Tag Archive for: prevention

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Taking Aspirin: Can It Really Prevent Colorectal Cancer? 

A 20-year Danish cohort study was recently published in the Journal of the National Cancer Institute, and was an accumulation of really surprising data from nationwide registries in regard to aspirin’s impact on the prevention of colorectal cancer (CRC).

This study followed 1,909,532 individuals for 18.2 years. The individuals, who were between 40-70 years old and had no cancer at baseline, were split into two main groups:

  • Those who use low-dose aspirin (as measured by having at least one prescription and nonuse of no prescriptions since baseline) 
  • Those who use high-dose aspirin (as measured by having at least two prescriptions and nonuse as less than two prescriptions since baseline)

Researchers then used the Cancer Registry to determine which individuals had been diagnosed with cancer during the 18.2-year follow-up period. Additionally, using the Prescription Registry, researchers were also able to keep track of individuals in the study who had refilled their aspirin prescriptions, and were able to further see the approximate dosage that each individual was taking. 

What Were the Study Findings?

Among all of the individuals who were accounted for during the approximate 18.2 years, 422,778 were diagnosed with cancer. While low-dose aspirin usage during a short period of time (<5 years) did not show statistical significance in preventing cancer, long-term use (5+ or 10+ years) was associated with at least a 10% reductions in risk for several cancer sites throughout the body (including the colon, rectum, esophagus, stomach, liver, pancreas, etc.). Additionally, high-dose usage was associated with an even higher percentage of risk reductions for developing these cancers.

Overall, this study found that individuals who took aspirin had less spread of cancer to their lymph nodes as compared to those who did not take aspirin. The study also found an association between aspirin usage and a reduction in the risk of CRC.

Unpacking the Study Findings: What Does This Mean? 

Aspirin’s role in preventing various cancers is surprising because one wouldn’t typically think there was a connection between the two. However, aspirin actually has capabilities of adjusting the immune system function, inherently allowing it to function better when it comes to fighting cancer cells. 

Though this seems like an exciting preventative measure, researchers insist that the increased-usage of this medication should not be encouraged. Aspirin raises the risk of serious bleeding, and could even be lethal if too much of the medication is consumed. However, this study really is interesting as it makes us wonder what other parts of daily life could unknowingly be helping us reduce the risk of cancer and other diseases. Additionally, it also raises questions on further research that could be done on the impact of medications on the immune system along with ways to strengthen the immune system to prevent various cancers. 

 

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

Photo credit: Dan Smedley on Unsplash

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Reviewing CRC From an Anthropological Lens: Who Is Most At Risk and Why?

By Parker Lynch

One cannot deny the importance of considering an individual’s risk of colorectal cancer (CRC) on the basis of their diet, exercising habits, and genetic predispositions. However, many other demographic factors can influence the likelihood of being diagnosed with CRC, as well as subsequent quality of life and survival outcomes. 

Lower socioeconomic status, for instance, is associated with a very high risk of developing CRC. Most of these community members are uninsured, which makes it difficult for them to receive the screenings that are otherwise readily accessible for those with insurance plans. A colonoscopy (one of the most important preventative screening measures for CRC) can cost anywhere from $500 to $6,000 without insurance, depending on the site where the procedure is conducted. For those on tight budgets, paying such amounts out-of-pocket every 5-10 years (depending on their personal risk of CRC) is quite unrealistic.

Tampa Bay Study

In a retrospective study conducted in 2021 by the CDC, researchers analyzed 13,982 uninsured patients with CRC who had received services at various free clinics in the Tampa Bay area between 2016 and 2018. These patients’ demographics are as follows: 

  • 5,139 (36.8%) were aged 50 years or older
  • Most were female (56.8%)
  • A large majority were non-Hispanic White (41.1%)
  • Majority were unemployed (54.9%)

Less than 7% of these patients had received any sort of preventive colorectal screening in their lives. 22.7% of these patients were smokers, and another 28.3% had diabetes. Not only are these patients more at risk for CRC because of their predisposed comorbidities, but they also don’t have the means to receive proper preventative screenings.

Bridging the Gap: Free Clinics

This study is one of many that sheds light on the healthcare treatment discrepancies among people of different socioeconomic statuses in America. The concerning statistics presented by these retrospective studies have motivated healthcare professionals and non-profit organizations to provide free clinics across the U.S. to make screening accessible to those who wouldn’t be able to otherwise afford it.

The NYC Health Department’s NYC Community Cares Project, for instance, provides free colonoscopies for uninsured residents referred from primary care sites. This program collaborates with various endoscopy centers and allows patients to work with primary care physicians, while also receiving free anesthesia and pathology services. Other interventions, such as the ColonoscopyAssist program, assists uninsured individuals in 30 states with the fees associated with CRC screening. This organization strives to eradicate a lot of the costs that are accumulated when someone gets preventative screening done, and reduces a colonoscopy’s cost to around $1,000 for a patient. Though this program doesn’t entirely eradicate colonoscopy costs, it still helps patients by significantly reducing the price, inherently making them much more feasible. 

Moving Forward

These public health interventions are vital to treating patients that suffer from America’s healthcare inaccessibility issues that run rampant throughout the country. Even though the U.S. spends more money on healthcare than any other wealthy country in the world, we have struggled to match other countries in patient satisfaction, accessibility, and life expectancy. 

Movements like the Community Cares Project in NYC, ColonoscopyAssist program, and other free/reduced-cost screening resources across the country are making huge strides in the CRC community. Should these endeavors continue to be subsidized by non-profit organizations, philanthropies, donations, and government support, uninsured individuals can receive timely preventative screenings. Increased access to these resources can ensure that patients from all socioeconomic backgrounds can receive the care that they need. 

 

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

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Pathways to Nutritional Prevention: an Infographic

Nutrition & Colorectal Cancer Prevention Series: Blog 3

In the previous installments of this blog series, we explored both the molecular pathways behind dietary prevention of colorectal cancer (CRC) as well as the barriers within the built environment that prevent individuals from properly accessing those preventative nutrients. This post will further explore strategies and resources that can aid communities in achieving a balanced diet.

With rising costs of living and barriers in the built environment such as food deserts, reducing CRC through dietary prevention can feel like a daunting task, but there are many resources available that can provide support in this process. 

So how can individuals identify resources that are available to them? This can be done through a multi-pronged approach from accessing fresh food from local organizations to engaging in nutritional education classes. 

Where can you find these resources? Findhelp.org is a database that provides direct links to resources in your zip code. Individuals can input their location and find resources from direct food access, to community gardens, to education. 

Our infographic below provides a snapshot of how integrating dietary pathways can help CRC prevention.

 

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

Photo credit: Nathan Dumlao on Unsplash

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 Identifying New Biomarkers in Fecal Samples to Detect Colorectal Cancer

Biomarkers allow scientists to identify certain diseases from a simple biological sample like urine, breath, or even feces. Volatile organic compounds (VOCs) are the byproducts of metabolic processes associated with cancer, necrosis, or other metabolic changes. Scientists have now identified a new biomarker associated with both colorectal cancer (CRC) and adenoma (noncancerous tumor) that can be used for detection.

The cross-sectional study included 24 newly diagnosed CRC patients, 24 patients with adenomas, and 32 individuals who had a normal colonoscopy between July 2017 and July 2020. Individuals with normal colonoscopies and those with adenomas had fecal samples collected before and after their colonoscopy. Samples were requested from CRC patients 3-4 weeks after diagnosis and before treatment.

Of the 60 VOCs identified, only 3 showed different peaks between CRC and the control groups: p-cresol, 1H-indole, and 3(4H)-DBZ. There was a statistically significant difference between p-cresol peak values in each group with the greatest difference between CRC and the control group. This was also the same for 3(4H)-DBZ. However, 1H-indole did not have a significant difference between the study groups.

After adjusting for sex, age, and body-mass index (BMI), the researchers found that only CRC was associated with increased p-cresol and 3(4H)-DBZ, and p-cresol seemed to be the best possible predictor of CRC. A combination of p-cresol and 3(4H)-DBZ “is also optimistic as a combined biomarker” according to the study authors.

p-cresol was also abundant among patients with adenomas compared to healthy controls. This was also the case after adjusting for age, sex, and BMI.

Although more work needs to be done to determine what processes produce these VOCs, these associations can launch a new set of studies to confirm its use in a clinical setting. Other biomarkers have been identified that can  predict CRC occurrence and mortality. Overall, the ability to better detect CRC and precancerous adenomas play an important role in global prevention efforts. A better understanding of the biological processes involved in these diseases is crucial for those efforts to be successful.

 

Kaylinn Escobar is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

Photo credit: National Cancer Institute on Unsplash

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Setting it Straight: The Colonoscopy Controversy

A new study published in the New England Journal of Medicine has sparked controversy—this 10-year study involving nearly 85,000 participants in Europe highlighted that colonoscopies cut the risk of colorectal cancer (CRC) only by about a fifth, far below estimates from earlier scientific studies, and didn’t substantially reduce deaths, raising the possibility that the invasive procedure is not worth it. Doctors in the U.S. are now concerned that the study’s results could cause doubt about the effectiveness of a colonoscopy, which is a recommended CRC screening approach for those 45 and older, to be conducted once in ten years. Despite the confusion about the effectiveness of colonoscopies, national news articles and gastroenterologists in the U.S. have rebuked these conclusions. 

A major limitation that experts found with the study was that only 42% of the people who were invited to get a colonoscopy actually had one. However, researchers still reported the outcomes for the entire cohort, regardless of whether or not they underwent a colonoscopy. The study found that of those who were invited to have a colonoscopy—whether they got it or not—there was an 18% reduction in developing the disease and no statistically significant reduction in the likelihood of CRC death. Many don’t believe that this is representative of what happens in the U.S., where colonoscopy is more widely accepted as a standard screening protocol compared to European countries, and was a serious shortcoming of the study. In fact, when the individuals who did not get a colonoscopy were removed from the study, the risk of developing CRC among those who did get a colonoscopy reduced by an estimated 31% and the risk of death reduced by about 50%.

As Robin Mendelsohn, MD, co-director of the Center for Young Onset Colorectal and Gastrointestinal Cancers at the Memorial Sloan Kettering Cancer Center, argues “in order for a colonoscopy to be effective, you have to have it done”.

Andrew Albert, MD, a member of the Colon Cancer Foundation (CCF)’s Interdisciplinary Medical Advisory Council (IMAC), said, “While the NordICC trial demonstrates the need for challenging the status quo related to colonoscopy, this remains an effective screening tool, particularly for individuals at average risk who may be on the fence about going in for screening. Misinformation is dangerous, especially in healthcare. If we miss catching colorectal cancer at an early stage—which is what a colonoscopy is very good at—it can have a big impact on survival. We need to remember that CRC is preventable, and treatable when caught early.”

IMAC member Matthew A. Weissman, MD, MBA, FAAP, told CCF, “I hope that the findings of this study, which have been taken out of context by many, will not discourage folks from getting screened for colon cancer by colonoscopy or other appropriate methods, which is extremely important in early detection (and prevention) of this deadly disease.”

In an accompanying editorial in the same issue, experts point to the need for a longer follow-up time for the impact of screening colonoscopy to be realized. They also point out that the skill of the endoscopist conducting the procedure has a significant impact on the detection rate—29% of endoscopists in the trial had an adenoma detection rate below the recommended 25%. 

Consequent to this study, the American Society for Gastrointestinal Endoscopy (ASGE) issued a public statement that colonoscopy remains the best and most proven way to detect and prevent CRC incidence and death. The American Cancer Society also weighed in on the study, pointing to the high number of participants who didn’t undergo the procedure. Adam Lessne, MD, a gastroenterologist at Gastro Health in Florida told VeryWell Health that “when you take away the limitations, it’s proven again that colonoscopies do save lives and they do reduce the risk of death.” 

The bottom line is that a screening test of any kind—stool-based or colonoscopy—is better than none, and CRC is preventable with regular screening. For detailed information on various CRC screening methods and current screening guidelines, visit this page on the Colon Cancer Foundation’s website. 

 

Kitty Chiu is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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