Mark Sumner

ACP Colorectal Cancer Screening Guidelines May Negate Screening Gains

The American College of Physicians (ACP) guidance against CT colonography use to screen for colorectal cancer (CRC) represents a step backward – particularly in underserved communities where screening rates are lower and CRC death rates are much higher. ACP's guidance to start routine screening at age 50 rather than 45 as the American Cancer Society recommends may also hinder recent gains against the nation's third leading cancer killer. About a third of those who should be screened for CRC can't or won't get a colonoscopy. We need more testing options – not fewer.

CT colonography (CTC) is an American Cancer Society and United States Preventive Services Task Force-recommended screening test. Landmark studies in the New England Journal of Medicine and elsewhere show CTC is less invasive than and comparably accurate to colonoscopy. Studies at the University of Wisconsin, National (US) Military Medical Centers, and in Europe show that use of the virtual exam significantly boosts screening rates and lowers costs — which can allow more providers to offer screening and save more lives.

Colorectal cancer death rates are 47% higher in Black men and 34% higher in Black women. A study says 19% of the racial disparity in colorectal cancer deaths is due to less screening. Recent census data shows that more Black and Hispanic people are getting screened with CTC compared to whites. Denying access to a test that is increasing screening in at-risk communities is not helpful.

CT colonography is an accurate, safe, and minimally invasive test that does not require sedation, allows people to go back to their daily activities, and is a preferred option for many who otherwise may not be screened. Doctors should discuss CT colonography with their patients. For more information on virtual colonoscopy, go to RadiologyInfo.Org/VirtualCT.

VA's Small Steps Are Leading To A Giant Step Toward Surviving Cancer

One in three Americans will be diagnosed with cancer in their lifetime. While the health care system has made incredible advances, far too many people still feel cancer's devastating impact.

In early 2022, President Joe Biden and First Lady Jill Biden re-ignited the Cancer Moonshot to reinvigorate national action to defeat cancer, with the goal to reduce cancer deaths by 50% in the next 25 years.

The Department of Veterans Affairs has been at the forefront of the Cancer Moonshot as a member of the president's Cancer Cabinet, and as the largest integrated provider of health care and cancer care nationwide. The VA serves about 9 million enrolled veterans at more than 1,300 health care facilities, including treating roughly 43,000 veterans for cancer every year.

President Joe Biden gives remarks during a Cancer Moonshot initiative event in the East Room of the White House on February 2, 2022, in Washington, D.C. (Photo by Anna Moneymaker/Getty Images)

To meet the Moonshot challenge, VA is boosting screening and virtual treatment options, leveraging technology and innovative therapies, and offering veterans access to new clinical trials. We are focused on reducing four major groups of cancer most diagnosed within the veteran population: lung, colorectal, prostate and bladder.

Lung cancer, for example, is the second most common type of cancer and is by far the leading cause of cancer death within the veteran community, taking approximately 5,000 veteran lives every year.

Early detection saves lives

According to the American Lung Association, nearly half of all lung cancer cases in the U.S. Are diagnosed at a late stage when the survival rate is only about 6%. The survival rate goes up to about 60% if diagnosed at an early stage. Consistent and routine screening is essential to the estimated 1-2 million veterans at risk for lung cancer.

High-quality, accessible screening is a cornerstone of VA's cancer care. In fact, in 2022, VA was recognized with a FedHealth IT Innovation Award for work by its National Center for Lung Cancer Screening to increase the number of eligible veterans getting screened for lung cancer.

VA's National Center for Lung Cancer Screening has worked to provide systematic, integrated, and high-quality screening. The center recently implemented an electronic health record alert at over 100 VA medical centers that provide lung cancer screening. These electronic alerts have become part of the system of care and have resulted in VA increasing the number of veterans screened for lung cancer by 560% compared to pre-pandemic screening rates.

During a Cancer Cabinet Community Conversation hosted by VA as part of the Cancer Cabinet, lung cancer survivor and U.S. Air Force veteran Brian Sturgill urged veterans to ask their provider about lung cancer screening and find out if they qualify. Sturgill, whose lung cancer was already metastatic when first diagnosed, is a survivor, but only after he underwent surgery to remove a section of his small bowel and a lobe of his lung.

"If we had screening 12 years ago, I don't know if I would have needed a small bowel resection," said Mr. Sturgill. Now well into his survivorship journey, Mr. Sturgill is a lung cancer clinical trial coordinator. His personal experience with clinical trials, lung cancer, and survivorship serves as a model for veterans and the importance of lung cancer screening.

Where you live shouldn't determine whether you survive

There are more than 2.7 million veterans enrolled in VA who live in rural and highly rural areas, many with no cancer specialists near their homes. VA is addressing this need through the creation and expansion of VA National TeleOncology, bringing sub-specialized cancer care to veterans in locations across the nation, with more than 55 sites currently active and more on the way, access to VA's virtual cancer care continues to grow.

Multidisciplinary teams will provide expert sub-specialized oncology services as well as care coordination across the cancer care continuum, from diagnosis to survivorship or palliative care. Through VA's recently launched Virtual Tumor Board, disease-specific experts lend their support for complex cases and rare cancers as well across the enterprise.

Clinical trials and the future of cancer care

The National Cancer Institute has partnered with the VA to enroll veterans with cancer — especially from underrepresented populations. As of 2021, 25% of patients enrolled in these trials were from minority populations.

We have created the Enhance Equity and Access to Clinical Trials, or ENACT, program that will add to existing programs and infrastructure while developing innovative strategies to help veterans and VA oncologists connect with clinical trials. This also means finding connections to clinical trials not traditionally used. For example, we have observed that there is a substantial improvement in survival over time that corresponds to the timing of approval of targeted therapy, particularly for non-small cell lung cancer.

A relentless commitment

VA has been a pioneer in the field of research, specifically cancer research. In 1933, Robert Schrek, a leader in the field of radiosensitivity, identified the first connection between sun exposure and skin cancer while at the Tumor Research Laboratory at the Hines VA Hospital in suburban Chicago. Longtime VA scientist Dr. Ludwig Gross was one of the great pioneers of cancer research and the father of modern retrovirology. During the years of the original race to the moon — the 1950s and 1960s — Gross was conducting laboratory studies on mice that eventually proved that leukemia in mice was caused by a virus.

The Cancer Moonshot has refocused VA's efforts on cancer, working to end cancer mortality as we know it. And VA is working to improve access for veterans at every step in their cancer care journey and helping veterans and their families take that giant leap to survival. To learn more about cancer care at VA, visit Cancer.VA.Gov.

Dr. Carolyn Clancy is the Veterans Health Affairs assistant under secretary for health for discovery, education and affiliate networks. Dr. Michael Kelley is the VA National Oncology Program executive director.

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At Home Colon Cancer Tests Equalize Access To Prevention, Especially For Black Americans

Colorectal Cancer disproportionately affects the Black population in America, and at-home testing ... [+] for the disease may help to bridge the gap.

getty

Technological innovation has evolved the healthcare market drastically. People are now able to monitor their health and wellness in ways that would have been unimaginable 50 years ago, including at-home testing for everything from everyday issues such as food allergies to finding out about the details of one's gut microbiome, to more weighty assessments of illnesses such as anemia.

Although there are few such ailments as tricky as cancer​—​and, yes, there are at-home tests for that.

While at-home testing for several types of cancer is currently available, the home testing kits for colorectal cancer can be fundamental in prevention of the disease, especially as its rates are rising amongst younger people. The passing of Oscar-nominated actor Chadwick Boseman in 2020 at the age of 43 was a turning point in the awareness of the disease and shone a light on the way colon cancer is affecting younger people and disproportionately affecting the Black population in America.

Dr. Narissa Joyner, a veteran Emergency Medical doctor in New York City, is acutely aware of the ... [+] lack of access Black Americans face when dealing with colon cancer.

Sollis Health

"Lack of access to care and attention to care disproportionately affects African Americans,​ ​especially women, for many reasons," says Dr. Narissa Joyner, Associate Medical Director, At-Home Care, Sollis Health, and a veteran Emergency Medical doctor in New York City including Lenox Hill's ER. In an e-mail correspondence the doctor says, "When it comes to cancer in general, being attentive to subtle symptoms and seeking preventative medical care are important first steps. Societal and cultural influences heavily affect the way many African Americans seek medical care; that narrative needs work."

According to the American Cancer Society, Colorectal cancer rates amongst Black adults "are the highest of any racial or ethnic group in the US. African Americans are about 20% more likely to get colorectal cancer and about 40% more likely to die from it than most other groups."

One company's at-home colon screening test aims for their product to act as an equalizer for the communities for which colon cancer is on the rise, particularly Black women. Guido Baechler, the CEO of Mainz BioMed, a company known for their at-home cancer detection kits echoed the statistics during a Zoom interview. "The general incidence of cancer is going down, very clearly down for older populations, but this is not true if you look at the younger population where the incidences are rising," he says.

According to a Yale University study, "Diagnoses of people under 55 years of age increased from 11% in 1995 to 20%, or 1 in 5 individuals," which has resulted in the medical community lowering the recommended screening age for this type of cancer from age 50 to 45. Meanwhile, reports published by Memorial Sloane Kettering state that, while the reasons for the increased levels of this type of cancer amongst the population are complex, for the Black population the reasons are clear: "Research suggests the most important factors in this disparity are access to high-quality screening and cancer care — not biological issues."

Guido Baechler is the CEO of Mainz Biomed which produces an at-home colorectal cancer test. He hopes ... [+] to bring testing to marginalized populations who otherwise would not have access.

Mainz Biomed

Although this is not about doom and gloom for Baechler and his teams, it's about affording opportunities to these populations with the hope to close these gaps and save lives.

"It's really important, what we're focusing on—it's the detection of cancer. What's unique in colorectal cancer is that you can actually, potentially, eliminate it if you identify it early and are regularly screened through testing. The earlier the better because the survival rate is higher," he says, and recommends testing between the advised cycles for colonoscopies of every 5-10 years to catch anything before it becomes an issue.

Dr. Joyner agrees. "Specifically for colon cancer, screening should be done earlier since we do know that earlier screening for colon cancer in African Americans is recommended. These home-testing kits could offer another avenue of screening that is easy to access, and I think they do have a possibility of helping to bridge the gap. When this is done in coordination with a patient's primary provider, it can offer a great resource to allow for early action and treatment if needed."

These kits test in two ways. First, through small collected stool samples which are tested for blood, which is a typical testing method in the US according to Baechler, who says this is best for detecting later-stage cancer. "Once the cancer starts bleeding, you can identify it. Unfortunately, though, that's quite often the late stage," he says.

The second aspect the test measures are DNA mutations through three different genes to detect elevation. If these genes are elevated, then that is a clear sign of the risk of early-stage cancer.

Baechler says, "We see, in our work, that people just want to be treated equally. So, through values of trust and transparency, which starts internally for us, we aim to extend these values to the people we want to help, and I hope we are able to influence opportunities towards equality in this space."

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