaningful impact on public health.

The Colon Cancer Foundation remains committed to supporting advancements in CRC prevention, early detection, and treatment. Join us in our mission to raise awareness and promote lifesaving screenings. 

Reference-
Impact of a Multicomponent Health System Intervention to Increase Colorectal Cancer Screening Participation in Patients with a Family History of Colorectal Cancer. Jain S, Galoosian A, Badiee J, Meshkat S, Popoola F; Presented at Digestive Disease Week 2023.

 

 Deepthi Nishi Velamuri is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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How Can We Improve Access to Blood-Based Colorectal Cancer Screening?

In a recent blog post, Parker Lynch discussed the accuracy of blood-based colon screenings that are becoming increasingly popular in colorectal cancer (CRC) prevention efforts. The non-invasive nature of these tests has the potential to improve CRC screening rates in the general population, which is becoming increasingly necessary with the rise in early-onset CRC rates. 

While these tests have high specificity and sensitivity, their newer status on the market raises questions about whether they will be covered by insurance plans for most Americans. 

At the recent American Society of Clinical Oncology meeting, researchers presented their findings on a new multi-cancer detection test that utilizes only a blood sample for cancer screening. This test is groundbreaking in its ability to quickly and accurately provide positive test results for a broad spectrum of cancers. It will be essential to cancer prevention movements in the colorectal sphere and across the board. 

While these new tests are groundbreaking for prevention efforts, ensuring that the population has equitable access to these tests will establish their validity as a public health tool. The much heralded Galleri multi-cancer detection test has a list price on the company website of $949 and states that most insurance plans do not cover it. Considering that a significant portion of Americans (40%) cannot afford to cover a $400 emergency bill, the Galleri test’s pricing and lack of coverage will create access barriers to the general American public. 

Blood-based biomarker tests specifically for detecting CRC will be more easily accessible to the public, but still can be challenging to obtain. The Centers for Medicare & Medicaid Services, for example, will cover a blood-based biomarker test every three years, for an individual who is between 45 and 85 years old, asymptomatic, and at an average risk for developing CRC. This leaves out the early-onset population (<45 years), many of whom are diagnosed at an advanced stage and may benefit from a blood-based testing approach.

To advance health equity in CRC prevention and care, these innovative new tests must become more accessible through pricing and insurance coverage. When all individuals can access high-quality cancer prevention, regardless of income or socioeconomic status, we can protect the most vulnerable members of our population. 

 

Emma Edwards is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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Breaking Barriers: Effective Approaches for Boosting Colorectal Cancer Screening Rates

By Deepthi Nishi Velamuri

Colorectal cancer (CRC) remains a serious public health issue in the U.S. that affects people from all walks of life, independent of race, gender, or age. The third most commonly diagnosed cancer in the U.S., an estimated 150,000 new cases and 53,000 deaths are attributed to CRC each year, highlighting the urgency for effective prevention and early detection strategies. [1]

Early and regular screening can improve detection rates and lead to better outcomes for CRC. However, there are significant disparities in the rates of CRC screening for some groups, such as medically underserved communities. Race and ethnicity, socioeconomic status, and access to healthcare services have a significant impact on CRC screening rates . 

During the annual Digestive Disease Week 2023 meeting,  several research studies were presented that identify interventions to improve CRC screening rates, specifically in medically underserved populations. The following interventions were identified in the systematic review to increase CRC screening rates among medically underserved populations:

  1. Multicomponent interventions: These interventions involved multiple elements, such as patient education, provider reminders, patient navigators, and mailed outreach. [2][3]
  2. Patient navigation: Interventions that included the use of patient navigators, who assist patients in navigating the healthcare system and overcoming barriers to screening, were effective in increasing screening rates. [3]
  3. Mailed stool-based kits with provider letters: Sending screening kits to patients by mail, along with a letter from their healthcare provider recommending the screening, was found to be a successful intervention. [3]

Multiple Elements to a Successful Screening Program

The study conducted by Shailavi Jain et al., [3] highlighted the impact of a multicomponent health system intervention to increase screening participation among patients with a family history of CRC. This intervention involved:

  • Electronic health record reminders to primary care providers
  • Reminders to patients to schedule a colonoscopy
  • Additional educational resources about familial CRC risk and the colonoscopy procedure 

The intervention increased colonoscopies ordered, scheduled, and completed among high-risk patients.

Another study focused on using patient-level structured data elements to optimize population-based CRC screening. The study utilized individualized health data, such as laboratory results and diagnosis codes, to identify patients with significant comorbidities who were unlikely to complete routine screening. This approach allowed for targeted screening efforts to be directed towards patients most likely to complete screening as intended by their primary care team. [4]

A meta-analysis examined the efficacy of an opt-out outreach method  to optimize screenings. [5] This approach involved giving patients the option to either opt-in or opt-out of receiving fecal immunochemical test (FIT) kits. The analysis showed that patients who were given the option to opt-out had a significantly higher FIT completion rate compared to those who were given the option to opt-in. 

Additionally, a quality improvement project evaluated the effectiveness of mailed reminders in increasing uptake of FIT. Mailed reminders were found to be an effective strategy in improving screening rates. [6]

Overall, these studies highlight the effectiveness of various interventions, including multicomponent approaches, patient navigation, mailed reminders, and opt-out outreach methods in increasing CRC screening rates among medically underserved populations and individuals with a family history of CRC. These interventions can inform the design of programs aimed at improving CRC screening in these populations.

References-

  1. American Cancer Society.
  2. Vella J., Patel, S, Bowman B., et al. Interventions to improve colorectal cancer screening among medically underserved populations: A systematic review. In: Digestive Disease Week 2023; May 6-9, 2023; Chicago, IL.
  3. Jain S, Galoosian A, Badiee J., et al. Impact of a multicomponent health system intervention to increase colorectal cancer screening participation in patients with a family history of colorectal cancer: A systematic review. In: Digestive Disease Week 2023; May 6-9, 2023; Chicago, IL.
  4. Corren R., et al. Flagging comorbidities using patient-level structured data elements to optimize population-based colorectal cancer screening: A systematic review. In: Digestive Disease Week 2023; May 6-9, 2023; Chicago, IL.
  5. Battepati D., et al. The efficacy of opt-out outreach method to optimize colorectal cancer screenings: A systematic review and meta-analysis.: A systematic review. In: Digestive Disease Week 2023; May 6-9, 2023; Chicago, IL.
  6. Ahmad Abu-Heija, Abdelnour D, et al. Effectiveness of mailed reminders in increasing uptake of fecal immunochemical testing for colorectal cancer screening: A quality improvement project.: A systematic review. In: Digestive Disease Week 2023; May 6-9, 2023; Chicago, IL.

 

Deepthi Nishi Velamuri is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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Could Blood-based Testing Improve CRC Screening Barriers?

By Parker Lynch

Despite the current methods that exist for people to receive preventative screenings, colorectal cancer (CRC) screening rates remain below the 80% national goal. Since the utilization of the current testing methods are subpar among average-risk adults in America, researchers are testing the reliability of a blood-based test, which remains a preferable screening method for a variety of preventive tests in the general population. The hope is that a preferred screening method would improve screening rates for CRC among average-risk adults. 

Testing the Reliability and Validity of a Blood-Based Test

The ECLIPSE clinical trial evaluated the performance of a cell-free DNA blood-based CRC screening test. Individuals who were average-risk (those with no identifiable risk factors or abnormal predispositions to being diagnosed with CRC), 45 years of age or older, and presenting for colonoscopy screening were recruited from 265 U.S. clinical sites between October 2019 and September 2022. This population was diverse, which makes the findings generalizable:

  • 54% female
  • 7% Asian
  • 12% Black/African-American 
  • 79% white
  • 12% Hispanic/Latino 

Prior to their colonoscopy, participants provided whole blood samples. In doing so, researchers were able to compare the validity of the blood-based tests when compared to the actual results that were obtained from the colonoscopy procedures. 

The trial found that the blood test was:

  • 90% sensitive to detecting Stage I – III CRC
  • 100% sensitive to detecting Stage IV CRC
  • 90% specific

In another study, researchers retrospectively analyzed blood samples of 425 individuals who were to undergo a colonoscopy. The blood samples were tested for specific genetic and epigenetic changes and these were then correlated with the individual’s colonoscopy results. 

Here’s a fun video that explains what genetic and epigenetic changes are.

The test was found to be:

  • 82% sensitive for CRC
  • 90% specific

Overall, the researchers concluded that this test provides clinically meaningful performance and has utility for CRC screening.  A limitation of the specificity/sensitivity study was the utilization of an older version of the assay. However, should the results of up-to-date versions of the assay remain statistically significant, blood-based screening could be a very effective and preferable CRC screening method. 

Both these studies demonstrate the effectiveness of blood-based tests, which will hopefully improve the rate at which people get their preventative testing for CRC.

 

Parker Lynch is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

 

Photo credit: Photo by Testalize.me on Unsplash  

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The Insider Scoop: Unveiling the Relationship Between Exercise and Colorectal Cancer Risk

Photo credit: Arek Adeoye on Unsplash

After publishing a blog post on Sarah Keadle, Ph.D.’s latest published research, entitled “Impact of Moderate-Vigorous Physical Activity Trajectories on Colon Cancer Risk over the Adult Life Course”, I had the opportunity to sit down and chat with her about these findings and what they mean for colorectal cancer prevention. Dr. Keadle holds graduate degrees from the University of Massachusetts Amherst and Harvard University and is Associate Professor, California Polytechnic State University, San Luis Obispo. 

CCF: What were your greatest revelations over the course of this research?

Dr. Keadle: The take home message is pretty consistent with what we see in terms of other physical activity in relation to other disease outcomes, that even moderate amounts of activity are really important. 

In our sample, the moderate group was doing about two hours a week of predominantly walking-type activities, and they were protected. Those who maintain that amount of activity over the life course were protected against colon cancer risk. 

Those who did a little more activity had a little bit more protection, so they were classified as the “high” active. These individuals were exceeding our current physical activity recommendations consistently throughout the life course relative to those who stayed inactive.

But then I think what’s also interesting is that there’s this: we were able to look at those who increased and those who decreased activity over time. The group who decreased their activity, the “early decreasers”, were in the 30-35- age group and had the worst risk—their risk of developing colon cancer was greater than those who stayed inactive. 

And those who were not active when younger but started increasing their activity by age 30, there was evidence suggesting that they may also be protected from developing colon cancer. So if you’re targeting middle-aged adults, it’s not too late to start being active. Even a moderate amount of activity appears to be protective.

                     Sarah Keadle, Ph.D.

CCF: What kinds of exercises would you recommend for people who have mobility issues and are limited in what activities they can do? 

Dr. Keadle: Much  of the data show that walking is the most accessible, and the best form of activity for most adults. For those with more serious limitations that don’t allow them to walk, there could be adaptations such as specialized gym equipment. But I think, for the vast majority of adults, if they feel intimidated by the thought of exercising or running, or exercise that will place a lot of stress on joints, or cause them pain or discomfort, you don’t have to be out of breath and sweating and uncomfortable to get the benefits of physical activity. There’s a lot of evidence that just moderate walking is one of the best forms of activity. 

As part of the 2018 physical activity guidelines, [the Department of Health and Human Services] launched the Move Your Way campaign to try to promote physical activity at the community level, and I know that they have several resources on how to adapt things to people with different types of disabilities. 

CCF: My next question is more about structural barriers to exercise. So people who are living in locations where they don’t really have access to safe parks and gyms. What would you recommend?

Dr. Keadle: That is a huge issue. I think one benefit potentially of COVID is that there are more online resources for at home activities and workouts that are targeted at different levels and different types of activities. So I think that’s a good place to start. It’s also important to spread the message of just getting up and moving, trying to not sit for really long periods of time. Get up and move around your house or try to find places that feel safe, even if it’s the backyard. To get outside and try to break up and get steps in is definitely beneficial. 

CCF: Those are great tips. And what kinds of policy changes, if any do you think would help alleviate some of those barriers?

Dr. Keadle: That’s a great question. So the CDC [Centers for Disease Control and Prevention] has launched a campaign around safe streets and complete streets programs to try to make it so that our streets are safer for people to bike, walk, and drive. I’m teaching a class right now on physical activity and public health to undergraduate students, and they ask, “We’ve reviewed the evidence. Physical activity is good. But, what are we actually doing about it?” And I think that the Move Your Way campaign has done a good job of trying to get more community level buy-in. And that’s one of the big things that needs to happen to kind of shift the culture around physical activity. 

I think that there are things happening, but it’s definitely slow, and I think aligning physical activity with other goals is important. So, if you have an activity program in a park that may make the park safer and in the long run, you also have the benefit of increasing physical activity. 

However, there’s not a lot of money in promoting physical activity. There’s no lobby group that will make money off of promoting physical activity. So, hopefully, we can capitalize on other initiatives and try to convince people to create those types of structural changes. Access to green space is a big predictor of physical activity, so making safe parks available is one of the biggest policy level changes I can think of. 

CCF: Yeah, well thank you so much. Lastly, I just want to say congrats again on the publication of the study back in January. That’s amazing. And what is next for you and your team in terms of either just exercise research or colon cancer research? 

Dr. Keadle: I have an intervention study for which we’re randomizing our last subject. The study is looking at a strategy to try to reduce screen time in adults. There’s a fair amount of data on kids, but we don’t know a lot about adults in terms of what’s the best way to get people off their screens. And if they do, are they more physically active? And what else changes along with that? 

I’m also continuing to do a few epidemiological studies about the interaction between physical activity and sedentary time and how that relates to health. It’s interesting because people cite lack of time as their biggest barrier to being physically inactive—it is the most commonly cited barrier. But then, if you look at the actual time-use data, people are spending like four hours a day on their phones.

So it’s perceived, and I get it that not everybody wants to exercise in the evening. But that’s where that messaging of “move more, sit less, break up sedentary time” and trying to make it approachable and just beginning to get it into people’s lifestyle is going to end up being a huge change in the long run. 

CCF: Absolutely, yeah. And maybe even communicating those messages through social media.

Dr. Keadle: Right. We have an app for our study, which feels ironic, that we’re trying to reduce screen time by creating an app that tracks their screen time and gives them feedback and strategies, but it lets [participants] set limits and things like that.

 

Emma Edwards is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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Connections & Comorbidities: The Link between Colorectal Cancer and Cardiovascular Disease

Welcome back to our ongoing series exploring the intricate relationship between colorectal cancer (CRC) and various health conditions. Our previous post uncovered the association between CRC and diabetes mellitus. Today, we embark on a new journey as we unravel the intriguing connection between cardiovascular disease and CRC. Through uncovering the latest research, we aim to shed light on shared risk factors and significant findings that emphasize the importance of addressing both these conditions. 

Shared Risk Factors Identified

A meta-analysis of 84 studies involving over 52 million participants has unveiled a clear association between cardiovascular disease and CRC. The analysis confirmed that individuals harboring risk factors for cardiovascular diseases, such as obesity, high body-mass index, diabetes, and smoking, face an increased likelihood of developing CRC. These shared risk factors act as crucial indicators of potential health complications. 

Intriguingly, the same study revealed a compelling insight: individuals who are obese and exhibit at least one metabolic abnormality, such as hyperglycemia, dyslipidemia, or hypertension, face a 31% higher risk of being diagnosed with CRC. This underscores the significance of managing weight and addressing metabolic health concerns as part of a comprehensive approach to reducing the risk of developing both cardiovascular disease and CRC. 

A study conducted in Taiwan involving a substantial cohort of over 94,000 patients delved into the relationship between cardiovascular disease and CRC prognosis. The findings demonstrated that individuals diagnosed with CRC are more prone to developing cardiovascular disease, particularly coronary heart disease, within the first three years following their CRC diagnosis. This highlights the need for comprehensive health management strategies encompassing cancer treatment and cardiovascular health for CRC patients. 

Uninsured and the Risk of CRC, Cardiovascular Disease 

In a noteworthy cohort study published in June 2022, researchers examined over 197,000 cases of CRC from the SEER database to study the prognosis of CRC patients. They assessed mortality trends due to cardiovascular disease and identified risk factors to develop a predictive model for cardiovascular disease outcomes in this population. The study unveiled a significant risk factor: lack of insurance coverage. It was found that CRC patients without insurance faced a higher likelihood of cardiovascular death than those with health coverage. These findings emphasize the need for further exploration of the link between social determinants of health and health outcomes. 

As we conclude our exploration of the connection between cardiovascular disease and CRC, it becomes increasingly evident that these two conditions share risk factors and impact each other’s prognosis. This knowledge encourages a holistic approach to

healthcare that prioritizes overall well-being and seeks to achieve optimal health outcomes for individuals facing these conditions. By addressing common risk factors, focusing on metabolic health, and implementing comprehensive healthcare strategies, we can strive to minimize the impact of both cardiovascular disease and CRC.

 

Emma Edwards is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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UnitedHealthcare to Implement Prior Authorization for Certain Colonoscopies

Update on June 2nd, 2023: Following an outcry from physician groups and patient advocacy groups, UnitedHealthcare (UHC) has slightly modified their policy. Gastroenterologists will now be required to submit an advance notification to UHC before conducting diagnostic or surveillance colonoscopy procedures. Under the revised policy, care will not be denied, so patients will not face out-of-pocket costs. However, physician groups remain skeptical.

 

Individuals who are covered under UnitedHealthcare’s commercial insurance will now require prior authorization for a colonoscopy. This policy, which goes live on June 1, 2023, does not apply to screening colonoscopy, which is conducted in individuals (45-74 years) at average risk who are healthy and do not display any gastrointestinal symptoms.

To understand the prior authorization process, read more here.

Procedures that will require prior authorization include:

  • Diagnostic colonoscopies: conducted in those who have a greater risk of colorectal cancer. This would include individuals with abnormal gastrointestinal symptoms, polyps in the colon, or a positive screening test.
  • Surveillance colonoscopies: conducted in those who have a personal history of colorectal polyps or cancer.

Will This Create Access Barriers for Patients?

Physicians are concerned that this procedural change will impact both patients and healthcare staff. Prior authorization adds a layer of administrative burden for clinics and hospitals. More importantly, gastroenterologists and oncologists are concerned that patients may face unnecessary delays in diagnostic procedures, which can potentially affect disease outcome.

Folasade May, M.D., Ph.D., M.Phil., expressed her concerns with long wait times—maybe even weeks or months—for the approval to come through. For patients with aggressive disease, being left undiagnosed while waiting for insurance approval could mean advanced stage cancer, which is usually difficult to treat.

Colonoscopy procedures can be expensive if paid for out of pocket. The procedure alone can cost on average $2,125; this can increase to an average of $2,543 with the added costs of anesthesia, pathology, and bowel preparation.

 

Surabhi Dangi-Garimella, Ph.D. is a Scientific Consultant with the Colon Cancer Foundation.

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The Link Between Diabetes and Colorectal Cancer: Exploring the Evidence

As colorectal cancer (CRC) rates rise globally, especially in the early-onset population, identifying high-level risk factors for developing this disease becomes ever more critical. The link between diabetes and the incidence of colon and rectal cancers was discovered in 1998 and has been well-established since then, as many trials have uncovered the strength of the association between these two diagnoses. 

In 2013, a meta-analysis of 26 observational studies among more than 200,000 patients assessed the relationship between CRC and all-cause mortality (death due to any cause), cancer-specific mortality, and disease-free survival. Interestingly, diabetes was found associated with poorer outcomes for all three categories. A key finding from this study: individuals who have diabetes and CRC have a 17% increased risk of death due to any cause.

A 2017 article on the epidemiology of the association between diabetes and CRC delved into the potential molecular mechanisms of this association and the therapeutic implications of treating both diseases, and found that: 

  • Diabetes mellitus and CRC have many overlapping risk factors
  • Hyperinsulinemia, hyperglycemia, and hyperlipidemia may all play a role in the development of these dual diagnoses
  • Environmental and genetic risk factors may also play a role
  • Promising therapies for treating a dual diagnosis are statins, ACE inhibitors, anti-fibrotic agents, among others

A study among 2023 individuals evaluated the association between type 2 diabetes risk, cholesterol levels, triglyceride levels, and CRC. Additionally, the study assessed the association between Lynch syndrome—which results from a genetic mutation that can lead to CRC—and these other variables, and found that:

  • Individuals with Lynch syndrome, type 2 diabetes, and elevated cholesterol levels had an increased risk of CRC
  • High triglyceride levels in those with Lynch syndrome did not increase CRC risk 
  • Hyperinsulinemia and hyperglycemia in diabetic patients may increase the risk of CRC

A more recent study looked at the clinical and therapeutic implications of diabetes treatment and CRC risk. They found that while not always the case, these drugs often reduced the risk of dual diagnosis. Newer therapies, such as anticancer drugs that target IGF-1R and RAGE receptors (receptors for advanced glycation end products), may also help prevent and treat diabetes-induced CRC. 

It will be essential for future research to continue to explore the mechanisms behind these two diseases and to collaborate to create effective treatments for individuals experiencing dual diagnoses.

 

Emma Edwards is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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