New research led by the Memorial Sloan-Kettering Cancer Center in the US has for the first time found that removing precancerous polyps during colonoscopy may halve the risk of dying from the disease. The large team of endoscopists, radiologists, pathologists, and epidemiologists, write about their findings in the 23 February online issue of the New England Journal of Medicine, NEJM. The study follows earlier research, also led by Memorial Sloan-Kettering, that showed removing precancerous polyps during colonoscopy prevents colorectal cancer from developing. Together, the two sets of findings would indicate that polyps removed during colonoscopy have the potential to progress and cause death from colorectal cancer. Lead author Dr Ann G. Zauber, a biostatistician at Memorial Sloan-Kettering, said in a press statement: "Our findings provide strong reassurance that there is a long-term benefit to removing these polyps and support continued recommendations of screening colonoscopy in people over age 50.
Colonoscopy for colorectal cancer screening saves lives, but a loophole in current Medicare law may cause patients to think twice before undergoing this vital test. Legislation just introduced seeks to ensure that colorectal cancer screening for all Medicare beneficiaries is free, as intended. The Patient Protection and Affordable Care Act waives the coinsurance and deductible for many cancer screening tests i, including colonoscopy, sigmoidoscopy and fecal occult blood testing (FOBT), which screen for colorectal cancer. Colonoscopy is a unique screening test because gastroenterologists are able to remove precancerous polyps and small cancers during the screening procedure. Under Medicare billing rules, removal of any polyp reclassifies the screening as a therapeutic procedure, for which patients will receive an unexpected coinsurance bill.
In the U.S., colorectal cancer is the third highest cause of cancer mortality. The American Cancer Society predicts that there will be almost 143, 000 new cases diagnosed this year, of which 4, 600 will be in New Jersey. Experts from the Cancer Institute of New Jersey (CINJ), a Center of Excellence of UMDNJ-Robert Wood Johnson Medical School will be available to discuss risk factors, treatment and prevention options surrounding colorectal cancer. Although scientists remain unclear about the exact cause of most colorectal cancers, risk factors, such as lack of exercise, poor diet and polyps in the colon or rectum areas, are known to contribute to the disease. Given that individuals over the age of 50 years also fall into a higher risk category, it is recommended that men and women have periodic colonoscopies, fecal occult blood tests and/or other screenings to check for colorectal cancer.
Among People With Health Insurance, The Recession And High Co-Pays Tied To Fewer Colonoscopy Screenings
The recent U.S. economic recession was the longest and most severe since World War II. During this period, personal spending on health care grew at the slowest rate in over 50 years, suggesting that Americans used less health care. A new study finds that these cut backs were not limited to Americans who lost their health insurance, nor restricted to unnecessary services. Researchers at the University of North Carolina at Chapel Hill School of Medicine found that during the recession, continuously insured Americans underwent fewer screening colonoscopies, a cost-effective, recommended preventive service. The study appears in the March issue of the journal Clinical Gastroenterology and Hepatology. The investigators estimated that during the recession period, dating from December 2007 to June 2009, roughly one- half million fewer Americans covered by commercial health insurance underwent colonoscopy screening for colorectal cancer than expected based on use in the preceding two years.
Discussions About End-Of-Life Care Between Physicians And Terminally Ill Cancer Patients Often Delayed Too Long
The vast majority of patients with incurable lung or colorectal cancer talk with a physician about their options for care at the end of life, but often not until late in the course of their illness, according to a new study by Dana-Farber Cancer Institute investigators published in the Annals of Internal Medicine. The researchers found that such belated conversations tend to occur under particularly stressful conditions - when patients have been admitted to a hospital for acute care. And the doctor who shares in the end-of-life care talk is often a hospital physician, rather than an oncologist who has treated the patient for much of his or her illness. Together, these circumstances may deprive patients of the opportunity for extended reflection and deliberation that would have been possible months earlier, when the conversation also could have occurred under less trying and hectic conditions, the authors suggest.