Colon cancer study backs blood stool screening test

NEW YORK (Reuters Health) - Although colon cancer screening is recommended by many organizations, less clear is which method is best to detect tumors and precancerous lesions. A new study in the New England Journal of Medicine suggests that a relatively inexpensive and non-invasive test may be just as effective as a colonoscopy.

Meanwhile, a 23-year study, also published in the journal, has confirmed that removing precancerous polyps, known as adenomas, during a colonoscopy can reduce the risk of death from colorectal cancer by half.

In an editorial in the Journal, Dr. Michael Bretthauer of Oslo University Hospital and Dr. Mette Kalager of Telemark Hospital, both in Norway, said that based on the results, "an appealing concept would be to use colonoscopy as a triage screening test, offering it once for everybody at 60 years of age" and using it to classify people into high- and low-risk categories. Low-risk people would not need further screening while those with adenomas would be evaluated regularly.

One in 20 Americans will develop colorectal cancer. About 140,000 cases are diagnosed in the United States each year, resulting in about 49,000 deaths, according to the National Cancer Institute. It is the third most common cancer worldwide.

Currently, the U.S. Preventive Services Task Force, a government-backed agency, recommends screening for people age 50 to 75 years by one of three methods: a colonoscopy every 10 years; annual stool testing; or a less-thorough look into the colon (known as flexible sigmoidoscopy) every five years in conjunction with stool testing every two to three years.

People often find the tests unpleasant, however.

For example, in the new study that compared stool testing with colonoscopy, only 34 percent went along with stool testing. The participation rate was even lower when colonoscopy was offered, even though doctors can use it to cut away those suspicious precancerous adenomas.

In theory, adenoma removal saves lives by preventing a tumor. Ann Zauber of the Memorial Sloan-Kettering Cancer Center in New York, chief author of the long-term evaluation of polyp removal, and her colleagues said their work demonstrates that.

"This study is showing both a reduction in colon cancer incidence and colon cancer deaths by removing the adenomas, and it's a long-term effect" she told Reuters Health in a telephone interview. "This is reassuring for people to come in for screening."

The conclusion is based on people who were sent for a colonoscopy between 1980 and 1990. The Zauber team compared their death rate to the estimated death rate from the Surveillance Epidemiology and End Results (SEER) program.

Over a period as long as 23 years, the rate from colorectal cancer among the 2,602 people who originally had adenomas removed was 53 percent lower than estimated from the SEER data. In all, 12 died from cancer in the removal group, while 25 had normally been expected to die of colorectal disease.

The lower rate includes the fact that 81 percent of the patients who had polyps removed continued to have periodic colonoscopies to check for growths.

Bretthauer and Kalager cautioned in their editorial that "the study mimics a situation in which 100 percent of the population complies with screening, which is not a real-life scenario."

CHEAPER, LESS INVASIVE TEST PERFORMS WELL

The COLONPREV study, being conducted in Spain, is designed to compare 10-year death rates in two groups: volunteers who received a one-time colonoscopy and volunteers who are being screened every two years using fecal immunochemical testing (FIT), a form of blood stool testing. A positive FIT test led to a colonoscopy.

After the first round of testing, the researchers report in the New England Journal of Medicine, colorectal cancer was found in 30 people in the 26,703-member colonoscopy group and 33 in the 26,599-person FIT group.

Colonoscopy uncovered twice as many advanced adenomas, about two percent of the sample vs. one percent.

But the chief author of the Spanish study, Enrique Quintero of Hospital Universitario de Canarias, told Reuters Health by phone that it was encouraging that the cheaper fecal test "detected half the advanced adenomas just in the first round."

The next round of FIT tests will uncover more growths, he predicted.

Death rates will not be examined until the 10-year followup is completed in 2021.

Quintero and his team also found that the people assigned to the FIT group were more likely to participate in screening than those who were in line for a colonoscopy.

The participation rates were 34 percent with the stool-sampling test compared to 25 percent for colonoscopy.

At this point in the study, the researchers concluded, "the numbers of subjects who needed to be screened to find one colorectal cancer were 191 in the colonoscopy group and 281 in the FIT group, and the numbers who needed to be screened to find any advanced (cancer) were 10 and 36."

That's important when the FIT test is so much cheaper than a colonoscopy, Quintero said. "This simple, non-invasive and cheap test is equally good at detecting colorectal cancer and identifying the high-risk individual that should undergo a colonoscopy."

And the complication rate, including bleeding, low blood pressure and slow heartbeat, was nearly five times higher in the colonoscopy group.

SOURCES: http://bit.ly/xJBNxg and http://bit.ly/xPLSv4 New England Journal of Medicine, February 23, 2012.

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Colon cancer study backs blood stool screening test

NEW YORK (Reuters Health) - Although colon cancer screening is recommended by many organizations, less clear is which method is best to detect tumors and precancerous lesions. A new study in the New England Journal of Medicine suggests that a relatively inexpensive and non-invasive test may be just as effective as a colonoscopy.

Meanwhile, a 23-year study, also published in the journal, has confirmed that removing precancerous polyps, known as adenomas, during a colonoscopy can reduce the risk of death from colorectal cancer by half.

In an editorial in the Journal, Dr. Michael Bretthauer of Oslo University Hospital and Dr. Mette Kalager of Telemark Hospital, both in Norway, said that based on the results, "an appealing concept would be to use colonoscopy as a triage screening test, offering it once for everybody at 60 years of age" and using it to classify people into high- and low-risk categories. Low-risk people would not need further screening while those with adenomas would be evaluated regularly.

One in 20 Americans will develop colorectal cancer. About 140,000 cases are diagnosed in the United States each year, resulting in about 49,000 deaths, according to the National Cancer Institute. It is the third most common cancer worldwide.

Currently, the U.S. Preventive Services Task Force, a government-backed agency, recommends screening for people age 50 to 75 years by one of three methods: a colonoscopy every 10 years; annual stool testing; or a less-thorough look into the colon (known as flexible sigmoidoscopy) every five years in conjunction with stool testing every two to three years.

People often find the tests unpleasant, however.

For example, in the new study that compared stool testing with colonoscopy, only 34 percent went along with stool testing. The participation rate was even lower when colonoscopy was offered, even though doctors can use it to cut away those suspicious precancerous adenomas.

In theory, adenoma removal saves lives by preventing a tumor. Ann Zauber of the Memorial Sloan-Kettering Cancer Center in New York, chief author of the long-term evaluation of polyp removal, and her colleagues said their work demonstrates that.

"This study is showing both a reduction in colon cancer incidence and colon cancer deaths by removing the adenomas, and it's a long-term effect" she told Reuters Health in a telephone interview. "This is reassuring for people to come in for screening."

The conclusion is based on people who were sent for a colonoscopy between 1980 and 1990. The Zauber team compared their death rate to the estimated death rate from the Surveillance Epidemiology and End Results (SEER) program.

Over a period as long as 23 years, the rate from colorectal cancer among the 2,602 people who originally had adenomas removed was 53 percent lower than estimated from the SEER data. In all, 12 died from cancer in the removal group, while 25 had normally been expected to die of colorectal disease.

The lower rate includes the fact that 81 percent of the patients who had polyps removed continued to have periodic colonoscopies to check for growths.

Bretthauer and Kalager cautioned in their editorial that "the study mimics a situation in which 100 percent of the population complies with screening, which is not a real-life scenario."

CHEAPER, LESS INVASIVE TEST PERFORMS WELL

The COLONPREV study, being conducted in Spain, is designed to compare 10-year death rates in two groups: volunteers who received a one-time colonoscopy and volunteers who are being screened every two years using fecal immunochemical testing (FIT), a form of blood stool testing. A positive FIT test led to a colonoscopy.

After the first round of testing, the researchers report in the New England Journal of Medicine, colorectal cancer was found in 30 people in the 26,703-member colonoscopy group and 33 in the 26,599-person FIT group.

Colonoscopy uncovered twice as many advanced adenomas, about two percent of the sample vs. one percent.

But the chief author of the Spanish study, Enrique Quintero of Hospital Universitario de Canarias, told Reuters Health by phone that it was encouraging that the cheaper fecal test "detected half the advanced adenomas just in the first round."

The next round of FIT tests will uncover more growths, he predicted.

Death rates will not be examined until the 10-year followup is completed in 2021.

Quintero and his team also found that the people assigned to the FIT group were more likely to participate in screening than those who were in line for a colonoscopy.

The participation rates were 34 percent with the stool-sampling test compared to 25 percent for colonoscopy.

At this point in the study, the researchers concluded, "the numbers of subjects who needed to be screened to find one colorectal cancer were 191 in the colonoscopy group and 281 in the FIT group, and the numbers who needed to be screened to find any advanced (cancer) were 10 and 36."

That's important when the FIT test is so much cheaper than a colonoscopy, Quintero said. "This simple, non-invasive and cheap test is equally good at detecting colorectal cancer and identifying the high-risk individual that should undergo a colonoscopy."

And the complication rate, including bleeding, low blood pressure and slow heartbeat, was nearly five times higher in the colonoscopy group.

SOURCES: http://bit.ly/xJBNxg and http://bit.ly/xPLSv4 New England Journal of Medicine, February 23, 2012.

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More Doubt on Link Between a Blood Chemical and Heart Disease

TUESDAY, Feb. 21 (HealthDay News) -- Having high levels of the amino acid homocysteine won't raise your risk of developing heart disease, a new analysis indicates.

The findings appear to close the door on the potential benefit of lowering homocysteine levels with folic acid supplements, according to report author Robert Clarke, of the University of Oxford in the United Kingdom, and his colleagues.

The researchers also said previous studies that suggested high levels of homocysteine might be a modifiable risk factor for heart disease were plagued by publication bias and methodological problems.

Clarke and his team analyzed data on nearly 50,000 heart disease patients and 68,000 healthy people, culled from 86 published studies and 19 unpublished studies. There was no increased risk of heart disease in people who had an MTHFR gene variant that is associated with 20 percent higher blood homocysteine levels.

The MTHFR gene plays a role in the production of methylene tetrahydrofolate reductase, which uses folate to break down and remove homocysteine.

The study appears in this week's issue of the journal PLoS Medicine.

"The discrepancy between the overall results in the unpublished and the published datasets is too extreme to be plausibly dismissed as a chance finding," the researchers wrote. "Some studies, particularly if small, might have been prioritized for publication by investigators, referees or editors according to the positivity of their results and some may have been liable to other methodological problems that bias the average of all results. To avoid such biases, we chiefly emphasize the new results from the previously unpublished datasets."

"The magnitude of the effect of publication bias is substantial and, in addition to distorting the association of MTHFR with [coronary heart disease] in published studies, publication bias may also help explain the discrepant findings recently reported for MTHFR and stroke," they concluded.

More information

The U.S. National Heart Lung and Blood Institute has more about coronary heart disease.

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New Blood Thinner May Prevent Blood Clots During Cancer Treatment

WEDNESDAY, Feb. 15 (HealthDay News) -- A new blood-thinning medication called semuloparin reduces the risk of blood clots in people undergoing certain cancer treatments, new research shows.

When people with cancer are treated with chemotherapy, they have an increased risk of developing blood clots (venous thromboembolism). These clots can be dangerous, and have the potential to cause heart attacks or strokes.

This new drug reduced the risk of blood clots by 64 percent, according to the study, which was funded by Sanofi, the drug's manufacturer. Sanofi was also responsible for the analysis of the study's results.

Semuloparin, which is not currently approved by the U.S. Food and Drug Administration, didn't appear to increase the risk of excessive bleeding, which can be a side effect of blood thinners.

"Thromboembolism and the effects are very significant," said Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City. Even if blood clots don't cause life-threatening complications, they can cause lifelong problems, such as pain and a decreased ability to exercise, she explained.

"What's interesting about this paper is that they're decreasing the rate of thromboembolism without increasing bleeding. This needs to be confirmed in other studies, but this drug may play an important role for cancer patients in the future," said Bernik, who was not involved with the research.

The current study included more than 3,000 people from 47 countries. All had been diagnosed with cancer, including cancers of the lung, pancreas, stomach, colon, rectum, bladder or ovary.

The study volunteers were randomly assigned to one of two groups. One group received treatment with semuloparin, which is a type of heparin, while they were undergoing chemotherapy. The other group received a placebo.

The medication or the placebos were given as an injection once a day. Treatment lasted an average of 3.5 months.

Blood clots occurred in just 1.2 percent of those taking semuloparin compared to 3.4 percent of those on the placebo, according to the study.

The incidence of any type of excessive bleeding was 2.8 percent for the semuloparin group and 2.0 percent in those on placebo. Major bleeding occurred in 1.2 percent of those on semuloparin and 1.1 percent of those on placebo.

Results of the study are published in the Feb. 16 issue of the New England Journal of Medicine.

In addition to preventing clots, heparin medications may also help fight cancer tumors, according to the authors of an accompanying editorial in the same issue of the journal.

"This study by itself did not show any effect on mortality, but when we included it in a meta-analysis, we found that there is a likely survival benefit," said one of the editorial's authors, Dr. Elie Akl, an associate professor of medicine at the State University of New York at Buffalo.

The meta-analysis done by Akl and his co-author reviewed 11 studies including more than 6,000 people taking heparin medications during chemotherapy. They concluded that for every 1,000 people being treated with chemotherapy for cancer, there would be 30 fewer deaths if people were also treated with heparin during their chemotherapy. They also estimated that there would be 20 fewer blood clots. And, they estimated that there would be one more major bleeding episode and five more minor bleeding episodes if everyone on chemotherapy were to receive heparin treatment.

"Patients with cancer, who have a low risk of bleeding and who have no problem with injecting themselves with heparin, are likely to benefit in terms of survival from heparin treatment," he said.

What isn't yet clear, Akl said, is if heparin would provide more or less benefit depending on the type of cancer someone has, and how far advanced the cancer is. He said that there are currently six different studies under way to help answer those questions. The cost of the medication is also unclear, since it has not been approved for use in the United States yet.

More information

To learn more about blood clots and cancer, read this information from the American Society of Clinical Oncology.

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