Save a life.

Your life! Just a quick post to share yet another journal article explaining the importance of getting a colonoscopy.

You can literally save your life just by getting checked.

I got you.

-- Dr. Dale

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Colorectal cancer screening cuts long-term mortality

By: MARY ANN MOON, Frontline Medical Communications

The long-term incidence of colorectal cancer was lower in patients who underwent screening by either endoscopy or fecal occult-blood testing than in those who did not, even if that screening took place decades earlier, according to two separate reports published online Sept. 19 in the New England Journal of Medicine.

Importantly, colorectal cancer–related mortality also was correspondingly lower in screened patients.

Identifying and removing colorectal polyps yields far-reaching benefits, saving lives for up to 30 years afterward, researchers involved in both studies said.

Dr. Aasma Shaukat

In the first study, Reiko Nishihara, Ph.D., of the Dana-Farber Cancer Institute and Harvard Medical School, Boston, and her associates assessed lower-GI endoscopy’s effect on the long-term risk of incident colorectal cancer in two large U.S. cohorts that were prospectively followed for 22 years. The Nurses’ Health Study involved 121,700 female nurses aged 30-55 years at baseline in 1976, and the Health Professionals Follow-Up Study involved 51,529 male health professionals aged 40-75 years at baseline in 1986.

For their secondary analysis of data from these cohorts, Dr. Nishihara and her colleagues examined the records of 57,166 female subjects and 31,736 male subjects who developed 1,815 incident colorectal cancers during 22 years of follow-up. "We were able to directly compare actual incidences of cancer among persons after polypectomy with the incidences among persons from the same background population who did not undergo endoscopy, while adjusting for potential confounders."

At their own discretion, 14,287 of the men and 31,423 of the women had undergone no lower endoscopy at all by 1998, the midpoint of follow-up; 3,578 men and 3,957 women had undergone colonoscopy with negative results; 8,091 men and 16,748 women had undergone sigmoidoscopy with negative results; and 1,259 men and 1,481 women had undergone lower endoscopy with polypectomy.

At the end of follow-up, the incidence of colorectal cancer was significantly lower among the men and women who had undergone any of these screening methods than among those who had not had any screening. The multivariate hazard ratios for colorectal cancer were 0.57 after endoscopy plus removal of adenomatous polyps (polypectomy), 0.60 after negative sigmoidoscopy, and 0.44 after negative colonoscopy.

"We estimated that 40% of colorectal cancers (including 61% of distal colorectal cancers and 22% of proximal colon cancers) that developed during follow-up would have been prevented if all the participants in our study had undergone colonoscopy," the investigators said (N. Engl. J. Med. 2013 Sept. 19 [doi:10.1056/NEJMoa1301969]).

This decrease in colorectal cancer occurred in both men and women, across all stages of disease at presentation, and regardless of subject age, body mass index, smoking status, or use of aspirin prophylaxis.

"Negative colonoscopy was associated with a lower incidence of both distal colorectal cancer and proximal colon cancer, whereas negative sigmoidoscopy and colonoscopy with polypectomy were associated primarily with a lower incidence of distal colorectal cancer," they said.

Notably, screening sigmoidoscopy and screening colonoscopy were associated with lower colorectal cancer–specific mortality, compared with no endoscopy.

The association between a negative colonoscopy and a significantly reduced incidence of colorectal cancer persisted for up to 15 years after the procedure. Thus, "our findings support the 10-year examination interval recommended by existing guidelines for persons at average risk who have a negative colonoscopy. Our study suggests that even a single negative colonoscopy is associated with a very low long-term risk of colorectal cancer," Dr. Nishihara and her associates said.

Among study subjects who were found to have adenomas, the reduced incidence of colorectal cancer persisted for up to 5 years after the procedure. Thus, "our data support screening at more frequent intervals for persons with a family history of colorectal cancer, which [also] supports current surveillance guidelines."

The researchers also examined DNA from stored specimens of tumors from 62 patients who developed colorectal cancer within 5 years of "passing" an endoscopy. Compared with other cancers, these interval cancers were much more likely to have CpG island methylator phenotype (CIMP), microsatellite instability, and high levels of LINE-1 methylation – all indicators of increased tumor aggressiveness.

It is possible that such lesions are particularly difficult to detect endoscopically or to remove adequately. "It remains unclear whether any of the challenges posed by these biological differences can be addressed by improvements in colonoscopic technique, including more meticulous inspection or improved bowel cleaning," the researchers said.

In the second study, a different research group found that adults who were screened for colorectal cancer using fecal occult blood testing (FOBT) had a 32% decrease in colorectal cancer–related mortality for up to 30 years afterward.

This association appeared to be stronger for men than for women, said Dr. Aasma Shaukat of the Minneapolis Veterans Affairs Health Care System and the University of Minnesota, Minneapolis, and her associates.

They performed a secondary analysis of data from the Minnesota Colon Cancer Control Study, in which 46,551 healthy men and women aged 50-80 years at baseline in 1975 through 1978 were randomly assigned to undergo annual, biennial, or no FOBT screening until 1993. Dr. Shaukat and her colleagues attempted to identify the mortality status and cause of death for as many of these study subjects as possible in 2011.

They identified 33,020 deaths, which represents 71% of the entire study population. A total of 732 deaths were from colorectal cancer.

Both annual and biennial FOBT screening reduced colorectal-cancer-specific mortality by approximately one-third for up to 30 years. The relative risk of death from colorectal cancer was 0.68 with annual FOBT and 0.78 with biennial FOBT, compared with no FOBT. Overall, the relative risk of death with any FOBT screening was 0.73, compared with no FOBT.

This reduction "is consistent with the effect of removing adenomas that would have progressed to cancer and death," Dr. Shaukat and her associates said (N. Engl. J. Med. 2013 [doi:10.1056/NEJMoa1300720]).

The decline in colorectal cancer-specific mortality was greater for men than for women.

"The high accessibility and acceptability of stool-based tests have major public health implications for improving screening rates, although this approach to screening involves more frequent testing than does screening with flexible sigmoidoscopy or colonoscopy," the investigators noted.

Dr. Nishihara’s study was supported by the National Institutes of Health, the Bennett Family Foundation, and the Entertainment Industry Foundation. Dr. Nishihara reported no ties to industry sources; one of her associates reported ties to Bayer Healthcare, Pfizer, Millenium Pharmaceuticals, and Pozen. Dr. Shaukat’s study was supported by the Veterans Affairs Merit Review Reward Program, the National Institutes of Health, and the National Cancer Institute. Dr. Shaukat and her associates reported no financial conflicts of interest.

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Copyright © 2014 Frontline Medical Communications . All rights reserved. This page was printed from http://www.acssurgerynews.com. For reprint inquires, call 877-652-5295, ext. 102.

New 3-D colonoscopy eases detection of precancerous lesions

This is exciting! http://www.eurekalert.org/pub_releases/2013-07/miot-n3c073113.php

New 3-D colonoscopy eases detection of precancerous lesions

New technology offers three-dimensional images, making it easier to detect precancerous lesions

Cambridge-- MIT researchers have developed a new endoscopy technology that could make it easier for doctors to detect precancerous lesions in the colon. Early detection of such lesions has been shown to reduce death rates from colorectal cancer, which kills about 50,000 people per year in the United States.

The new technique, known as photometric stereo endoscopy, can capture topographical images of the colon surface along with traditional two-dimensional images. Such images make it easier to see precancerous growths, including flatter lesions that traditional endoscopy usually misses, says Nicholas Durr, a research fellow in the Madrid-MIT M+Vision Consortium, a recently formed community of medical researchers in Boston and Madrid.

"In conventional colonoscopy screening, you look for these characteristic large polyps that grow into the lumen of the colon, which are relatively easy to see," Durr says. "However, a lot of studies in the last few years have shown that more subtle, nonpolypoid lesions can also cause cancer."

Durr is the senior author of a paper describing the new technology in the Journal of Biomedical Optics. Lead author of the paper is Vicente Parot, a research fellow in the M+Vision Consortium. Researchers from Massachusetts General Hospital (MGH) also participated in the project.

In the United States, colonoscopies are recommended beginning at age 50, and are credited with reducing the risk of death from colorectal cancer by about half. Traditional colonoscopy uses endoscopes with fiber-optic cameras to capture images.

Durr and his colleagues, seeking medical problems that could be solved with new optical technology, realized that there was a need to detect lesions that colonoscopy can miss. A technique called chromoendoscopy, in which a dye is sprayed in the colon to highlight topographical changes, offers better sensitivity but is not routinely used because it takes too long.

"Photometric stereo endoscopy can potentially provide similar contrast to chromoendoscopy," Durr says. "And because it's an all-optical technique, it can give the contrast at the push of a button."

Originally developed as a computer vision technique, photometric stereo imaging can reproduce the topography of a surface by measuring the distances between multiple light sources and the surface. Those distances are used to calculate the slope of the surface relative to the light source, generating a representation of any bumps or other surface features.

However, the researchers had to modify the original technology for endoscopy because there is no way to know the precise distance between the tip of the endoscope and the surface of the colon. Because of this, the images generated during their first attempts contained distortions, particularly in locations where the surface height changes gradually.

To eliminate those distortions, the researchers developed a way to filter out spatial information from the smoothest surfaces. The resulting technology, which requires at least three light sources, does not calculate the exact height or depth of surface features but creates a visual representation that allows the colonoscopist to determine if there is a lesion or polyp.

"What is attractive about this technique for colonoscopy is that it provides an added dimension of diagnostic information, particularly about three-dimensional morphology on the surface of the colon," says Nimmi Ramanujam, a professor of biological engineering at Duke University who was not part of the research team.

The researchers built two prototypes — one 35 millimeters in diameter, which would be too large to use for colonoscopy, and one 14 millimeters in diameter, the size of a typical colonoscope. In tests with an artificial silicon colon, the researchers found that both prototypes could create 3-D representations of polyps and flatter lesions.

The new technology should be easily incorporated into newer endoscopes, Durr says. "A lot of existing colonoscopes already have multiple light sources," he says. "From a hardware perspective all they need to do is alternate the lights and then update their software to process this photometric data."

The researchers plan to test the technology in human patients in clinical trials at MGH and the Hospital Clinico San Carlos in Madrid. They are also working on additional computer algorithms that could help to automate the process of identifying polyps and lesions from the topographical information generated by the new system.

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The research was funded by the Comunidad de Madrid through the Madrid-MIT M+Vision Consortium.

Written by Anne Trafton, MIT News Office

Understanding Colonoscopy

6/29/13 || Dr. Dale Prokupek Hello friends, current patients and prospective patients:

Colon cancer ranked as the second leading cause of death in the US. This has been a threat not only to Americans but even to other races around the globe. In fact, it has been touted to cause death to more than 50,000 American before the year ends. Unlike other forms of illness; this is often detected by the individual once the disease has progressed to a critical stage. This can also be the reason why many people end up with unmanageable condition once they get to know that they have such illness. And just like other types of cancer, colon cancer is untreatable. But early detection gives better chances of survival. That is why some people submit to colonoscopy procedure to verify if they have the illness.

What is Colonoscopy and What Benefit Does It Offer?

Colonoscopy is the modern breakthrough of medical science that allows doctors to view the inside linings of your colon. This way, they are able to check if there are polyps or abnormal tissue growth on the intestinal linings which may lead to colon cancer if left unmanaged. A flexible tube called colonoscope is inserted to your bowels to visualize the insides of your colon and rectum. Anesthetics are also provided to alleviate the discomfort that this procedure may bring. Aside from visualizing abnormal tissues, doctors can also excise unusual tissue growth found. They will send it for biopsy to verify if it is cancerous or not. This way, possible development of colon cancer can be stopped before it even starts.

Why Many People Choose Not to Submit for Colonoscopy

The main reason why some people refuse to undergo colonoscopy is because of the thought of being embarrassed during the procedure. Thinking about someone inserting a tube to your bowels can be scary and very uncomfortable. But more than that, the 2 days preparation for the procedure is even more daunting. You will need to take clear liquid diet and laxative during this period to cleanse your bowel and make it more visible while colonoscopy is being done. This alone makes the procedure less desirable. However, some people would rather go through this process rather than suffer the ill effects of colon cancer later on.

When is the Best Time to Have Colonoscopy?

Medical practitioners often suggest that an individual submit for colonoscopy at regular intervals once the person reaches 50 years old. However, you do not need to wait for that age if you are experiencing early symptoms of colon cancer. This can be as simple as unusual bowel movement or blood on stool. If you have a family history of colon cancer, then you have more reason to submit for this procedure.

Is There Any Substitute for Colonoscopy?

The good news is; a new research is being conducted wherein blood samples can be used as early detection of colon cancer. This means that you can save yourself from the embarrassment of undergoing colonoscopy or submitting sample for a stool exam. A blood test may allow medical practitioners to detect deviations in SD2 gene; which is touted to be a biomarker for colon cancer. However, unless this blood test for early colon cancer is medically accepted, you need to content yourself with what stool exam and colonoscopy procedure have to offer.

-- Dr. Dale