Screening for early detection of Colorectal Cancer - Research Paper Example

? Screening for early detection of Colorectal Cancer Among Americans Colorectal cancer is the 4th commonest type and it is capable of being cured if caught in the early stages. In Canada it is the second most fatal type of cancer ( Colon Cancer Check, Ontario, January 2011) It begins with the growth of small polyps which can bleed and which in time can both cause cancer and narrowing of the lumen. The cancers can also spread to other parts of the body. The incidence of the condition rises after the age of 50. Dr Dennis Lee (1996) lists a number of possible causes. These include family history, a high fat diet and a history of ulcerative colitis. Lee states that it is thought that the breakdown of fats in the intestine produces carcinogens. The condition in its early stages may not be noticed by the person concerned, but can be detected in a number of ways. The United States Preventative Services Task Force recommends that every citizen aged between 50 and 75 be tested, thus prolonging the lives of 60 % of those affected. Those over this age can request a test. Detection can be done by testing stools for the presence of blood. This is done either using the chemical guaiac or by seeking for antibodies. Somewhat more invasive is a sigmoidoscopy, i.e. the lower bowel is examined using a flexible tube. A colonoscopy is a more extensive version of this, but searches the whole colon and may involve the removal of any suspicious polyps. This would normally be a follow up to other tests. In some cases a barium enema is used and the results x-rayed. In some cases a complete stool is sent for analysis. There is continued research on this topic. Pertinent issues to the delivery of healthcare raised by this topic. Because this condition is so prevalent in American society it is important that as much as possible to cut its incidence and severity as a life threatening condition. This can be done be early detection so that any polyps can be removed before they become cancerous. Therefore it is necessary that all those aged 50 – 70 have regular checks – perhaps every two years. If this is to be achieved the subject will need publicity, education, central organization and funding. Another area that requires public education would be in the area of diet. Americans tend to consume a high fat, high dairy food diet. Something similar to the ‘5 a day’ campaign in the United Kingdom - that is the promotion of the idea that everyone needs to eat at least 5 portions of fruit and vegetables each day. ( NHS Choices , 5 a Day). Putnam, Allshouse and Kantor (2002) report a huge jump in average calorie intake within the United States over the last 25 years, this despite a recent tendency to use lower fat options. According to a report cited by Barone, (2007) those with colon cancer who ate a healthier diet, i.e. one based upon fruit, vegetables, poultry and fish, stand a better chance of total recovery than those who continue to consume lots of red meat, fats, refined carbohydrates, fat and sugar. The latter have a higher chance of the cancer recurring according to a study by Meyerhardt. Government Involvement In 2010 the NIH Consensus Development Program, part of the United States Human and Health Services, produced a statement entitled ‘Enhancing Use and Quality of Colorectal Cancer Screening.’ This document covers such things as trends in screening and how this might be improved. It considers such things as how screening can be monitored and what research is required and so indicates that this topic is one of concern to government agencies. The aim was ‘To provide health care providers, patients, and the general public with a responsible assessment of currently available data on enhancing use and quality of colorectal cancer screening.’ In 2004 the American Food and Drug Administration approved new treatment for advanced colorectal cancer. However more new treatments have since become available and require assessment and acceptance. Literature National Center for Biotechnology Information, U.S. National Library of Medicine, Genes and Disease.( 1998) – this book points out that, although other factors are involved, colorectal cancer is the commonest genetically inherited type of cancer. This is something else the public and their medicals practitioners need to know. Cancer Advances in Focus, Colorectal Cancer ( November 2010) This article lists the various advances in treatment over a number of years and also records a drop in incidence. It is estimated that half of this decrease is due to increased screening levels. The article reveals the progress made and gives hope for the future. Thorne , Hutchings and Elwyn, ( 2006) The effects of the Two-Week Rule on NHS colorectal cancer diagnostic services: A systematic literature review This rule was made in order to ensure that those suspected of having colorectal cancer within the United Kingdom had access to a specialist within two weeks. 10.3 % of those referred were eventually found to have the cancer. Unfortunately the results of the study were that patients were still not being discovered at an earlier stage of the condition. The conclusion was that such referral methods need further evaluation. Clinical Practice and Practice Economics Committee., American Gastroenterological Association, ( 2001) Technical Review on Hereditary Colorectal Cancer and Genetic Testing, Gastroenterology This article, although it does admit that hereditary factors are important, points out that in 80% of cases there is no hereditary evidence. It is concerned with improvements in risk assessment. Importantly it is stated that genetic factors justify medical checks on those at risk. Erler, J., 2011, The Role of Lysyl Oxidase in SRC-dependent Proliferation and Metastasis of Colorectal Cancer” ,Journal of the National Cancer Institute.Erler and colleagues in the United Kingdom reported new drug treatments, as reported by Mansell, but it would be more effective to cut initial rates of this often fatal condition. Current Policy In America the National Comprehensive Cancer Network, one of the American Institutes of Health, has as its current aim ‘to improve care, with respect to cancer screening, diagnosis, treatment, and follow-up.’ It has recently updated its guidelines based upon recent studies so the government is up to date with current research.( 2011) For instance they now recommend that discovering the KRAS gene status of tumors , primary or secondary be included in the pre-treatment of anyone diagnosed with corectal cancer which is producing metastases. As can be seen from the diagrams below different states have varying policies with regard to reimbursement of costs of testing. Diagram 1 Diagram 2 Current Legislation According to the 2009 Colorectal Cancer Legislation Report Card there was at that time no central legislation requiring insurers to cover the cost of testing for colorectal cancer. It shows very patchy coverage among the various states and with the positon being worse than for breast cancer. Even in places considered the best stools would only be tested for occult blood every 5 years. However since then the Colorectal Cancer Prevention, Early Detection, and Treatment Act of 2009,, also referred to as HR 1189, an amendment of the Public Health Service Act, has now been passed. This will bring about a national corectal screening program for Americans aged 50 and over and those who are particularly likely to develop the condition. ( Corectal Cancer Coalition 2011) The bill will also ensure the provision of help for those diagnosed as having lower bowel polyps or cancer. An example of state legislation would be that of Oklahoma where SB14 was approved in February 2007 ( Oklahoma State Senate , February 2007) which requires medical insurance companies too cover the cost of corectal cancer screening. While individual states do have the right to bring in their own laws surely something such as this would be easier to co-ordinate and legislate for on a national basis. If diagnosed early it is pointed out after 5 years only 10% will have succumbed. If the condition has spread to other organs the 5 year survival rate is much lower at only 10% which is why early testing is so important and should be promoted. Conclusion Testing and treatment for colorectal cancer is an ongoing effort. New treatments continue to come on line, but unless the condition is detected at an early stage colorectal cancers will continue. This means that not only will people die , but also that huge resources will be required for treatment – palliative or otherwise. The public, and particularly those with a family history of bowel cancer, need to be educated on this important subject. That should be the role of government as well as the various cancer charities. This will result in a more coordinated campaign reaching many more potential sufferers. Government recommendations need to be turned into legislation so that screening is available to all. References Diagrams 1 and 2 NCI Cancer Bulletins, retrieved 15th 2011 from http://www.cancer.gov/aboutnci/ncicancerbulletin/archive/2004/113004/page5 Other References 2009 Colorectal Cancer Legislation Report Card, retrieved 12th February 2011 from 2009 Colorectal Cancer Legislation Report Card 5 a Day, NHS Choices, ( undated) retrieved 12th February 2011 from http://www.nhs.uk/livewell/5aday/pages/5adayhome.aspx Barone M. ( 14th August 2007) Typical American Diet Linked to Higher Risk of Colon Cancer Recurrence and Death, Best Syndication, retrieved 12th February 2011 from http://www.bestsyndication.com/?q=081407_chemotherapy-colon-cancer-stage-iv-recurrence-prognosis.htm Cancer Advances in Focus, Colorectal Cancer ( November 2010) retrieved 12th February 2011 from http://www.cancer.gov/cancertopics/factsheet/cancer-advances-in-focus/colorectal Clinical Practice and Practice Economics Committee., American Gastroenterological Association, ( 2001) Technical Review on Hereditary Colorectal Cancer and Genetic Testing, Gastroenterology retrieved 12 February 2011 from http://www.usagiedu.com/articles/gencan/gencan.pdf Colon Cancer Check, Ontario, (January 2011) retrieved 11th February 2011 from http://health.gov.on.ca/en/ms/coloncancercheck/ Corectal Cancer Coalition, ( 2011) retrieved 16th February 2011 from http://fightcolorectalcancer.org/policy_news/2009/03/congressional_resolution_has_a_very_clear_messagecover_your_butt#more-3875 Colorectal Cancer Prevention, Early Detection, and Treatment Act of 2009, retrieved 14th February 2011 from http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.1189: Lee, D. ( 1996) What are the causes of colon cancer?, Medicine Net.com, retrieved 11th February 2011 from http://www.medicinenet.com/colon_cancer/page2.htm National Center for Biotechnology Information, U.S. National Library of Medicine, ( 1998) Genes and Disease., retrieved 12th February 2011 from http://www.ncbi.nlm.nih.gov/books/NBK22218/ Mansell, P. ( 1st February 2011) ICR researchers find new target for bowel cancer drugs, Pharma Times, retrieved 12th February 2011 from http://www.pharmatimes.com/Article/11-02-01/ICR_researchers_find_new_target_for_bowel_cancer_drugs.aspx NCCN Updates Guidelines for Colorectal Cancer( 2011) National Comprehensive Cancer Network, retrieved 12th February 2011 from http://www.nccn.org/about/news/newsinfo.asp?NewsID=194 NIH Consensus Development Program, ( February 2011) Enhancing Use and Quality of Colorectal Cancer Screening, retrieved from http://consensus.nih.gov/2010/colorectalstatement.htm Oklahoma State Senate , (February 2007) Senate Committee Approves Corectal Cancer Bill, retrieved 17th February 2011 from http://www.oksenate.gov/news/press_releases/press_releases_2007/pr20070215c.html Patient Handout ‘Colorectal Cancer :Screening Saves Lives’( July 2009) , Centers for Disease Control and Prevention, retrieved 11th February 2011 from http://www.cdc.gov/cancer/colorectal/pdf/SFL_brochure.pdf Putnam,J. Allshouse,J., and Kantor, L., ( 2002) U.S. Per Capita Food Supply Trends: More Calories, Refined Carbohydrates, and Fats, Food Review, retrieved 12th February 2011 from http://www.ers.usda.gov/publications/FoodReview/DEC2002/frvol25i3a.pdf Thorne, K., Hutchings, H., and Elwyn, G.( 2006) The effects of the Two-Week Rule on NHS colorectal cancer diagnostic services: A systematic literature review, retrieved February 2011 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1479333/ United States Food and Drug Administration, ( 12th February 2004) FDA Approves Erbitux for Colorectal Cancer, United States Department for Health and Human Services, retrieved 12th February 2011 from http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2004/ucm108244.htm Read More