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by Abram Katz | Mar 30, 2010 1:06 pm

(1) Comment | Commenting has been closed | E-mail the Author

Posted to: Health Care, Science/ Medical

Abram Katz Photo You don’t hear much about colon cancer, yet it is the second leading cause of cancer deaths in the United States, and can be virtually cured if detected early.

Dr. Edward Chu, chief of medical oncology and deputy director of the Yale Cancer Center, said a vast majority of patients do not have any symptoms until colorectal cancer is advanced, and difficult to treat.

“It is still a very significant public health problem,” he told about 40 men and women attending a free health talk earlier this month at Yale-New Haven Hospital.

“However, there has been a significant drop in colon cancer cases in the past 20 years because of better screening and treatments,” he said.

The National Cancer Institute estimated that about 150,000 men and women would be diagnosed with colorectal cancer annually, and that just under 50,000 will die from the disease.

Only cancer of the lung, breast or prostate is more deadly.

The best screening test is a colonoscopy, during which a tiny video camera is snaked from the beginning to the end of the large intestine.

The test is not particularly pleasant, but it is far less expensive in pain, suffering and cost than colon cancer treatment, he said.

Chu said after the talk that the Yale Cancer Center has progressed to “personalized medicine,” meaning that treatments are tailored to individual patients’ genetic profiles. The presence or condition of certain genes suggests what chemotherapy drugs are likely to be most effective.

“In its earliest stages, we can cure 90 percent of patients,” Chu said. Once the cancer has spread to other parts of the body the 5-year survival rate drops to 5 to 10 percent, he said. This means that out of 100 patients with metastatic colon cancer, only 5 to 10 will be alive 5 years after the cancer is treated.

And while some other diseases have controllable risk factors, the highest risk factors for colon cancer are age and family history, neither of which can be altered.

Since Chu himself has a strong family history of colon cancer he started screening tests about 10 years before the recommended age of 50.

Certain groups of people are also more prone to colon or rectal cancer, Chu said. African-Americans are at a higher risk for a more aggressive type of cancer starting at an earlier age. Asians, however, are at a lower risk until they move to the U.S., where their risk rises.

This is probably explained by a change to the high-fat, low-fiber American diet, Chu said. A sedentary life style, smoking and alcohol consumption are also risk factors, although how they relate to the colon is not clear.

Exercise, folic acid, vitamin D and calcium seem to lower the risk of colon cancer, but the reasons remain unknown.

Colon cancer usually starts as a polyp, a small growth inside the intestine, Chu said. If left undisturbed, a precancerous polyp usually takes about 8 to 12 years to develop into cancer, he said.

“Men get screened more often than women, though their rate of colon cancer is identical,” he said.

In 2001 Medicare started to reimburse patients for colonoscopy. The rate of testing increased from about 20 percent to around 50 percent by 2008, Chu said.

However, that means that 50 percent of adults 50 and older are not being screened. “Screening is far cheaper than treating the disease. In 2007 treatment cost $7 billion to $8 billion. By 2020, the expense is expected to increase to 20 to $25 billion,” he said.

“Screening is a drop in the bucket. It is cost effective,” he said.

Treatment typically includes surgery followed by chemotherapy. Newer drugs, such as Avastin and Erbitux, target pathways critical for the growth of malignancies. These targeted therapies have fewer side effects, he said.

“In 1980 there was one drug, 1-5 fluorouracil, and the medial survival rate for metastatic colon cancer cancer was 8 to 10 months. Now the median survival rate is 24 to 28 months,” he said.

Comment

posted by: Bill on March 31, 2010 7:24am

Interesting, a colonoscopy costs $800 - $1,200. There was no mention of the virutal colonoscopy which costs $500 - $900 or of stool testing which is much less costly or invasive. Personally, I’ve opted for the later.

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