Colon Cancer Diagnosed at Earlier Ages

profile_CRC150223Colorectal cancer is the third most commonly diagnosed cancer and second leading cause of cancer deaths in the United States.

Disease risk increases with age, but those of certain ethnic backgrounds are being diagnosed with the condition at younger ages than ever before, say authors of a new study from the University of Missouri School of Medicine.

On average, African Americans, Hispanics and Pacific Islanders were diagnosed between the ages of 64 and 68, while whites were typically diagnosed at age 72, according to the study. When diagnosed, minority groups also had more advanced stages of cancer.

Researchers suggested that lower screening rates and lower income levels were two factors leading to the detection rates varying among cultures.

Dr. Sakie Hussain, a medical director of the endoscopy center at Advocate Trinity Hospital in Chicago, is adamant about early detection. Colon cancer is 100 percent preventable and he doesn’t see why anyone should ever have to die from the disease.

“When you have breast cancer, the first cells they find in a biopsy are cancerous, but in a colonoscopy exam, when we find hybrid cells called polyps, it is not cancerous,” says Dr. Hussain. “Once we remove them, you no longer have to worry about anything.”

Symptoms can include a change in bowel habits, rectal bleeding, weakness and fatigue or unintended weight loss.

“A colonoscopy is not painful,” says Dr. Hussain. “We watch it very carefully and we don’t start the test until we are sure you are sleeping. Ninety-percent of our patients wake up and don’t realize that the colonoscopy has already been done.”

The US Preventive Services Task Force (USPSTF) recommends regular screenings starting at 50 years old.

Stress Connected with Greater Chance of Memory Impairment

If you’re older and feeling stressed out you may be more likely to develop mild cognitive impairment, say researchers. MCI is often a precursor to full blown Alzheimer’s disease or other dementias. And you may be at greater risk if you’re also female, depressed and less educated.

Scientists at Albert Einstein College of Medicine and Montifiore Health System in New York City found that highly stressed participants were more than twice as likely to become impaired than those who were not. Because stress is treatable, the results suggest that detecting and treating stress in older people might help delay or even prevent the onset of Alzheimer’s.

Each year, approximately 470,000 people in the U.S. are diagnosed with Alzheimer’s disease. As of 2013, as many as 5 million Americans were living with the condition, according to the CDC. It often starts with symptoms of mild cognitive impairment—a pre-dementia condition that significantly increases the risk of developing Alzheimer’s in the following months or years.

This study looked at the connection between chronic stress and the most common type of mild cognitive impairment, known as “amnestic mild cognitive impairment,”  or aMCI. This is primarily characterized by memory loss.

“Our study provides strong evidence that perceived stress increases the likelihood that an older person will develop aMCI,” said Richard Lipton, M.D., senior author of the study, professor of neurology at Einstein and Montefiore, and Chair of Neurology at Einstein

Managing stress may modify risk
Perceived stress includes the daily hassles we all face, as well as the way we handle these events. The good news is that perceived stress is a modifiable risk factor for cognitive impairment, making it a potential target for treatment, said study authors.

For example, “perceived stress can be altered by mindfulness-based stress reduction, cognitive-behavioral therapies and stress-reducing drugs. These interventions may postpone or even prevent an individual’s cognitive decline,” said study co-author Mindy Katz, M.P.H., senior associate in the Saul R. Korey Department of Neurology at Einstein.

How they did it
The researchers studied data collected from 507 people enrolled in the Einstein Aging Study (EAS), a community-based group of older adults. Since 1993, the EAS has systematically recruited adults 70 and over who live in Bronx County, N.Y. Participants undergo annual assessments that include clinical evaluations, a neuropsychological battery of tests, psychosocial measures, medical history, assessments of daily-living activities and reports (by participants and those close to them) of memory and other cognitive complaints.

Starting in 2005, the EAS began assessing stress using the Perceived Stress Scale (PSS). This widely used 14-item measure of psychological stress was designed to be sensitive to chronic stress (due to ongoing life circumstances, possible future events and other causes) perceived over the previous month. PSS scores range from 0 to 56, with higher scores indicating greater perceived stress.

The diagnosis of aMCI was based on standardized clinical criteria including the results of recall tests and reports of forgetfulness from the participants or from others. All 507 enrollees were free of aMCI or dementia at their first PSS assessment and later underwent at least one annual follow-up evaluation. They were followed for an average of 3.6 years.

Seventy-one of the 507 participants were diagnosed with aMCI during the study. The greater the participants’ stress level, the greater their risk for developing aMCI: for every 5 point increase in their PSS scores, their risk of developing aMCI increased by 30 percent.

Similar results were obtained when participants were divided into five groups (quintiles) based on their PSS scores. Participants in the highest-stress quintile (high stress) were nearly two and a half times more likely to develop aMCI than were people in the remaining four quintiles combined (low stress). When comparing the two groups, participants in the high-stress group were more likely to be female and have less education and higher levels of depression.

To confirm that stress was independently increasing risk for aMCI in this study, the researchers assessed whether depression—which increases the risk for stress as well as for cognitive impairment and Alzheimer’s disease—might have influenced the results. They found that depression did not significantly affect the relationship observed between stress and the onset of aMCI.

The findings were published online iAlzheimer Disease & Associated Disorders.

Maybe your New Year’s resolutions should include signing up for that meditation class?

What’s a woman to do?

And, the debate over mammography continues.

This time, it’s the American Cancer Society causing a stir. The organization revised their recommended breast cancer screening guidelines and it’s already causing some dissention.  bc-screeningACS said the updated guidelines provide evidence-based recommendations for breast cancer screening for women at average risk of breast cancer. Details are in the Oct. 20 Journal of the American Medical Association.

What does this mean for most women? 

The ACS strongly recommends that women with an average risk of breast cancer should undergo regular screening mammogram starting at age 45. (The old recommendation was to begin screening around age 40).

  • Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (i.e., if her clinician thinks she should).
  • Women aged 45 to 54 years should be screened annually.
  • Women 55 years and older should transition to screening every two years with an opportunity to continue screening annually (again, based on clinician input)
  • Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer. Previously, most women stopped screening around age 74.

Sandhya Pruthi, M.D., a breast clinic physician and Mayo Clinic Cancer Center researcher said that the updated guidelines still reinforce the value of regular breast screening. ”The benefit of mammography has been shown to reduce death from breast cancer and women who are screened do get that benefit.”

However, ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age. Dr. Pruthi said she found that surprising. “I think that’s a little unfortunate, because I think there’s always an opportunity where the doctor may feel something that’s a little different on a clinical breast exam and a mammogram may not see it,” she says. “Because we know that mammograms still may have a difficult interpretation, especially in dense breast tissue.”

A 2013 article from the American Academy of Family Physicians noted, “clinical breast examination plus mammography seems to be no more effective than mammography alone at reducing breast cancer mortality. Teaching breast self-examination does not improve mortality and is not recommended; however, women should be aware of any changes in their breasts and report them promptly.”

Breast cancer is the most common cancer in women worldwide. In the United States, an estimated 231, 840 women will be diagnosed with breast cancer in 2015, according to the ACS report. Breast cancer continues to rank second, after lung cancer, as a cause of cancer death in women in the United States, and it is a leading cause of premature mortality for women. In 2012, deaths from breast cancer accounted for 783, 000 years of potential life lost and an average of 19 years of life lost per death.

Even though mortality from breast cancer has declined steadily since 1990, largely due to improvements in early detection and treatment, it’s estimated that more than 40,000 women in the United States will die of breast cancer in 2015.

The last ACS screening update was published in 2003. This revised approach now aligns more closely with that of the U.S. Preventive Services Task Force.  The USPSTF guidelines were considered controversial when issued in 2009, and conflicted with the previous ACS recommendations.

“If having to return for more screening after a mammogram is going to upset you, you might want to start at 45. If missing a growing cancer would upset you more, you might want to stick with recommendation to begin screening at 40,” said breast cancer survivor JoAnn Pushkin. Pushkin is Executive Director at DenseBreast-info, Inc., and cofounder of D.E.N.S.E. (Density Education National Survivors’ Effort), a national grassroots effort to raise awareness about breast density, and its inherent cancer risk.

Pushkin noted that:

  • The most rigorous scientific studies have shown that the most lives are
  • saved by screening beginning at age 40.
  • One in six breast cancers occur in women in their 40s.
  • Major American medical organizations with expertise in breast health such as the American Congress of Obstetricians and Gynecologists (ACOG), American College of Radiology, and Society of Breast Imaging recommend that women start getting annual mammograms at age 40.

What about women who may be at higher risk?

AAFP notes that “women with an estimated lifetime breast cancer risk of more than 20 percent or who have a BRCA mutation, screening should begin at 25 years of age or at the age that is five to 10 years younger than the earliest age that breast cancer was diagnosed in the family.”

Confused yet?

What it really comes down to is that every woman needs to talk with her health care provider. Mammography and additional screening is an individual decision —  based on health status, risk, breast density, family history, comfort with exposure to radiation and many other factors. The idea is to make the most informed decision possible — what’s right for you may not be right for your best friend, your sister, or your neighbor.

I lost a friend to breast cancer last week. She was 53. She got regular screenings, found the cancer early, and went through rounds of chemo, all the side effects, and brief remission. Then the cancer returned, with a vengeance. It migrated to her bones, liver and brain.

Would earlier and more frequent screening have saved her? Probably not. But finding it early perhaps gave her a little more time with her daughter, who is only just turning 13.

When screening guidelines or treatment protocols change, there’s inevitably a period of confusion and controversy. Guidelines are developed based on current scientific evidence and best practices. They may change again. They probably will.

These are recommendations. If you’re concerned, confused or unsure, pick up the phone and have a conversation with your health care provider. Do what’s appropriate for you.

Poll Finds Overwhelming Support For Medicare Paying For End-Of-Life Talks

The public overwhelmingly supports Medicare’s plan to pay for end-of-life discussions between doctors and patients, despite GOP objections that such chats would lead to rationed care for the elderly and ill, a poll released Wednesday finds.

constant-63613__180Eight of 10 people surveyed by the Kaiser Family Foundation supported the government or insurers paying for planning discussions about the type of care patients preferred in the waning days or weeks of their lives. (KHN is an editorially independent program of the foundation.) These discussions can include whether people would want to be kept alive by artificial means even if they had no chance of regaining consciousness or autonomy and whether they would want their organs to be donated. These preferences can be incorporated into advance directives, or living wills, which are used if someone can no longer communicate.

The Centers for Medicare & Medicaid Services earlier this year proposed paying doctors to have these talks with patients. A final decision is due out soon. The idea had been included in early drafts of the 2010 federal health care law, but Sarah Palin and others opponents of the law labeled the counseling sessions and other provisions “death panels” motivated by desires to save money, and the provision was deleted from the bill.

The notion of helping patients prepare for death has support among many doctors, who sometimes see terminal patients suffer from futile efforts to keep them alive.  Last year, the Institute of Medicine issued a report that encouraged end-of-life discussions beginning as early as 16 years old. The Kaiser poll found that these talks remain infrequent. Only 17 percent of those surveyed said they had had such discussions with their doctor or another health care professional, even though 89 percent believe doctors should engage in such counseling. A third of respondents said they had talked to doctors about another family member’s wishes for how they would want to be cared for at their end.

While none of these proposals calls for the cost of care to weigh on these discussions, the final years of life are indeed expensive for America’s health care system. The Dartmouth Atlas of Health Care has calculated that a third of Medicare spending goes to the care of people with chronic illnesses in their last two years of life. That is likely to increase as the population of those older than 65 increases. An analysis by the Kaiser foundation found that Medicare spending per person more than doubled from age 70 to 96, where it peaked at $16,145 per beneficiary in 2011.

The Kaiser poll found less public support for a cost-containment provision that did make it into the health law. The “Cadillac tax” begins in 2018 and will impose a tax on expensive insurance that employers provide to their workers. Sixty percent oppose the plan, which economists have long favored as a way to discourage lavish coverage and make people aware that extensive use of Medicare services is linked to premiums.

The poll also found that 57 percent of people favor repealing the medical device tax, another piece of the health law that Republicans in Congress are trying to repeal. The tax applies of artificial hips, pacemakers and other devices that doctors implant.

The poll was conducted from Sept. 17 through Sept. 23 with 1,202 adults. The margin of error was +/- 3 percentage points.

Kaiser Health Tracking Poll: September 2015

via Kaiser Health News

Yoga Shows Benefits for Arthritis Suffers

Yoga may be a safe and effective way to keeping moving for the one in five adults who live with arthritis.

In a randomized trial of people with two common forms of arthritis — knee osteoarthritis and rheumatoid arthritis — those who practiced yoga had about a 20 percent improvement in physical health with similar improvements in pain, energy, mood and carrying out day-to-day activities and tasks.

The study by researchers from Johns Hopkins is believed to be the largest randomized trial to date to examine the effect of yoga on physical and psychological health and quality of life among people with arthritis.

“There’s a real surge of interest in yoga as a complementary therapy, with one in 10 people in the U.S. now practicing yoga to improve their health and fitness,” says Susan J. Bartlett, Ph.D., an adjunct associate professor of medicine at Johns Hopkins and associate professor at McGill University “Yoga may be especially well suited to people with arthritis because it combines physical activity with potent stress management and relaxation techniques, and focuses on respecting limitations that can change from day to day.”

According to the Arthritis Foundation,

  • More than 50 million U.S. adults have doctor-diagnosed arthritis
  • By 2030, an estimated 67 million people will be diagnosed with arthritis.
  • It is the nation’s primary cause of disability
  • Among working age adults (18-64) those with arthritis or a rheumatic condition lose more workdays every year — a combined 172 million– due to illness or injury than adults with any other medical condition.
  • Arthritis and related conditions account for $156 billion annually in lost wages and medical costs, including 44 million outpatient visits and nearly 1 million hospitalizations.

Without proper management, arthritis affects not only mobility, but also overall health and well-being, participation in valued activities, and quality of life. There is no cure for arthritis, but one important way to manage arthritis is to remain active. Yet up to 90 percent of people with arthritis are less active than public health guidelines suggest.

Study participants were randomly assigned to either a wait list or eight weeks of twice-weekly yoga classes, plus a weekly practice session at home. Participants’ physical and mental wellbeing was assessed before and after the yoga session by researchers who did not know which group the participants had been assigned to.

Compared with the control group, those doing yoga reported a 20 percent improvement in pain, energy levels, mood and physical function, including their ability to complete physical tasks at work and home. Walking speed also improved to a smaller extent, though there was little difference between the groups in tests of balance and upper body strength. Improvements in those who completed yoga was still apparent nine months later.

Instructors were experienced yoga therapists with additional training to modify poses to accommodate individual abilities. Participants were screened by their doctors prior to joining the study, and continued to take their regular arthritis medication during the study.

Check out this video from WebMD with yoga poses for rheumatoid arthritis sufferers.

Hopkins researchers have developed a checklist to make it easier for health practitioners to safely recommend yoga to their patients. People with arthritis who are considering yoga should “talk with their doctors about which specific joints are of concern, and about modifications to poses,” suggested Clifton O. Bingham III, M.D., associate professor of medicine at Johns Hopkins University School of Medicine and director of the Johns Hopkins Arthritis Center. “Find a teacher who asks the right questions about limitations and works closely with you as an individual. Start with gentle yoga classes. Practice acceptance of where you are and what your body can do on any given day.”

Results were published in the April issue of the Journal of Rheumatology.


photo: Kevin Dinkel