Colonoscopy Prevents Death, a Study Affirms

In patients tracked for as long as 20 years, the death rate from colorectal cancer was cut by 53 percent in those who had the test and whose doctors removed precancerous growths, known as adenomatous polyps, researchers reported on Wednesday in The New England Journal of Medicine. The test examines the inside of the intestine with a camera-tipped tube.

“For any cancer screening test, reduction of cancer-related mortality is the holy grail,” said Dr. Gina Vaccaro, a gastrointestinal oncologist at the Knight Cancer Institute at Oregon Health and Science University who was not involved in the research. “This study does show that mortality is reduced if polyps are removed, and 53 percent is a very robust reduction.”

Colorectal tumors are a major cause of cancer death in the United States and one of the few cancers that that can be prevented with screening. This year, more than 143,000 new cases and 51,000 deaths are expected. Incidence and death rates have been declining for about 20 years, probably because of increased use of screening tests and better treatments. But only about 6 in 10 adults are up to date on getting screened for colorectal cancer, according to federal estimates.

Cancer screening tests have come in for greater scrutiny recently. A government panel recommended in October that men no longer get the P.S.A. blood screening test for prostate cancer after concluding it did not save lives. The new study on colonoscopy has limitations — it is not a randomized clinical trial — but some experts say it nonetheless was well done and helps answer questions about the effectiveness of the procedure.

Earlier research had proved that removing precancerous polyps could greatly reduce the incidence of colorectal cancer. But a major question remained: Did removing the polyps really save lives? In theory, it was possible that doctors were finding growths that would not have killed the patient, or missing ones that could be fatal.

“This study puts that argument to rest,” said Dr. David A. Rothenberger, a professor and deputy chairman of surgery at the University of Minnesota Masonic Cancer Center. He was not part of the study.

Robert A. Smith, the senior director for cancer control at the American Cancer Society, said, “This is a very big deal.”

A team of researchers led by Dr. Sidney J. Winawer, a gastroenterologist at Memorial Sloan-Kettering Cancer Center in New York City, followed 2,602 patients who had adenomatous polyps removed during colonoscopies from 1980 to 1990. Doctors compared their death rate from colorectal cancer with that of the general population, where 25.4 deaths from the disease would have been expected in a group the same size. But among the polyp group, there were only 12 deaths from colorectal cancer, which translates into a 53 percent reduction in the death rate.

The new study did not compare colonoscopy with other ways of screening for colorectal cancer and so does not fully resolve a longstanding medical debate about which method is best. Tests other than colonoscopy look for blood in the stool or use different techniques to examine the intestine. All the tests are unpleasant, and people are often reluctant to have them.

Although doctors have differed about which method is best, they agree that it is important to get over the squeamishness and have some type of test, usually starting at age 50. Screening is worthwhile because colorectal cancer is one of the few types of cancer (cervical and skin cancer are others) in which premalignant growths have been identified and the disease can be prevented if those growths are detected and cut out. Research indicates that not every polyp turns into cancer, but that nearly every colorectal tumor starts out as an adenomatous polyp.

Even if intestinal cancer has already developed, it can still be cured if it is found early and treated.

“Not all adenomas become cancers, and not all cancers cause death,” said Ann Zauber, the lead author of the study and a statistician at Sloan-Kettering. But in many cases, she said, “we have gotten those that would have had the potential to go on and cause a cancer death.”

Dr. Smith, at the American Cancer Society, said the new study on colonoscopy was well done, and noted that changes in death rates can be difficult to measure because they require long-term studies like this one.

But Dr. Harold C. Sox, an emeritus professor of medicine at Dartmouth Medical School and former editor of a leading medical journal, Annals of Internal Medicine, cautioned that the new study was not the last word. He said it was not clear that the same reduction in the death rate found in the study would occur in the general population.

Nonetheless, he said, “I suspect that removing polyps does reduce colorectal cancer mortality.”

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Study: Colonoscopy cuts colon cancer death risk

LOS ANGELES (AP) — Millions of people have endured a colonoscopy, believing the dreaded exam may help keep them from dying of colon cancer. For the first time, a major study offers clear evidence that it does.

Removing precancerous growths spotted during the test can cut the risk of dying from colon cancer in half, the study suggests. Doctors have long assumed a benefit, but research hasn't shown before that removing polyps would improve survival — the key measure of any cancer screening's worth.

Some people skip the test because of the unpleasant steps need to get ready for it.

"Sure, it's a pain in the neck. People complain to me all the time, 'It's horrible. It's terrible,'" said Dr. Sidney Winawer, a gastroenterologist at Memorial Sloan-Kettering Cancer Center in New York who helped lead the study. "But look at the alternative."

A second study in Europe found that colonoscopies did a better job of finding polyps than another common screening tool — tests that look for blood in stool. Both studies were published in Thursday's New England Journal of Medicine.

Colorectal cancer is the second leading cause of cancer death in the United States and the fourth worldwide. More than 143,000 new cases of cancers of the colon or rectum are expected in the U.S. this year and nearly 52,000 people will die from it, according to the American Cancer Society.

Deaths from colorectal cancer have been declining for more than two decades, mostly because of screening including colonoscopies and other tests, the organization says. People of average risk of colon cancer ages 50 to 75 should get screened, but only about half in the U.S. do.

A government-appointed panel of experts recommends one of three methods: annual stool blood tests; a sigmoidoscopy (scope exam of the lower bowel) every five years, plus stool tests every three years; or a colonoscopy once a decade.

In a colonoscopy, a thin, flexible tube with a tiny camera is guided through the large intestine. Growths can be snipped off and checked for cancer. Patients are sedated, but many dread the test because it requires patients to eat a modified diet and drink solutions the day before to clear out the bowel. It usually costs more than $1,000, compared with a $20 stool test.

Researchers at Sloan-Kettering previously showed that removing polyps during colonoscopy can prevent colon cancer from developing, but it was not clear whether it saved lives.

The new study followed 2,602 patients who had precancerous growths removed during colonoscopies for an average of 15 years. Their risk of dying from colon cancer was 53 percent lower than what would be expected among a similar group in the general population — 12 patients followed in the study died, versus 25 estimated deaths in the general population.

The study was not a randomized trial that's the gold standard in medical research. But Robert Smith, director of screening at the American Cancer Society, said it's the first direct evidence that removing polyps can reduce the risk of colon cancer death.

"There's no question that these are findings that we can take to the bank," said Smith, who had no role in the research.

The National Cancer Institute and several cancer organizations paid for the study.

Government and private cancer groups also funded the second study in the journal, led by researchers in Spain. About 53,000 participants were given a colonoscopy or a stool blood test. Both tests found similar numbers of colon cancer cases — about 30 in each group.

However, colonoscopies found advanced growths in twice as many people — 514 versus 231 of those given the stool test. Colonoscopy also found 10 times more people with less serious growths than the stool test did.

Neither test proved very appealing — only a quarter of patients offered a colonoscopy had one. Similarly, only a third agreed to the offered stool test.

The Spanish study is continuing and similar research in the U.S. and Norway that began recently is looking at the long-term impacts of colonoscopy.

Stephen Raquet, of Mount Kisco, N.Y., finds the test reassuring even if the preparation is unpleasant. He had his first colonoscopy 13 years ago at age 41, earlier than usual because of a family history of colon cancer.

The sudden death of his 45-year-old sister from the disease prompted Raquet to get checked out. He had a precancerous growth removed at Memorial Sloan-Kettering in 1999, and has had the test every three years since.

During his last appointment four months ago, doctors said he can come back in five years.

"It's given me peace of mind," said the 54-year-old business executive.

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Online:

Guidelines: http://www.uspreventiveservicestaskforce.org/uspstf/uspscolo.htm

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Follow Alicia Chang's coverage at http://www.twitter.com/SciWriAlicia

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US couple get 8 years each in son's cancer death

CLEVELAND (AP) — The parents of an 8-year-old boy who died from Hodgkin lymphoma after suffering for months from undiagnosed swollen glands were sentenced to eight years in prison Thursday following their guilty pleas to denying him medical treatment.

Attorneys for Monica Hussing, 37, and William Robinson Sr., 40, had said the parents had financial problems and tried to get checkups for their son but couldn't afford it.

The couple was given the maximum sentence by Cuyahoga County Judge Michael Astrab, who accepted their guilty pleas last month to attempted involuntary manslaughter in a last-minute plea deal before their trial was about to begin. They were handcuffed and taken into custody immediately. Both plan to appeal the sentence.

"I loved my son," Robinson told the judge, occasionally wiping his eyes with a tissue. He said he was sorry.

"I tried to help my son," Hussing said as family members in the courtroom quietly sobbed.

Hussing's sister, Shelia Slawinski, cried as she stood before the judge and gave voice to her nephew, Willie Robinson.

"I told my sister," Slawinski said. "I offered to help my sister."

According to the prosecution's pre-sentencing memo to the judge, at least eight family members noticed Willie's deteriorating health over a period of more than two years and most spoke to the couple about it. One relative described the boy's swollen neck glands as the size of a softball.

"Twenty-nine months he suffered," Slawinski said. "Twenty-nine months they had to do something and they chose not to."

Asked outside court why her sister hadn't taken care of Willie and hadn't enrolled him or three siblings in school, Slawinski said it was easier for Hussing to stay in bed during the day and do drugs. Both parents have abused drugs, their attorneys earlier told the judge.

Hussing's oldest daughter, Lillian, 18, defended her mother in court and said Willie was able to do the same things other 8-year-olds do. "He was able to play, go outside," she said.

The judge looked surprised and asked the teen if she would be willing to repeat her statements under oath and possible penalty of perjury. She did.

The judge compared the autopsy photo of Willie's emaciated body to concentration camp victims. "If anybody, anybody, didn't know this kid was sick, they are seriously, seriously disturbed," Astrab said.

Two doctors told the judge before the sentencing that no sick child would be turned away from a hospital.

Willie Robinson collapsed at his home on March 22, 2008. Prosecutors say he had begged his parents to take him to see a doctor but was rejected. Hodgkin lymphoma is a highly treatable cancer.

Lillian Hussing said earlier the family didn't have money for medical care and tried repeatedly to get help from social services and visited a free clinic but left when told they would have to pay $180.

The family soon moved to Cleveland and the boy died within weeks.

Prosecutors say that while the boy was suffering, the parents claimed financial hardship but paid $87 to have a pit bull treated for fleas. Hussing's defense attorney, John Luskin, said the dog belonged to Hussing's parents and her parents paid for the treatment.

Trumbull County Children Services says it had worked with the family to provide Willie health care, getting involved after receiving a phone call in July 2007. Agency officials said a case worker visited the family at least monthly and pushed the parents to have a medical follow-up on his swollen neck but they didn't.

However, Robinson's attorney Thomas Rein said previously that a social worker who visited the family in January 2008 "indicated the kids were healthy and happy." He said no one knew the boy had cancer until he died and an autopsy was performed.

And Lillian Hussing said a case worker had told the family the boy's lump looked like a swollen gland and to hold off until they could secure financial assistance before getting it checked.

About two weeks after they moved to Cleveland, she said, her brother came down with something. Her mother treated him with cold medicine and he died within three days.

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In prostate cancer, other death risks may be higher

NEW YORK (Reuters Health) - Some men with prostate cancer may have increased risks of dying from causes other than the cancer itself, a new study finds.

Researchers found that when men had their prostate cancer diagnosed after developing symptoms -- and not after screening tests -- they had heightened risks of dying from heart problems or other cancers.

It's not clear what to make of the findings at this point. Mainly, they raise questions for future studies, said Dr. Anthony D'Amico, of the Dana-Farber Cancer Institute and Harvard Medical School in Boston.

"This is a study of associations, and does not prove cause-and-effect. It's really hypothesis-generating," said D'Amico, who was not involved in the research.

One possibility, according to the study authors, is that hormonal therapy has something to do with the increased risk of heart disease death.

D'Amico agreed that could be a factor. A number of studies, he told Reuters Health, have suggested that hormonal therapy for prostate cancer could raise the risk of heart disease death.

But, D'Amico added, that link has only been seen in men with a history of heart disease going into the therapy.

SCREENING VS. USUAL CARE

The findings, reported in the British Journal of Urology International, are based on a subgroup of men who took part in a European clinical trial on prostate cancer screening.

The men, who were ages 55 to 74, were randomly assigned to either undergo periodic prostate cancer screening or be part of a control group that stuck with "usual" health care.

The researchers followed death rates among 372 men who were diagnosed with prostate cancer through screening, comparing them with 1,488 men who'd been screened but found cancer-free.

They also followed 221 men in the usual-care group who'd been diagnosed with prostate cancer after developing symptoms. Those men were compared with 884 men from the control group who had not been diagnosed with the cancer.

Looking at that latter group, the researchers found that men with prostate cancer were more likely to die from cardiovascular disease or other types of cancer over the next six years.

Just under 12 percent died of cancers other than prostate tumors, versus 7 percent of men who had not been diagnosed with prostate cancer. And 5 percent died of heart disease or stroke, compared with just over 3 percent of other men.

In contrast, men who'd had their prostate cancer caught through screening showed no increased risk of death compared with men free of prostate cancer.

OFTEN SLOW-GROWING

Prostate cancer screening, such as with PSA blood tests, often catches very early tumors that may or may not be life-threatening. Prostate cancer is often slow-growing, and may never progress to the point of being lethal.

But when men are diagnosed because they've developed symptoms (like problems passing urine and low back pain), the cancer is often at a more-advanced stage.

For those men, one treatment option is hormonal therapy to lower a man's levels of testosterone, which can fuel prostate tumors' growth.

Several studies have linked the therapy to higher-than-normal risks of cardiovascular "events," like blood clots or heart attacks, or death from heart complications.

In this study, 27 percent of men diagnosed with prostate cancer based on symptoms ended up having hormonal therapy, according to the researchers, led by Dr. Pim J. van Leeuwen of Erasmus Medical Center in Rotterdam.

So, they say, hormonal therapy might help explain the increased risk rate of death from cardiovascular problems.

D'Amico agreed that that's a possibility, and called it the most "interesting" point from the findings.

As for the increased rate of death from other cancers, D'Amico speculated that men with more-aggressive prostate cancer may be genetically vulnerable to other cancers as well.

Or, he added, being part of a medical study may have meant they were more likely to have screening tests for other cancers.

For now, the reasons for the findings are unclear. "This is not something that would change clinical practice," D'Amico said.

Like with any treatment for prostate cancer, experts say the risks of hormone therapy have to be weighed against the potential benefits. For men with "high-risk" cancer that is likely to progress, for example, studies have shown that a combination of hormonal therapy and radiation can boost survival.

Men with early prostate cancer diagnosed through screening would not be the ones given hormone therapy, D'Amico said.

For those men, surgery may be an option -- and so may "active surveillance." That means putting off treatment altogether and monitoring the cancer over time.

According to the National Cancer Institute, about half of the more than 190,000 U.S. men diagnosed with prostate cancer in 2009 fell into the "low-risk" category -- meaning their cancer had low odds of progressing.

SOURCE: http://bit.ly/yw2VMt BJU International, online January 30, 2012.

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Ohio couple get 8 years each in son's cancer death

CLEVELAND (AP) — The parents of an 8-year-old boy who died from Hodgkin lymphoma after suffering for months from undiagnosed swollen glands were sentenced to eight years in prison Thursday following their guilty pleas to denying him medical treatment.

Attorneys for Monica Hussing, 37, and William Robinson Sr., 40, had said the parents had financial problems and tried to get checkups for their son but couldn't afford it.

The couple was given the maximum sentence by Cuyahoga County Judge Michael Astrab, who accepted their guilty pleas last month to attempted involuntary manslaughter in a last-minute plea deal before their trial was about to begin. They were handcuffed and taken into custody immediately. Both plan to appeal the sentence.

"I loved my son," Robinson told the judge, occasionally wiping his eyes with a tissue. He said he was sorry.

"I tried to help my son," Hussing said as family members in the courtroom quietly sobbed.

Hussing's sister, Shelia Slawinski, cried as she stood before the judge and gave voice to her nephew, Willie Robinson: "I am so in pain ... please take me to the doctor ... the last four weeks have been the most painful."

"I told my sister," Slawinski said. "I offered to help my sister."

According to the prosecution's pre-sentencing memo to the judge, at least eight family members noticed Willie's deteriorating health over a period of more than two years and most spoke to the couple about it. One relative described the boy's swollen neck glands as the size of a softball.

"Twenty-nine months he suffered," Slawinski said. "Twenty-nine months they had to do something and they chose not to."

Asked outside court why her sister hadn't taken care of Willie and hadn't enrolled him or three siblings in school, Slawinski said it was easier for Hussing to stay in bed during the day and do drugs. Both parents have abused drugs, their attorneys earlier told the judge.

Hussing's oldest daughter, Lillian, 18, defended her mother in court and said Willie was able to do the same things other 8-year-olds do. "He was able to play, go outside," she said.

The judge looked surprised and asked the teen if she would be willing to repeat her statements under oath and possible penalty of perjury. She did.

The judge compared the autopsy photo of Willie's emaciated body to concentration camp victims. "If anybody, anybody, didn't know this kid was sick, they are seriously, seriously disturbed," Astrab said.

Two doctors told the judge before the sentencing that no sick child would be turned away from a hospital.

Willie Robinson collapsed at his home on March 22, 2008. Prosecutors say he had begged his parents to take him to see a doctor but was rejected. Hodgkin lymphoma is a highly treatable cancer.

Lillian Hussing said earlier the family didn't have money for medical care when they lived in Warren, tried repeatedly to get help from social services and visited a free clinic but left when told they would have to pay $180.

The family soon moved to Cleveland and the boy died within weeks.

Prosecutors say that while the boy was suffering, the parents claimed financial hardship but paid $87 to have a pit bull treated for fleas. Hussing's defense attorney, John Luskin, said the dog belonged to Hussing's parents and her parents paid for the treatment.

Trumbull County Children Services says it had worked with the family to provide Willie health care, getting involved after receiving a phone call in July 2007. Agency officials said a case worker visited the family at least monthly and pushed the parents to have a medical follow-up on his swollen neck but they didn't.

However, Robinson's attorney Thomas Rein said previously that a social worker who visited the family in January 2008 "indicated the kids were healthy and happy." He said no one knew the boy had cancer until he died and an autopsy was performed.

And Lillian Hussing said a case worker had told the family the boy's lump looked like a swollen gland and to hold off until they could secure financial assistance before getting it checked.

About two weeks after they moved to Cleveland, she said, her brother came down with something. Her mother treated him with cold medicine and he died within three days.

She said the boy never complained about his neck.

"He played, he went outside, he wrestled, he played video games," the boy's sister said. "He was the happiest kid you could imagine. It never seemed like he was suffering."

The emotional aftermath from their son's death led the couple to split, according to Luskin.

The couple's four other children under 18 were placed in the custody of a family member. Luskin said Lillian Hussing, upon turning 18, decided to return to live with her mother.

Rein said Robinson agreed to plead guilty so his children could be spared any further grief and wouldn't have to suffer by testifying. Lillian Hussing said her mother took a plea bargain because of the uncertainty of a trial and fear she could be sent to prison for a long time.

As part of the deal, the prosecution agreed to drop four counts each against each parent, including child endangering. Prosecutors didn't agree to a sentence recommendation. Both Luskin and Rein had said they hoped the judge would consider probation.

"There's not a day my client ... starts without shedding a tear for his son," Rein said.

The coroner ruled that the boy was a victim of medical neglect and died from pneumonia due to Hodgkin lymphoma.

Hodgkin lymphoma is a highly treatable cancer, with as many as 95 percent of patients in early stages of the disease surviving for five years or more with treatment. It's one of the most common forms of cancers among children.

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Ohio couple get 8 years in in son's cancer death

CLEVELAND (AP) — The parents of an 8-year-old boy who died from Hodgkin lymphoma after suffering for months from undiagnosed swollen glands were sentenced to eight years in prison Thursday following their guilty pleas to denying him medical treatment.

Attorneys for Monica Hussing, 37, and William Robinson Sr., 40, had said the parents had financial problems and tried to get checkups for their son but couldn't afford it.

The couple was given the maximum sentence by Cuyahoga County Judge Michael Astrab, who accepted their guilty pleas last month to attempted involuntary manslaughter in a last-minute plea deal before their trial was about to begin. They were handcuffed and taken into custody immediately. Both plan to appeal the sentence.

"I loved my son," Robinson told the judge, occasionally wiping his eyes with a tissue. He said he was sorry.

"I tried to help my son," Hussing said as family members in the courtroom quietly sobbed.

Hussing's sister, Shelia Slawinski, cried as she stood before the judge and gave voice to her nephew, Willie Robinson: "I am so in pain ... please take me to the doctor ... the last four weeks have been the most painful."

"I told my sister," Slawinski said. "I offered to help my sister."

According to the prosecution's pre-sentencing memo to the judge, at least eight family members noticed Willie's deteriorating health over a period of more than two years and most spoke to the couple about it. One relative described the boy's swollen neck glands as the size of a softball.

"Twenty-nine months he suffered," Slawinski said. "Twenty-nine months they had to do something and they chose not to."

Asked outside court why her sister hadn't taken care of Willie and hadn't enrolled him or three siblings in school, Slawinski said it was easier for Hussing to stay in bed during the day and do drugs. Both parents have abused drugs, their attorneys earlier told the judge.

Hussing's oldest daughter, Lillian, 18, defended her mother in court and said Willie was able to do the same things other 8-year-olds do. "He was able to play, go outside," she said.

The judge looked surprised and asked the teen if she would be willing to repeat her statements under oath and possible penalty of perjury. She did.

The judge compared the autopsy photo of Willie's emaciated body to concentration camp victims. "If anybody, anybody, didn't know this kid was sick, they are seriously, seriously disturbed," Astrab said.

Two doctors told the judge before the sentencing that no sick child would be turned away from a hospital.

Willie Robinson collapsed at his home on March 22, 2008. Prosecutors say he had begged his parents to take him to see a doctor but was rejected. Hodgkin lymphoma is a highly treatable cancer.

Lillian Hussing said earlier the family didn't have money for medical care when they lived in Warren, tried repeatedly to get help from social services and visited a free clinic but left when told they would have to pay $180.

The family soon moved to Cleveland and the boy died within weeks.

Prosecutors say that while the boy was suffering, the parents claimed financial hardship but paid $87 to have a pit bull treated for fleas. Hussing's defense attorney, John Luskin, said the dog belonged to Hussing's parents and her parents paid for the treatment.

Trumbull County Children Services says it had worked with the family to provide Willie health care, getting involved after receiving a phone call in July 2007. Agency officials said a case worker visited the family at least monthly and pushed the parents to have a medical follow-up on his swollen neck but they didn't.

However, Robinson's attorney Thomas Rein said previously that a social worker who visited the family in January 2008 "indicated the kids were healthy and happy." He said no one knew the boy had cancer until he died and an autopsy was performed.

And Lillian Hussing said a case worker had told the family the boy's lump looked like a swollen gland and to hold off until they could secure financial assistance before getting it checked.

About two weeks after they moved to Cleveland, she said, her brother came down with something. Her mother treated him with cold medicine and he died within three days.

She said the boy never complained about his neck.

"He played, he went outside, he wrestled, he played video games," the boy's sister said. "He was the happiest kid you could imagine. It never seemed like he was suffering."

The emotional aftermath from their son's death led the couple to split, according to Luskin.

The couple's four other children under 18 were placed in the custody of a family member. Luskin said Lillian Hussing, upon turning 18, decided to return to live with her mother.

Rein said Robinson agreed to plead guilty so his children could be spared any further grief and wouldn't have to suffer by testifying. Lillian Hussing said her mother took a plea bargain because of the uncertainty of a trial and fear she could be sent to prison for a long time.

As part of the deal, the prosecution agreed to drop four counts each against each parent, including child endangering. Prosecutors didn't agree to a sentence recommendation. Both Luskin and Rein had said they hoped the judge would consider probation.

"There's not a day my client ... starts without shedding a tear for his son," Rein said.

The coroner ruled that the boy was a victim of medical neglect and died from pneumonia due to Hodgkin lymphoma.

Hodgkin lymphoma is a highly treatable cancer, with as many as 95 percent of patients in early stages of the disease surviving for five years or more with treatment. It's one of the most common forms of cancers among children.

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