Colon Cancer

Is Screening Colonoscopy Worth It?

Hey guys, 

As you prepare for fall... the jackets, scarves and pumpkin spice lattes are sure to keep you comfortable as Los Angeles attempts to drop in temperature.  As the new season welcomes leaves to your lawn, it's also a great opportunity to turn over a new leaf yourself, and end the year in tip-top shape.

Did you know?  Colon Cancer is the second leading cause of cancer death in America, responsible for 58,000 deaths per year.  Did you know that a colonoscopy screening can prevent over 90% of these?

Everybody age 50 to 75 should be screened for colorectal cancer.  Patients at high risk—notably those with a family history, a known genetic risk, inflammatory bowel disease or certain other disorders—should start earlier.  

What are you afraid of?  A lot of people are unaware of their need to be screened with a colonoscopy. And even worse, many know they need it, though they are afraid of the procedure.  

Please, don’t be scared.  And please don't be stubborn. Do yourself and your family a favor and strongly consider giving me a call so we can take care of you.  And if you're under the recommended age of 50, please share this and encourage a loved one.  

Let's check-off the "I'm healthy!" box as you close 2014 safe and sound.  

It's a proven lifesaver.  And I'll be by your side the entire time.

Live well, 

-- Dr. Dale

 

The Elderly & Colon Cancer

This is interesting.  Please be share with your elderly friends and family. -- Dr. Dale

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Older Patients Fare Less Well After Colorectal Cancer Surgery

By David Douglas

April 15, 2014

NEW YORK (Reuters Health) - Although there's been a reduction in US colorectal cancer operations as well as improved outcome in recent years, the elderly still don't do as well as younger patients, according to California-based researchers.

As Dr. Michael J. Stamos told Reuters Health by email, "Although we were pleased to observe an overall decrease in the number of cases performed as well as a steady decrease in mortality, the risk adjusted mortality and morbidity of the elderly group remains substantially higher than the younger cohort."

In an April 9th online paper in JAMA Surgery, Dr. Stamos and colleagues at the University of California, Irvine note that an estimated 50% of all cancers and 70% of all cancer deaths occur in the elderly.

"With the 'graying' of the US population," continued Dr. Stamos, "more elderly patients can be expected to seek care, including for colorectal cancer. We therefore aimed to examine the trends and outcomes of colorectal cancer resection in the elderly by comparing patients over 65 years with patients between 45 and 64 years old."

The investigators used the Nationwide Inpatient Sample for the years 2001 to 2010. Over half (63.3%) of the more than 1 million patients estimated to have had colorectal cancer resection were more than 64 years old and 22.6% were 80 years old or older.

Elective laparoscopies were much more frequent in patients under 65 compared to those age 80 and above (46.0% vs 14.1%).

Patients age 80 and older were also 1.7 times more likely to undergo urgent admission than those younger than 65 years. Moreover, the older patients were more likely to stay at least 2.5 days and have hospital charges that were almost $9500 higher.

Over the study period, mortality decreased by a mean of 6.6%, with the most considerable decrease observed in the population 85 years old and older (9.1%).

Nevertheless, there was higher risk-adjusted in-hospital mortality with advancing age. The odds ratio ranged from 1.32 in patients aged 65 to 69 to 4.72 in those age 85 and older. Corresponding ratios for risk-adjusted morbidity were 1.25 and 1.96.

The researchers conclude that the data will help surgeons counsel patients and will "also reveal a demand for a reevaluation of current care patterns, reinforcing the need for future studies to account for the changing population landscape."

#Winning

THIS IS GOOD NEWS!!!!! -- Dr. Dale

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http://www.medscape.com/viewarticle/822296

Dramatic Decline in CRC in US Attributed to Colonoscopy

The latest statistics on colorectal cancer (CRC) in the United States, which go up to 2010, show that both incidence and mortality rates continue to fall.

Overall, deaths from CRC have been falling at around 3% per year over the last decade (2001 to 2010). Overall incidence rates have also been falling, by an average of 3.4% per year, but there is a marked variation by age. Incidence is decreasing in adults over 50 years of age, with a particularly sharp drop in the over-65s, attributed to colonoscopy, but it has increased slightly in younger adults under the age of 50. And blacks still have the highest burden of disease; they are 25% more likely to be diagnosed with colorectal cancer and 50% more likely to die from the disease than whites.

The findings, by Rebecca Siegel, MPH, and colleagues from the American Cancer Society, were published online March 17 in CA: A Cancer Journal for Clinicians.

The team analyzed data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program and the Centers for Disease Control and Prevention's National Program of Cancer Registries, as provided by the North American Association of Central Cancer Registries (NAACCR).

Dramatic Decline in the Over-65s

The researchers highlight the "dramatic decline" in CRC incidence seen in older adults (over 65s); it was falling at a rate of 3.6% from 2001 to 2008, but this decline accelerated in the last 2 years for which data are available, to 7.2% from 2008 to 2010.

This fall is probably related to the higher screening rates in this age group, Siegel told Medscape Medical News. Adults 65 and older have fewer barriers to screening related to cost because they are eligible for Medicare, which has covered colorectal cancer screening even for those at average disease risk since 2001.

In 2010, 64% of adults 65 and older reported being current for colorectal cancer screening versus 55% of adults 50 to 64, she noted. Although there are several different tests available for CRC screening, the "dramatic declines in incidence in recent years have been largely attributed to the uptick in colonoscopy because it is the only test for which use increased from 2000 to 2010; use of fecal immunochemical testing and sigmoidoscopy declined during that time period," she explained.

Colonoscopy offers a double whammy in that it can both prevent CRC by detecting and removing precancerous polyps and detect the cancer in its early stages, when there is a better chance of successful treatment.

Stool tests are very good for detecting cancer early, but much less able to lower incidence by detecting precancerous lesions, Siegel told Medscape Medical News.

Used to Be Top Cancer Killer

Back in the late 1940 and early 1950s, CRC was the most common cause of cancer death, the researchers note.

Now it has dropped to the third leading cause of cancer death (after lung cancer and prostate cancer in men and breast cancer in women).

This is in part due to historic changes in risk factors (such as decreased smoking, decreased red meat consumption, and increased use of aspirin), as well as the introduction and dissemination of early detection tests and improvements in treatment, the researchers write.

"This is great news," Siegel commented. "Colorectal cancer is 1 of only 2 cancers that we can actually prevent through screening, with cervical cancer being the other."

"Unfortunately, many adults — 23 million Americans — who should be screened for colorectal cancer have never been tested. It's important to get the word out about how life-saving these screening tests are," she said.

This point was highlighted in a press release from the American Cancer Society (ACS). The continuing drops in CRC incidence and mortality "show the lifesaving potential of colon cancer screening," commented Richard Wender, MD, chief cancer control officer at the organization.

The data in the study show that colonoscopy screening (in adults aged 50 to 75 years) increased from 19% in 2000 to 55% in 2010.

Dr. Wender highlighted an initiative from the National Colorectal Cancer Roundtable that aims to increase screening rates to 80% by 2018.

Disturbing Increase in Younger Adults

While the overall incidence of CRC has been falling over the last decade, the researchers note a distinct age divide — with a decrease of 3.9% per year among adults aged over 50 years, but an increase in incidence of 1.1% per year among adults under 50 years of age.

This increase in CRC among younger adults was confined to tumors of the distal colon (increasing by 1.3% per year) and the rectum (1.8% annually).

"Although the cause of this increase is unknown, the rise in obesity prevalence and the emergence of unfavorable dietary patterns have been implicated," they write.

A similar trend has been reported in Norway, the researchers note.

"We were actually among the first to publish this disturbing trend in 2009," Siegel commented. "Although the obesity epidemic is the obvious culprit, the rise is the strongest for rectal cancer and a link between obesity and rectal cancer has not been firmly established in women."

"It's important to note that ACS guidelines do recommend colorectal cancer screening beginning at age 40 for adults with first-degree relatives who were diagnosed with 1 or more polyps before age 60," she said.

 

[Follow up is important] even in young adults who are unlikely candidates for the disease.

 

"It is also important that clinicians are diligent about follow-up of colorectal cancer symptoms, even in young adults who are unlikely candidates for the disease," she added.

Higher Burden in Blacks

The review shows blacks continue to have the highest burden of disease.

The incidence of CRC is highest in blacks (approximately 25% higher than in whites), and there is an even greater disparity for CRC mortality rates, which are approximately 50% higher in blacks compared with whites (29.4 vs 19.2 per 100,000 population).

"A higher prevalence of risk factors and lower screening prevalence contributes to both the higher incidence and mortality in blacks," Siegel commented.

"In addition, blacks have lower survival than whites even for similar-stage disease. This is because blacks are less likely to receive standard-of-care treatment, including surgery, adjuvant chemotherapy, and radiation," she explained. Studies show that for similar-stage disease, equal treatment results in equal outcomes, she added.

In the study, the researchers trace back the history of this disparity. CRC mortality used to be lower in blacks compared with whites in the 1960s, and the racial crossover occurred around 1970 for women and 1980 for men. After that, rates diverged rapidly over the next 3 decades. During the 1980s and 1990s, steep declines had begun in whites, but the rates in blacks were still increasing (in men) or were stable (in women). This mortality gap appears to have leveled off in recent years, the researchers write. From 2006 to 2010, annual declines in mortality rates were similar among black and white men, and slightly larger among black than white women.

"The good news is that the gap in mortality rates between blacks and whites appears to have peaked in the mid-2000s and may be slowly growing smaller," Siegel commented.

A less scary colonoscopy?!

This is great research!!  Just had to share. -- Dr. Dale

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http://www.medscape.com/viewarticle/822198

Novel Stool DNA Test May Enhance Colon Cancer Screening

March 19, 2014

An investigational multi-target stool DNA test for screening colorectal cancer detects significantly more cancers than the currently available fecal immunochemical test (FIT), researchers report.

But it does so at the cost of more false-positive results.

"This new test is the most sensitive noninvasive test for detecting colorectal cancer," said lead study author Thomas F. Imperiale, professor of medicine at the Indiana University School of Medicine in Indianapolis.

"The advantages are that it could be done less frequently than annually. We are going to have to have computer simulation analyses tell us what an appropriate interval would be," he told Medscape Medical News in a telephone interview.

"The new test is very good at detecting curable-stage cancers. If there is a downside, it's that the specificity is not as good as FIT. That's the way it goes with diagnostic tests. The more sensitive they are, usually the less specific they are," he said.

The study was published online March 19 in the New England Journal of Medicine.

The test, known as Cologuard, is produced by Exact Sciences and was codeveloped by the Mayo Clinic. It consists of quantitative molecular assays for KRAS mutations, aberrant NDRG4 and BMP3 methylation, and β-actin, plus a hemoglobin immunoassay. The test is currently under review at the US Food and Drug Administration; the company is scheduled to appear before the Molecular and Clinical Genetics Panel of the Medical Advisory Committee on March 27.

Noninvasive Alternative to Colonoscopy

Despite widespread recommendations and the availability of several screening tests, a substantial proportion of the American population does not get screened. The noninvasive nature of this stool DNA test might make colorectal cancer screening more acceptable, Dr. Imperiale said.

He and his team evaluated 9989 asymptomatic people 50 to 84 years of age who were considered to be at average risk for colorectal cancer and who were scheduled to undergo a screening colonoscopy.

All participants provided a stool specimen before routine bowel preparation for colonoscopy.

On colonoscopy, colorectal cancer was identified in 65 participants — a prevalence of 0.7%. Of these, 60 had stage I to III cancers. In addition, advanced precancerous lesions were identified in 757 (7.6%) participants.

Stool DNA testing identified 60 of the 65 participants with cancer, for a sensitivity of 92.3%, including 56 of the 60 participants with stage I to III cancers, for a sensitivity of 93.3%.

DNA testing sensitivity did not vary significantly by cancer stage or location in the colon, Dr. Imperiale reported.

DNA testing also identified 321 of the 757 advanced precancerous lesions, 27 of the 39 (69.2%) participants with high-grade dysplasia, and 42 of the 99 (42.4%) participants with sessile serrated polyps 1 cm or larger.

The sensitivity of the DNA test increased as lesion size increased, and was higher for distal advanced precancerous lesions than for proximal lesions (54.5% vs 33.2%).

Age did not affect its sensitivity for detecting cancer.

For the 9167 participants who had colonoscopy findings other than colorectal cancer or advanced precancerous lesions, such as nonadvanced adenomas or negative results, the specificity of the DNA test was 86.6%.

For the 4457 participants with negative colonoscopy results, the specificity of the DNA test was 89.8%. In this subgroup, specificity was 94.0% for participants younger than 65 years and 87.1% for those 65 years and older.

For colorectal cancer, overall sensitivity was significantly better with DNA testing than with FIT (92.3% vs 73.8%; P = .002).

The sensitivity of DNA testing was also better than of FIT for advanced precancerous lesions (42.4% vs 23.8%; P < .001).

However, for people with nonadvanced or negative findings on colonoscopy, specificity was worse with DNA testing than with FIT (86.6% vs 96.4%; P < .001).

To detect 1 cancer, 154 people would need to be screened with colonoscopy, 166 with DNA testing, and 208 with FIT.

Number of False-Positives With Stool DNA Concerning

Results with this stool DNA test are "encouraging", said Douglas Robertson, MD, chief of gastroenterology at the White River Junction Veterans Affairs (VA) Medical Center in Vermont and associate professor of medicine at the Dartmouth Medical School in Hanover, New Hampshire.

He and his colleague, Jason A. Dominitz, MD, from the VA Puget Sound Health Care System and the University of Seattle, coauthored an accompanying editorial.

"The test is showing progress in terms of being able to detect cancer, but it remains to be seen how it will function in real-world clinical practice," Dr. Robertson told Medscape Medical News.

 

Dr. Douglas Robertson

"Ultimately, one of the dictums of colorectal cancer screening is that the best test is the one that gets done," he noted.

Another concern is the false-positive rate. The more frequently the test returns a false-positive result, the more colonoscopy exams will be required, he explained.

The interval with which this test would be applied in clinical practice is also not clear, Dr. Robertson said. "It probably can't be applied every year because the false-positive rate would be pretty high and you might end up doing colonoscopies on everybody over time anyway," he said.

"These are real-world practical issues that still need to be sorted out with stool DNA testing," he said. "It's exciting because the test clearly is functioning better than FIT, but how it will translate into clinical outcomes in practice we don't yet know."

Dr. Robertson said the results of this study could help to inform the US Preventive Services Task Force (USPSTF) as it re-evaluates recommendations for colorectal cancer screening.

"Right now, the USPSTF recommends 3 tests: colonoscopy, sigmoidoscopy, and stool testing with FIT. The last time they looked at the data, they didn't think there was enough support for fecal DNA testing so they did not endorse or recommend its use. This study might change that. Before, fecal DNA technology picked up about 50% of the cancers; now, in a similar study years later and with a newer version of the test, fecal DNA is detecting more than 90% of cancers," he explained.

"It is definitely working better than it used to; there's no question about that, Dr. Robertson said. "Whether the USPSTF will recommend it as an option remains to be seen."

The study was supported by Exact Sciences Inc. Dr. Imperiale has disclosed no relevant financial relationships. Dr. Robertson reports being on the advisory board of Pill Cam Colon (Given Imaging).

Colorectal cancer screenings RISE! (But Breast & Cervical fall.)

This is bittersweet.   According to Preventing Chronic Disease magazine and the NCI, "From 2008 to 2010, overall rates of breast and cervical cancer screening slightly decreased, but screening rates for colorectal cancer rose by 7 percentage points." Although it saddens me that screening for breast and cervical cancer have fallen, I'm so happy that colon cancer screenings have risen by 7% from 2008-2010.

Please don't ever forget how important all screening are to a healthy living.  Don't be scared!

I got you.

-- Dr. Dale

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Cancer Screening Rates Fall Below CDC Target Goals

Roxanne Nelson

March 05, 2014When it comes to cancer screening, the Healthy People initiative is short of meeting its targets, particularly for certain population subgroups.

From 2008 to 2010, overall rates of breast and cervical cancer screening slightly decreased, but screening rates for colorectal cancer rose by 7 percentage points.

The rates of cancer screening and counseling by healthcare providers were also below designated targets.

The report was published in the February issue of Preventing Chronic Disease.

"Our report tracks established Healthy People objectives," said report author Carrie N. Klabunde, PhD, an epidemiologist in the Health Services and Economics of the National Cancer Institute (NCI). "There are Healthy People objectives and target screening rates for breast, cervical, and colorectal cancer screening, all of which are recommended by the US Preventive Services Task Force."

However, Healthy People does not have a target screening rate for prostate cancer screening, she told Medscape Medical News.

"The Healthy People developmental objective is consistent with current US Preventive Services Task Force and other guidelines that advise doctor–patient discussions and informed decision-making on whether or not to undergo PSA testing," Dr. Klabunde explained.

The NCI and Centers for Disease Control and Prevention focus their cancer screening monitoring activities on the screening types and tests that are evaluated by the US Preventive Services Task Force, which is administered by the Agency for Healthcare Research and Quality, she added.

Healthy People is a program of nationwide health-promotion and disease-prevention goals, which are set by the US Department of Health and Human Service. The current report provides data from the National Health Interview Survey (NHIS), which is used for setting and evaluating several of the Healthy People targets in cancer.

Dr. Klabunde and her colleagues compared several Healthy People 2020 goals, including cancer screening and healthcare provider counseling, with established 2020 targets.

Breast and Cervical Cancer Screening Declines

For breast cancer screening, the Healthy People 2020 target goal is 81.1%. Overall, the proportion of women who reported getting a mammogram from 2008 to 2010 declined, but it was not significant. However, there were differences in the various segments of the population. Non-Hispanic blacks, non-Hispanic Asians, and women with public health insurance all showed decreases in screening, but in this time period, the changes were not significant.

Conversely, in 2010, women in the highest-income group exceeded the target goal of 81.1%, and the overall population and 7 designated subgroups fell within 10 percentage points of this target. But women lacking health insurance, those without a source of usual care, and those whose incomes fell below 200% of the federal poverty level were at least 20 percentage points below the target.

The decline in cervical cancer screening was more pronounced. In the same time period, cervical cancer screening overall declined significantly by 1.5 percentage points (P = .0479). There were also small nonsignificant decreases in most subgroups.

The researchers note that there were modest increases in screening for those without a source of usual care and non-Hispanic Asians — the 2 groups that had shown some of the lowest screening levels in 2008.

In 2010, the overall population, non-Hispanic whites, non-Hispanic blacks, those with private health insurance, and those with a usual source of care fell within 10 percentage points of the target screening goal of 93.0%. Women with the highest incomes (at or above 400% of the federal poverty level) were within 2 percentage points of the target, at 91.4%.

As with breast cancer screening, those lacking insurance and a usual source of care were at least 20 percentage points below the target.

Colorectal Cancer Screening Goes Up

In contrast to breast and cervical cancer screening, more people are getting screened for colorectal cancer. For the population as a whole, there was a significant increase of 7 percentage points from 2008 to 2010, and screening rates increased significantly for nearly all subgroups (except non-Hispanic Asians and the uninsured).

Although the screening goal of 70.5% wasn't met by any group, 4 subgroups (non-Hispanic whites, those with incomes at or above 400% of the federal poverty level, those with private health insurance, and those with a usual source of care) came within 10 percentage points of it. Conversely, as with the other types of cancer screening, individuals lacking insurance, those with incomes less than 200% of the federal poverty level, and those without a usual source of care were at least 20 percentage points below the target. The same was true for Hispanics and non-Hispanic Asians.

Counseling and Genetic Screening

According to 2010 estimates, 53.9% of women 21 to 65 years of age who underwent Pap testing in the previous 3 years also reported receiving a physician recommendation. This falls short of the 66.2% target. Similarly, 59.5% of women 50 to 74 years of age reported receiving a recommendation for a mammogram in the previous 12 months, which also fell short of the 76.8% target.

For mammograms and Pap tests, those without insurance or a usual source of care were furthest from the target rates.

Rates for genetic counseling for breast or ovarian cancer appear to have risen, from about 35% of eligible women in 2005 to nearly 60% in 2010. However, because of the small sample sizes, a trend toward increasing percentages cannot be confirmed, the researchers write. The 2020 target is 38.1%.

Dr. Klabunde and her colleagues point out that because counseling for PSA testing was a developmental objective for Healthy People 2020, no target was set. NHIS 2010 data indicate that 39.7% of men 50 to 74 years of age had received counseling about PSA testing, and counseling rates were slightly higher for men with higher incomes or private insurance. Conversely, they were quite low for men lacking health insurance or a usual source of care.

Prev Chronic Dis. 2014;11:130174. Abstract

Director's Briefing: Testing to Prevent Colon Cancer

In the latest Director’s Briefing video, CDC Director Dr. Tom Frieden talks about the importance of testing to prevent colon cancer. About 23 million adults haven’t gotten the life-saving tests they need to find colon cancer early. Testing can find precancerous growths and saves lives. People are encouraged to talk with their doc about testing options. The best test is the test that gets done.

Alternatives to colonoscopy.

So, guess what?  Colorectal cancer is the second-leading cause of cancer deaths in the U.S. for men and women combined, the illness is highly curable when detected early. BUT, there are alternatives to the often uncomfortable colonoscopy.

Virtual (CT Scan)

  • *no sedation
  • *still have to drink the "prep drink"
  • *misses polups less than a centimeter, which means the results could lead to a false sense of security.

Blood Stool Test

  • *have your doctor test your stool for blood.
  • *very good to DETECT colon cancer hopefully at an early stage, but does NOT prevent colon cancer.

I got you.

-- Dr. Dale

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Reminder: Aspirin + Everyday = Lower Risk for Colon Cancer

Q U I C KN O T E

I just wanted to remind everyone that taking a baby aspirin, or 81mg per day, helps lower the risk of colon cancer by 30%.

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Cancer.org

Screening still crucial

One proven method for preventing colon cancer is to get screened for the disease. "It is still very important to get screened for colorectal cancer so that colorectal polyps can be detected and removed before they ever turn into cancer," says Eric Jacobs, PhD, strategic director of epidemiology at the American Cancer Society.

The American Cancer Society recommends regular colon cancer screening for men and women starting at age 50. People who are at a higher-than-average risk of the disease (such as those with a family history of colon cancer) may need to begin getting tested earlier, or have more frequent tests.

That goes even for people who take aspirin regularly for other reasons, Jacobs notes. "Aspirin use will not prevent most cases of colorectal cancer."

Puffing the cancer stick.

Friends, We all know smoking is bad.  But why can't we stop?

We wear a seatbelt in the car.  We wear a jacket during blizzards.  Day-to-day we protect ourselves from harm.

We diet to appear healthy.  We exercise to feel healthy.  And we read articles to stay healthy.

Yet smoking, one of the most harmful addictions, is just too hard to quit.

Should this article influence you to stop smoking, speak with me for how I can help.  There are certain medications that can double your chances of quitting for good.  From there you'll cut cravings, cut withdrawals and save money.  Along with your life.

I got you.

-- Dr. Dale

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A surgeon general's report expands the death toll and list of diseases caused by smoking.

http://www.usatoday.com/story/news/nation/2014/01/17/surgeon-general-report-smoking/4476323/

Liz Szabo, USA TODAY

 

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A new report from the surgeon general finds that smoking causes even more physical and financial damage than previously estimated, killing 480,000 Americans a year from diseases that include diabetes, colorectal cancer and liver cancer.

The report, released today, represents the first time the surgeon general has concluded that smoking is "causally linked" to these diseases. The report finds that smoking causes rheumatoid arthritis, erectile dysfunction and macular degeneration, a major cause of age-related blindness. Smoking causes inflammation, impairs immune function and increases the risk of death from tuberculosis, an infectious disease. Smoking also harms pregnant women and their fetuses by causing birth defects called cleft lips and palates and by causing ectopic pregnancy, which occurs when a fertilized egg implants in the fallopian tubes instead of the uterus.

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The new report — issued 50 years after the first surgeon general report on smoking — finds that exposure to secondhand smoke, previously linked to cancer and heart attacks, also causes strokes.

"Amazingly, smoking is even worse than we knew," says Thomas Frieden, director of the Centers for Disease Control and Prevention. "Even after 50 years, we're still finding new ways that smoking maims and kills people."

In spite of 31 previous surgeon general reports on smoking, "the battle is not over," says acting Surgeon General Boris Lushniak. "The problem isn't solved. We still have 18% of our adult population smoking. And 5.6 million kids who are alive today will die early unless we take immediate action."

If it undertakes aggressive measures — such as educational campaigns, tax increases and bans on smoking in public places — Lushniak says the USA has the potential to "create a tobacco-free generation."

The report raises the annual death toll from smoking by about 37,000 additional lives lost, noting that tobacco has killed 20 million Americans since 1964, when the first surgeon general report on smoking was released. The higher death tolls reflect new science about how tobacco harms the body, the report says.

Nearly 2.5 million of those premature deaths were in non-smokers exposed to secondhand smoke. An additional 100,000 were babies who died of sudden infant death syndrome (SIDS) or complications from prematurity, low birth weight or other conditions caused by parental smoking.

Edward McCabe, the March of Dimes' chief medical officer, says he hopes the report will give women even more motivation to quit smoking before becoming pregnant. Nearly 21% of women of childbearing age smoke, although many quit at least temporarily after learning they're pregnant.

The American Diabetes Association has long advised diabetics to avoid tobacco smoke, says Robert Ratner, the group's chief scientific and medical officer. Smoking impairs how the body responds to insulin, he says.

Ratner says the science on smoking and diabetes is not clear-cut. Though population-based studies show smokers have an increased risk of diabetes, Ratner says, "I am unaware of any data which directly links smoking to causing diabetes."

Smoking exacts a huge financial toll, as well, costing the country nearly $286 billion a year in direct medical costs of smokers and those exposed to secondhand smoke, as well as in lost productivity due to premature deaths, the new surgeon general report says.

The report notes that the country has made major progress in combating tobacco since the 1964 report. Adult smoking rates have fallen by more than half since then to about 18%. In 2011, for the first time, a Gallup poll found that a majority of Americans supported a ban on smoking in all public places.

David Sutton, a spokesman for Altria, the parent company of tobacco giant Philip Morris USA, says he doesn't contest the scientific evidence that cigarettes cause cancer and other diseases.

"As we've said for some time, there is no safe cigarette," Sutton says. Philip Morris supports strong FDA regulation of tobacco, as well as tobacco-free products, such as electronic cigarettes. "FDA regulation has the potential to reduce the harm caused by smoking."

A spokesman for R.J. Reynolds Tobacco, a leading cigarette maker, declined to comment.

The American Lung Association and other health groups say the USA should aim to reduce adult smoking rates to less than 10% within the next 10 years.

The lung association outlined several steps to achieve this goal:

•The White House should release long-awaited rules regulating all tobacco products, including e-cigarettes and cigars. The group called on the White House to ensure all smokers have access to approved smoking-cessation medications and counseling.

•Congress should increase federal tobacco taxes and close loopholes, so all tobacco products are taxed equally.

•The Food and Drug Administration should remove menthol-flavored cigarettes from the market as a way to reduce the number of new smokers.

•States should fully fund anti-smoking efforts. States receive about $80 per person a year from the Master Settlement Agreement of 1998, between tobacco companies and state attorneys general, Frieden says. Although the CDC recommends that states spend at least $12 per person annually on tobacco control, states spend an average of $1.50. In comparison, Frieden says, the tobacco industry spends an average of $28 per person each year to promote its products.

Ah, ha, ha, ha, stayin' alive.

Love this!  Due to early screening, treatment and prevention, along with the decrease in smoking, cancer deaths have dropped 20% over the past 20 years. According to Ahmedin Jemal of the American Cancer Society, the most progress has been made in colon, breast and prostate cancer.

The report estimates that in 2014, "about 1,600 people will die from cancer each day." Additionally, "lung, colon, prostate and breast cancers are the most common causes of cancer death."  This is important to REMEMBER because these account for, "almost half of the all cancer deaths...just over one in four cancer deaths is from lung cancer," the researchers noted in the same report.

Friends and family, let's start this new year right.  SCREENING + TREATMENT = PREVENTION.

I got you!

Dr. Dale, Colon Globe Winning (something like that)

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http://consumer.healthday.com/cancer-information-5/breast-cancer-news-94/u-s-cancer-deaths-decline-again-report-683602.html

U.S. Cancer Deaths Decline Again: Report

Better prevention, screening and treatment are keys to continued progress, experts say

By Steven Reinberg HealthDay Reporter

TUESDAY, Jan. 7, 2014 (HealthDay News) -- The rate of cancer deaths among Americans continues to decline, according to a new report. Over the last 20 years, the overall risk of dying from cancer has dropped 20 percent, researchers found.

The fastest decline in cancer death risk has been among middle-aged black men, for whom death rates have dropped by about 50 percent, the study authors report.

"We continue to make progress against cancer," said report co-author Ahmedin Jemal, vice president for surveillance and health services research at the American Cancer Society.

But despite this progress, black men still have the highest cancer incidence and death rates of all groups -- about double those for Asian Americans, who have the lowest rates, the authors pointed out in a news release from the American Cancer Society.

The decline in cancer deaths from 1991 to 2010 varied by age, race and sex, researchers found. For example, there was no decline in deaths for white women 80 and older, but a 55 percent decline among black men aged 40 to 49 years old.

This progress is largely because of better prevention, screening and treatment, Jemal said. The dramatic decline in cancer among black men is most likely attributable to decreases in smoking, he added.

Jemal said most of the progress has been made in colon, breast and prostate cancer. These cancers can be screened for and, when caught early, have better outcomes, he said.

In addition, decreased smoking has reduced the number of lung cancers, Jemal said.

But some cancers, such as pancreatic cancer, for which there is no screening and for which treatment often comes too late, remain just as deadly, he said.

Jemal, however, expects a brighter future as screening increases as more Americans get access to health insurance through the Affordable Care Act. Not having insurance is the biggest barrier to screening, he explained.

Still, more needs to be done to close the improvement gap between races, an expert said.

"The halving of the risk of cancer death among middle-aged black men in just two decades is extraordinary, but it is immediately tempered by the knowledge that death rates are still higher among black men than white men for nearly every major cancer and for all cancers combined," John Seffrin, chief executive officer of the American Cancer Society, said in a society news release.

The report was published Jan. 7 in CA: A Cancer Journal for Clinicians.

Dr. Anthony D'Amico, chief of radiation oncology at Brigham and Women's Hospital in Boston, said, "The good news is that the rate of deaths has declined again for almost the 10th consecutive year."

D'Amico also believes that these declines are the result of better screening, especially screening for prostate cancer. In addition, new treatments are reducing deaths, he said.

"Something good is happening and I would attribute that to screening and better treatments," D'Amico said. "We have better treatments for men and women, so screening can only help," he added.

In 2014, it's estimated there will be over 1.6 million new cancer cases and nearly 586,000 cancer deaths in the United States, according to the report. Although the number of new cancers and cancer deaths continues to increase as the population increases and ages, the rate of new cancers and cancer deaths is declining, Jemal explained.

For men, prostate, lung and colon cancer will make up half of all newly diagnosed cancers. Prostate cancer alone will account for about one-quarter of the cases, the researchers estimate.

Among women, the most common cancers will be breast, lung and colon cancer. Taken together, these will account for half of all cases. Breast cancer alone is estimated to account for 29 percent of all new cancers.

In 2014, about 1,600 people will die from cancer each day, the report estimates. Lung, colon, prostate and breast cancers are the most common causes of cancer death. These account for almost half of the all cancer deaths. Just over one in four cancer deaths is from lung cancer, the researchers noted.

From 2006 to 2010, cancer rates dropped 0.6 percent per year among men while remaining stable among women. During the same time, death rates from cancer dropped by 1.8 percent per year among men and 1.4 percent per year among women, the investigators found.

Moreover, during the last 20 years, the death rate from cancer has continued to drop from a high of about 215 per 100,000 people to about 172 per 100,000 people in 2010. This means that 1,340,400 fewer cancer deaths (952,700 among men and 387,700 among women) were avoided during that time period, the researchers explained.

More information

For more facts on cancer, visit the American Cancer Society.

SOURCES: Ahmedin Jemal, Ph.D., vice president, surveillance and health services research, American Cancer Society; Anthony D'Amico, M.D., Ph.D., chief, radiation oncology, Brigham and Women's Hospital, Boston; American Cancer Society, news release, Jan. 7, 2014; Jan. 7, 2014, CA: A Cancer Journal for Clinicians

Last Updated: Jan. 07, 2014

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