A less scary colonoscopy?!

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

__________________________

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).

I love this so much #ColonoscopyFearsBEGONE

This is just perfect...and something I can't stop emphasizing.  Don't let your fear in the colonoscopy discourage you from being tested and saving your life.   Don't be sacred; let me help you.  I even have a gift for you once you're done! :) -- Dr. Dale

http://www.greatfallstribune.com/article/20140218/LIFESTYLE20/302180006/

Written by Minding Your Meds Randy L. Kuiper

March is National Colorectal Cancer Awareness Month. Colorectal cancer is one of the leading causes of cancer deaths in the United States. Approximately 140,000 Americans are diagnosed with colorectal cancer every year, with more than 50,000 people dying from it. Up to 60 percent of these deaths could be prevented with proper screening.

The risk of getting colorectal cancer increases with age, with more than 90 percent of cases occurring in people ages 50 or older. For this reason, routine initial screening is recommended for most people after they reach the age of 50. For the majority of people, a follow-up screening is recommended every 10 years until age 75.

These screening tests literally can save your life. Screening is essential because patients with early colorectal cancer often do not show any notable symptoms.

The screening procedure used most often is a colonoscopy. Colonoscopies can detect precancerous polyps that can be removed easily during the procedure before they turn into cancer. In addition, colonoscopy procedures done as recommended also can potentially detect colorectal cancer in an earlier stage before it spreads to other areas of the body. Effective treatment at an early stage often can be curative.

Unfortunately, too many people are still not getting colorectal cancer screening. Recent data indicates that almost one-third of adults aged 50 to 75 years have never been screened.

Lack of health insurance and not having a regular health care provider were major reasons most people cited for not getting screened. However, I believe many people use their unpleasant perceptions of undergoing the colon cleansing process as an excuse for not getting screened. This is unfortunate as both the preparation process and the actual colonoscopy procedure are actually tolerated very well by patients.

The accuracy of a colonoscopy relies heavily on the proper evacuation of the bowel of fecal material. The preparation usually begins the day before the procedure and involves a liquid diet along with taking various laxatives and bowel evacuation solutions until the bowel is fully cleansed. There are multiple types of regimens used to effectively clean out the bowel. Many involve drinking a large bottle of polyethylene glycol (PEG) with electrolytes (e.g. GoLytely, Nulytely, etc).

Colonoscopy providers will provide you with detailed instructions outlining exactly what you are to do and when you are to do it.

Many people have heard that some of the PEG products taste horrible, mainly related to a salty taste and rotten egg smell. There are measures that can dramatically reduce these complaints.

The actual colonoscopy procedure usually lasts about 30 minutes. Patients typically receive sedative and pain medications. Pain related to the procedure is usually minimal. Patients may experience a minor gas discomfort related to the air that is introduced into the colon as part of the procedure to allow for better visualization.

Although many patients say they were awake during the procedure, most will not be able to recall the actual events of the colonoscopy because of sedation.

The Centers for Disease Control and Prevention’s Colorectal Cancer Control Program has set a goal of increasing the screening rate from 65 percent to 80 percent in 2014.

Make a serious effort to urge your family members and friends who are older than 50 and who have not been screened as recommended to get it done. You may just be saving their lives.

Randy L. Kuiper has been a registered pharmacist in Montana since 1981. He is the clinical coordinator for Benefis Hospitals Pharmacy. He can be contacted by email at randykuiper@benefis.org.

I love this story. G E T...C H E C K E D!

I could go on and on about all the different times unexpected things like this have happened in my office. Don't be scared, friends.  I got you.

-- Dr. Dale

http://www.miamiherald.com/2014/02/03/3910400/flush-away-those-colonoscopy-fears.html

Posted on Mon, Feb. 03, 2014 Flush away those colonoscopy fears By Lisa Gutierrez The Kansas City Star FRED BLOCHER / MCT Colon cancer survivor Danielle Ripley-Burgess, of Lee's Summit, Mo., supports an organization that takes an educational traveling exhibit about the disease. It features a 40-foot-long model of a colon that young and old can crawl through, as seen Dec. 14, 2013, at New Summit Church in Lee's Summit. She couldn’t tell her mom that something was wrong because it was way too embarrassing.She didn’t even like to walk down the toilet paper aisle at the grocery store.So when Danielle Ripley-Burgess, 30, of Lee’s Summit, Mo., was in junior high school and began finding blood in the toilet after going to the bathroom, “I didn’t say anything about it for a long, long time. I was mortified.” When she finally did, she and her mom, at first, did their own research on the Internet and figured that because Danielle was so young, the problem had to be something benign, like hemorrhoids. Wrong. Just a few weeks after her 17th birthday in 2001 she was diagnosed with stage 3 colon cancer, going from prom plans to hospital stays in the blink of an eye. Today, at 30, she’s a wife and mother running a marketing firm – Semicolon Communications, wink, wink – and doing what she can to get people talking about what she once feared. She’s not above using props, either. Big ones. In early December she arranged to have a 40-foot crawl-through model of a colon trucked into town. The message? Being afraid to talk about what happens in the bathroom could kill you. Colorectal cancer is the second-most deadly cancer, but the majority of cases are preventable with the use of a common screening procedure called a colonoscopy. Precancerous growths found during a colonoscopy – recommended every 10 years beginning at 50 – can be removed on the spot. That’s important because those growths, or polyps, can stick around in your colon for years and become full-blown cancer. “This is the only situation in all of medicine where the test used to screen for a cancer is also the method for preventing that same cancer,” said Larry Geier, a genetics oncologist at the University of Kansas Cancer Center and one of Ripley-Burgess’ doctors. “In all other situations – mammogram, Pap smear – the screening test may be effective for early detection but provides no ability to prevent the cancer itself.” And yet, people fear the colonoscopy. Statistics show that only half of Americans older than 50 have ever had one, or any other type of colorectal cancer screening process. The ick factor is high. Here are the excuses patients give Geier. • “I don’t like the idea of a doctor sticking a scope up my rectum. I am too modest for that.” • “I hear the preparation for the test is very difficult, and I don’t want to do that.” • “I am not having any symptoms, therefore I don’t have cancer.” • “I just don’t have time for that.” “I have heard each of these reasons too many times over the years, and none of them are worth taking the chance, or what I consider to be playing ‘Russian roulette' with your colon,” Geier said. Only 10 percent of all people diagnosed with the disease are younger than 50. But while cases of colon cancer among adults 50 and older are falling, rates among younger adults like Ripley-Burgess are rising, according to the Colon Cancer Alliance. “There is definitely a trend toward younger age at the time of diagnosis of colon cancer over the last two decades,” Geier said. “Changes in diet, better screening and more awareness of early symptoms may each have a role but still don’t provide adequate explanation.” What happened to Ripley-Burgess was rare. She was diagnosed with colon cancer at 17 and again at 25, when all but a foot of her large intestine had to be removed. “I have to be kind of careful with what I eat, when I eat.” No big chili dogs for lunch, for example. “It’s normal for me now.” It was her bad luck to be, Geier put it, “genetically programmed” to develop colon cancer at such a young age. She has a genetic trait known as Lynch syndrome, which affects about 1 in every 4 to 5 Americans and is largely underdiagnosed.  Colon Cancer Warning Signs  • Blood in the stool (frequently not visible to the naked eye), a change in stool habits, a gradual decrease in the size of the stool, increasing abdominal pain, unexplained weight loss • Those symptoms are much more likely to occur when the tumor is in the rectum or the very last part of the colon. Cancers that are higher up in the colon frequently don’t signal their presence with these symptoms until the tumor is quite large. That’s why screening for the cancer when there are no symptoms is critical. • Anyone with one or more of these symptoms should tell their doctor. Source: Larry Geier, genetics oncologist at the University of Kansas Cancer Center. Read more here: http://www.miamiherald.com/2014/02/03/v-print/3910400/flush-away-those-colonoscopy-fears.html#storylink=cpy