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Tag: colonoscopy

  • New study finds alarming rise in cancer rates among people under 50

    New study finds alarming rise in cancer rates among people under 50

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    Queen Stewart, a lawyer and mother of two, learned she had breast cancer at age 35. She found the lump herself because she was too young for insurance-paid screenings.

    “I just cried, and I just worried so much about whether I would be here for my girls,” Stewart told CBS News. 

    According to a new study published this week in BMJ Oncology, cancer rates worldwide have risen dramatically in people under the age of 50.

    Researchers examined data from 204 countries between 1990 and 2019. They found that there were more than 3.26 million early-onset cancer cases reported in those countries in 2019, up from 1.82 million in 1990, an increase of 79.1%.

    The study defined early-onset cancer as a diagnosis that occurs between the ages of 14 and 49.

    The number of early-onset cancer deaths rose from about 800,000 in 1990 to 1.06 million in 2019, researchers found.

    Of the 29 types of cancer that were studied, breast cancer in 2019 accounted for the most early-onset cases, 16.5%, as well as the most early-onset deaths, 12.84%.

    Meanwhile, both early-onset prostate cancer and nasopharyngeal cancer showed the fastest increases in incident rates of any types of cancer over that 30-year period.

    “Those numbers are remarkable,” said Dr. Christopher Flowers, an oncologist at the University of Texas MD Anderson Cancer Center.

    The study said that while genetics is a contributing factor to the increase, poor diet, alcohol and tobacco use, physical inactivity and obesity also play major roles.

    “Dietary risk factors (diet high in red meat, low in fruits, high in sodium and low in milk, etc.), alcohol consumption and tobacco use are the main risk factors underlying early-onset cancers,” the study concluded.

    Researchers found that the availability of medical care by region can also impact the number of cases and deaths.

    “I think it’s important for younger individuals who meet screening criteria to consider and pursue screening at age-appropriate times,” Flowers said.

    In the U.S., the recommended age to start colon cancer screenings was recently lowered from age 50 to 45, while the recommended age for breast cancer screenings was lowered from 50 to 40.

    “Look at the importance of screening, and that really gets to the point around those screenable cancers: there’s breast cancer, colorectal cancer, cervix cancer,” Flowers said.

    The study projected that early-onset cancer rates will increase 31% by 2030, while cancer deaths will rise 21%. 

    Meanwhile, Stewart had a double mastectomy, chemotherapy and radiation. She’s now in remission and says she has a new lease on life.

    “It had me create a sense of urgency in my life to live now, to find joy, to be more present for my family,” Stewart said. 

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  • Mayim Bialik Shares Selfies From Her Colonoscopy: ‘It’s Not Terribly Fun Getting Older’

    Mayim Bialik Shares Selfies From Her Colonoscopy: ‘It’s Not Terribly Fun Getting Older’

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    By Brent Furdyk.

    Mayim Bialik has a message for people in her age group: get a colonoscopy!

    The 47-year-old “Big Bang Theory” alum posted a video and a few selfies on Instagram, in which she’s wearing a hospital gown about to undergo a colonoscopy.

    “It’s not terribly fun getting older. Especially when you have to get a routine colonoscopy and really wish you didn’t have to,” she wrote.


    READ MORE:
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    “Well, I’m sharing this because: 1. Let’s remove the stigma of routine things that we really should not have problems as a society talking about – ignoring things doesn’t make them go away! Also let’s not be Puritanical about colonoscopies. It’s a thing. 2. It wasn’t bad at all. 3. I have tips to share another time to help you not have it be so bad. 4. Please don’t put off taking care of your body. It’s connected with your mind and your mental and emotional well-being. Be proactive,” she added.

    She then shared a followup video to let her followers know how it all went.

    “Okay, I am home. I have survived the colonoscopy,” she shared, but admitted that “the prep can be daunting.”


    READ MORE:
    Mayim Bialik, Ken Jennings Have Only Met Twice In Person Since Joining ‘Jeopardy!’

    “This is one of those things a lot of people put off,” she added. “And I highly recommend you do not put it off if you are of the age they recommend a colonoscopy… preventative care in this arena is very important.”

    She concluded by saying, “It’s not as scary as you anticipate. I survived and you can, too.”

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    Brent Furdyk

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  • Seniors With Few Years Left Often Advised to Get Colonoscopy

    Seniors With Few Years Left Often Advised to Get Colonoscopy

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    March 21, 2023 – Most of the time, when a polyp is found during an older adult’s colonoscopy, it is unlikely that a concerning polyp or colon cancer will be found during a future surveillance scan. Yet most patients are advised to repeat the colonoscopy even if they aren’t expected to live very long, a new study has found. 

    “Given the lack of clear guidance about when to stop colonoscopy in older patients, I am not surprised that physicians recommend surveillance even in patients with low life expectancy,” said Ziad Gellad, MD, MPH, with Duke University Medical Center in Durham, NC, who was not involved in the research.

    “These are nuanced decisions that require shared decision making. It’s not easy to tell patients that they are too old to get preventive care, especially patients in whom your only interaction is the procedure itself,” Gellad said. 

    Current guidelines recommend doctors and patients make decisions about repeat colonoscopy in older adults with prior polyps, weighing the potential benefits (identifying and removing meaningful polyps to prevent cancer) against the burdens and potential harms, such as bleeding.

    While most colon polyps are not harmful, a subset of polyps, if allowed to grow, have the potential to develop into cancer, a transformation that can take 10 to 15 years. This long timeline highlights the importance of considering life expectancy in deciding which patients should have a repeat colonoscopy.

    The new study involved nearly 10,000 adults age 65 and older undergoing surveillance colonoscopy due to a prior polyp. Fewer than 1 in 10 of these individuals were found to have advanced polyps or colorectal cancer during a repeat colonoscopy. 

    Yet the vast majority (87%) of individuals whose doctor gave a recommendation to stop or continue colonoscopy were advised to return for another procedure at some point – even when they had no significant colonoscopy findings or limited life expectancy, including less than 5 years. 

    In some cases, the recommended time to repeat colonoscopy was greater than the individual’s life expectancy.

    Complications during colonoscopies happen to about 26 in every 1,000 people — nearly 10 times greater than the potential benefits as seen in their study in terms of identifying cancer.

    These findings “may help refine decision-making” about the potential benefits and harms of pursuing or stopping surveillance colonoscopy in older adults with a history of polyps, write the investigators, led by Audrey Calderwood, MD, with Dartmouth Hitchcock Medical Center in Lebanon, NH. 

    Based on their findings, they think older adults expected to live fewer than 5 more years should skip surveillance colonoscopy.  The same goes for individuals whose life expectancy is between 5 and less than 10 years and they only have “low risk” polyps.

    For the healthy senior with a life expectancy of 10 or more years and recent “advanced” polyps, they suggest the doctor provide a recommendation for future surveillance colonoscopy with a caveat that the ultimate decision is dependent on health and priorities at the time the colonoscopy is due.

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  • Your Next Colonoscopy Could Get an Assist From AI

    Your Next Colonoscopy Could Get an Assist From AI

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    Nov. 11,  2022 – Artificial intelligence holds a lot of potential in medicine, helping doctors find skin cancer, flagging potential issues on a chest X-ray, and assisting in many other procedures. Screening for colorectal cancer during a colonoscopy is another prime example.  

    A colonoscopy — recommended for Americans at average cancer risk starting at age 45 — won’t be much different for patients with the addition of artificial intelligence, or AI. But behind the scenes, AI could be making detection of any precancerous polyps or cancerous lesions more likely. 

    “AI-enhanced colonoscopy effectively turbocharges the physician’s ability to find even the most subtle precancerous polyps,” says Tyler M. Berzin, MD, a gastroenterologist at the Center for Advanced Endoscopy at Beth Israel Deaconess Medical Center in Boston. 

    The technology is designed to flag anything the computer “sees” as suspicious, but it does not replace the training and expertise of a gastroenterologist. Even with AI, doctors remain at the patient’s side and perform the procedure. 

    The doctor remains in full control, says Prateek Sharma, MD, a gastroenterologist and professor of medicine at University of Kansas School of Medicine in Kansas City, KS. “AI is assisting and alerting them to colon polyps — the precancerous lesions in the colon — so that the doctor can remove them.”

    Controversy Continues

    Size, height, and numbers matter with polyps. Doctors generally remove or biopsy lesions 10 millimeters and larger. 

    But there remains less consensus about the best approach to smaller polyps.

    “The clinical relevance of detecting and removing small (5 to 9 mm) or diminutive (less than 5 mm) adenomas is a subject of ongoing debate,” Berzin and co-authors wrote in a leading gastroenterology journal in May 2020. 

    One of the potential disadvantages to using AI polyp tools, for example, is “the risk of removing a higher number of diminutive or hyperplastic polyps, which increases cost and risk, without any benefit to the patient,” Berzin says. 

    “Trained gastroenterologists are experts at identifying and removing precancerous colon polyps,” Berzin says. “But a gastroenterologist working with an AI polyp detection tool has a big advantage because AI computer vision tools can simultaneously analyze every pixel of the endoscopy monitor and can do so without being distracted or fatigued for even a millisecond.”

    The benefit for patients is “another pair of eyes looking for polyps and helping the doctor,” says Sharma, who is also chair of the Artificial Intelligence Task Force at the American Society for Gastrointestinal Endoscopy.

    How It Works

    AI is based on computer instructions called algorithms that learn the difference between worrisome and benign colonoscopy images and videos. AI gets better over item in a process called machine learning. When an AI system spots a potential area of concern, the technology calls attention to it by framing it within a box on the screen. Some systems also sound an audible alarm. 

    “We are seeing more interest in using these algorithms since they will standardize endoscopists’ polyp detection and, therefore, reduce the number of colon cancers missed,” says Sravanthi Parasa, MD, a gastroenterologist at the Swedish Health Services in Seattle. 

    “These products are slowly gaining traction. During colonoscopy scheduling, patients should ask if their endoscopist has access to augmented diagnostic tools,” she says. 

    The technology is not accurate 100% of the time – there can be false positives where the system flags a bubble in the colon, for example, as potentially dangerous. That’s just one reason that doctors still have the final say on whether a polyp is suspicious or not. 

    AI or no AI, “colonoscopy has long been our most effective tool for preventing colon cancer, detecting precancerous polyps earlier than any other screening method,” says Berzin, who is also an associate professor of medicine at Harvard Medical School.

    AI Can Be Costly

    AI and machine learning already play a role in “smart” technologies (smartphones, smartwatches, and smart speakers), self-driving cars, and speech recognition software. But the use of AI in medicine is comparatively new. And like a lot of novel technologies, it’s also expensive. “The AI equipment needs to be purchased and is expensive,” Sharma says.  

    “The cost of the algorithms currently can be prohibitive for some centers in the current health care landscape,” Parasa agrees. “The cost is likely to come down as more algorithms enter the GI market, as it is with other software solutions.”

    Colorectal Cancer Is Common

    Not counting some kinds of skin cancer, colorectal cancer is the fourth most common cancer in Americans. It is also the fourth leading cause of cancer-related deaths in the United States, the CDC reports. More than 150,000 Americans will be diagnosed with colorectal cancer and more than 50,000 will die in 2022, according to National Cancer Institute figures

    Future Insights

    More research is needed to examine how humans and this technology interact, Berzin says. “The most interesting research in this space will not be about comparing ‘physician versus AI,’ but will be focused on understanding the nuances of ‘physician plus AI.’”

    In the U.S., there are at least three FDA-approved AI algorithms for polyp detection, and more are being developed, Parasa says. 

    “In addition, other applications which are currently available on the European market might be available in the U.S. market in the near future, including polyp characterization.”

    “As the field matures, we will likely see more AI augmentation tools that will assist us in detecting and diagnosing GI conditions in real time,” she adds. “A suite of algorithms like this will definitely improve patient care and outcomes.”

    Even though AI is somewhat of a work in progress in medicine, Berzin expects the combination of doctor and AI technology “will translate into the highest possible protection from colon cancer in the long term.”

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  • How a Wrong Diagnosis Masked a Young Woman’s Cancer

    How a Wrong Diagnosis Masked a Young Woman’s Cancer

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    Nov. 7, 2022 — Two years ago, then 28-year-old Ashley Teague began losing weight. At the time, the Indianapolis, IN, native and mother of two was 6-foot-1 and weighed about 270 pounds.

    She chalked it up to her busy schedule. She had started a photography business and was travelling “all the time.”

    She didn’t know why, but she began losing weight without exercising and without changing her diet, she says. 

    But a few months later, Teague began having intermittent pain on her left side. She went to see he doctor, who said she needed blood work. After everything came back normal, she was told to change her diet and avoid spicy food, which she says she did. 

    A few weeks later, Teague says she began having black, tar-like stools and then diarrhea. She says whatever she ate went right through her within 10 to 15 minutes of eating, so she went back to the doctor.

    Worried, she questioned if she should get a colonoscopy. She says she was turned down, being told she was too young to need the procedure. Desperate for answers, Teague asked for additional tests.

    “I said OK, can I at least get a CT? Can we just run some more tests because I know my blood work came back fine, but I’m literally telling you, something’s not right, I’m not feeling right. I’m not sleeping through the night, I’m being woke up to my stomach [sounding like] somebody’s fighting in there, it’s just a constant rumble. And she’s like ‘OK, it sounds like IBS, so we’re going to treat you for IBS.’”

    The results of the CT scan and more blood work came back fine, but she says the IBS medication provided no relief.

    “I go back [and] I said, “This stuff isn’t working. The medicine for IBS isn’t working,” she says, noting that at this point, she was having blood in her stools.  

    Teague’s 56-year-old mother was also a patient at the same medical practice where she was being treated. After being diagnosed with kidney cancer at 38 and then breast cancer at 52, the two-time cancer survivor underwent genetic testing and found out she had Lynch syndrome, which is a genetic disorder caused by a mutation in a gene. It increases the risk of various types of cancer.

    The gene typically is inherited and is passed from parents to children. If one parent has it, there’s a 50% chance their children will also have the gene. According to the CDC, people with Lynch are more likely to get colorectal, endometrial, stomach, liver, kidney, brain, and skin cancers. And they often develop these cancers at an early age — before they turn 50.

    Colorectal and endometrial cancers are the most common cancers caused by Lynch. The likelihood of getting colon cancer if you have the condition can be as high as 80% to 85%.

    The syndrome is extremely underdiagnosed. Most people aren’t aware they have the gene until they get cancer and undergo genetic testing. Lynch Syndrome International, an organization founded by survivors, their families, and health experts specializing in the syndrome, estimates that about 1 million people in the U.S. have Lynch syndrome but only 5% are currently diagnosed.

    Teague says she told her providers that her mother had Lynch syndrome, but they never suggested she be tested for the disorder.

    “I’m telling them my mom had Lynch, I’m telling them that she had kidney and breast cancer.”

    But when her father had cancerous polyps removed from his colon, “all of a sudden everybody’s scrambling to get me a colonoscopy,” she says. 

    By now, 7 months had gone by. Teague’s colonoscopy revealed a large mass that was the size of a baseball on her colon. It was cancerous. 

    “My heart just sank,” she says. 

    Teague says she got excellent care from her surgeon. But unfortunately, most of her colon had to be removed. 

    “They left me about 5 to 6 inches of colon. He was able to merge it with my small intestine so that I wouldn’t have to have a colostomy bag and would still be able to use the restroom regularly,” she says. 

    Teague says the surgeon who treated her was the first doctor to suggest she get tested for Lynch syndrome. Once she did, it wasconfirmed that she did have the condition. The American Cancer Society estimates there will be 106,180 new cases of colon cancer in the U.S. this year. Approximately 4,200 colorectal cancers a year are caused by Lynch syndrome, according to the CDC. 

    Moving Forward

    It may seem like what Teague experienced is extreme, but Otis Brawley, MD, professor of oncology and epidemiology at Johns Hopkins University, says most of what happened during her 7-month journey was not so out of the ordinary.

    “If you have someone who is 28 years old who comes in, ‘I’ve got weight loss, I’ve got nondescript symptoms,’ the doctor should — because so many people come in with that and it is absolutely nothing — the doctor should talk to them, the doctor should counsel them, and the doctor should not go directly to a colonoscopy even though the patient is asking for one.”

    But “if they have a prolonged period of having these problems, several months, well documented where they come back to the doctor several times, then it might be appropriate to do some imaging to include colonoscopy,” he says. 

    Brawley also says that people with Lynch should undergo surveillance of their colon and several other organs like the uterus, starting in their 20s. 

    His advice to someone having a similar experience to Teague: Be persistent.

    “Try to keep an open dialogue with your [doctor] and preferablytry to keep the same [doctor],” he says. “Let them know that what you started trying out last week, 2 or 3 or 4 weeks ago, is not working and you still have the symptoms. That is all part of the diagnostic process. The mistake is some people think, ‘Oh, I came in and I said I had this, the doctor should diagnosis it immediately.’ That is not the case. Very frequently you have to go back over and over again to see the doctor. And it’s very common for people to have very nondescript abdominal problems, and it’s fine to say ‘I believe this is irritable bowel syndrome and let’s do these things and if it continues, come back.’ And that’s the way it should be worked at.”

    But Brawley concedes it’s hard to second guess these things when you weren’t in the room.

    That said, “black, tarry stools actually mean blood in the stools,” he says. “That would prompt most doctors to want to do some type of colonoscopy.”

    Still, it’s not always cut and dry.

    Teague says when she told the doctors there was blood in her stools, they ordered a CT scan, which Brawley says was “the appropriate thing to do.”

    Teague was persistent. She made multiple trips to her doctor’s office. She says sometimes she was in such pain she made several visits to the emergency room, creating a paper trail.

    From the time she started going to the doctor with symptoms to the time the colonoscopy found the tumor was 7 months. By then, she had lost about 30 pounds.

    “A little bit outside of the length of time that it would be, that I would consider to be normal,” Brawley says. “I would say, I would hope that these sorts of things would be diagnosed within 3 or 4 months, but 7 months with folks having appointment issues and especially during COVID time, that’s not that outrageous, it’s on the edge of what I would call acceptable.”

    “Unfortunately, in our system, our system is not that great in doing things expediently,” Brawley says. 

    Mandeep Sawhney, MD, associate professor of medicine at Harvard Medical School and a gastroenterologist at Beth Israel Deaconess Medical Center, is a Lynch syndrome expert. He says the rates of colon cancer and the number of people dying from the disease are going down. All good news, but that’s only half the story.

    “For reasons that we don’t fully understand, the rates of colon cancer are increasing in our younger patient population, and that’s unusual. People born in 1990 are two times more likely to develop colon cancer and four times more likely to develop rectal cancer than people born in 1950. A significant proportion of cancers that develop in young patients are the result of syndromes like Lynch syndrome. And because cancers overall are uncommon in young patients, it often takes much longer for them to get diagnosed because [doctors] don’t often think that a person in their 20s or 30s could have colon cancer.”

    “One of the things we’ve been really been talking to our primary care [doctors] about, especially with the understanding that there’s a marked increase in young people getting colon cancer, is to keep that up and center when you see a patient who’s complaining of bleeding from rectum and when you see a patient who’s complaining of change in bowel habits that you don’t have a good explanation for. Don’t ignore young patients with bleeding or these symptoms. Consider a full evaluation like you would with an older patient.”

    Sawhney recommends that children of Lynch syndrome patients get tested between 16 to 18 years of age.

    “If you look at 100 young patients who develop colon cancer, I’d say about 25% to 30% will have Lynch syndrome, but the other 70% we never come up with an explanation for why they develop cancer at a young age. And that’s worrisome, especially considering that we really made big strides in colon cancer because of screening, because of colonoscopy that are being done. For once, we are actually seeing a drop in the number of cancers that are being diagnosed, and that’s great, but at the same time we’re seeing this alarming trend where for reasons we just don’t understand, young people, sometimes in their 20s or 30s are getting colon cancer, which we never really saw before.”

    Two years out from her surgery, Teague has not fully regained her appetite. She says her mental health has deteriorated. She has anxiety, is a bit more paranoid, and says she’s becoming a hypochondriac. But she believes she survived her ordeal for a reason. So she’s sharing her story in the hopes it may help others, especially millennials.

    “I do want our millennials to know do not be discouraged. Keep going to the doctors, keep making the appointments, keep going to the ER, create a paper trail so once you do get a doctor who’s going to take you seriously, they can look back,” she says. “Do not be discouraged by no insurance, do not be discouraged by our age, do not be discouraged by the circles that the medical professionals talk. Don’t let anyone talk circles around you, don’t let anyone convince you that you’re not feeling what you’re feeling. If you know something’s not right, if you feel something’s not right, keep advocating for yourself.”

    Teague says she will have her daughters, ages 10 and 6, tested for Lynch when they turn 18.

    A GoFundMe page has been set up to help with her medical bills as well as the startupcosts for a foundation she’s creating to shine a light on colon cancer awareness and educate people globally about Lynch syndrome.

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  • Colonoscopy Benefits Lower Than Expected, Study Shows

    Colonoscopy Benefits Lower Than Expected, Study Shows

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    Oct. 10, 2022 — Getting a colonoscopy might not offer as many benefits as we previously thought about what is considered a gold standard in cancer screening, according to a surprising new study out of northern Europe. 

    After a 10-year follow-up study of people who were invited to receive a colonoscopy, researchers compared their results to a group of people who did not get the cancer screening. The former group had only an 18% lower risk of getting colon cancer, and the procedure didn’t make much difference in colon cancer deaths, according to results published in The New England Journal of Medicine.

    Colon cancer — the second leading cause of cancer in the U.S. and the third in the world — is commonly found in adults over age 50.

    During a colonoscopy, doctors insert a small camera through your anus to examine your large intestine and rectum (AKA your colon).

    “The absolute risks of the risk of colorectal cancer and even more so of colorectal cancer–related death were lower than those in previous screening trials and lower than what we anticipated when the trial was planned,” says Michael Bretthauer, MD, a gastroenterologist from the University of Oslo Department of Medicine in Norway, and lead researcher of the study.

    If you hate colonoscopies, don’t start jumping with glee just yet. The study also had its flaws. 

    Researchers invited about 28,000 people enrolled in a long-term Northern European healthy study to get a colonoscopy. A little less than half — 42% — (actually received it. 

    “It’s hard to know the value of a screening test when the majority of people in the study didn’t get it done,” says William Dahut, MD, chief scientific officer at the American Cancer Society.

    However, study patients who did undergo a colonoscopy had a 31% decrease in the risk of colorectal cancer, and cancer-related deaths dropped in half as compared to those who were not screened. This result points to the value of continued screening.

    Getting a colon cancer screening is still the best method of prevention, says Karen Knudsen, PhD, chief executive officer at the American Cancer Society.

    “The American Cancer Society recommends colorectal cancer screening, including colonoscopy, for adults beginning at age 45,” Knudsen says. “There’s no reason to change that direction. Recommended cancer screenings should be a routine part of good health.”

    Click here for more information on colon cancer screening.

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