Poor less likely to be screened for colon cancer (Reuters Health-25/07/2005)

People who are poor, uninsured, born outside the U.S. or smokers are less likely to be adequately screened for colorectal cancer, according to the results of a new survey of nearly 10,000 New Yorkers. Based on the findings, the researchers estimate that nearly 1 million New Yorkers are at risk of developing colorectal cancer that will not be detected by screening. Approximately 50,000 Americans die every year from colorectal cancer. Research shows that screening tests can reduce the death rates by finding abnormalities before they become cancerous. Still, significantly fewer people get screened for colorectal cancer than for cervical or breast cancers, and in New York City, only one third of the people with colorectal cancer are diagnosed in the early stages of the disease. Currently, experts in New York recommend that people 50 or older undergo colonoscopy every 10 years.

Dr. Lorna E. Thorpe of the New York City Department of Health and Mental Hygiene, and colleagues conducted a randomized telephone survey of 9,802 adults living in New York City, asking if they were ever screened for colorectal cancer. The findings are published in the journal Cancer. The investigators found that 55 percent of participants 50 years old or older had been screened recently, and 42 percent said they'd received a colonoscopy within the past 10 years. However, some people were less likely to be adequately screening than others. For instance, people who were poor and Asians were less likely to be screened for colorectal cancer. Current smokers, non-exercisers, and people born outside of the U.S. were also less likely to report being screened for colorectal cancer.

Non-Hispanic blacks and women were more likely to say they'd gotten checked for the disease with a fecal occult blood test, rather than a colonoscopy, which is considered the "preferred colorectal cancer screening test," Thorpe and her team write. "Screening tests for colorectal cancer are highly effective for early cancer detection, which results in earlier stage diagnosis and reduced mortality. An increase in colorectal cancer screening rates to the levels seen for breast and cervical cancer screening would result in significant reductions in colorectal cancer incidence and mortality."

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No Evidence Calcium Fights Colon Cancer (HealthDayNews-20/07/2005)

Calcium supplements may help prevent the development of polyps that can lead to colorectal cancer, but there's no evidence calcium actually prevents the malignancy itself, researchers say. In a review of two earlier studies involving more than 1,300 individuals, Israeli researchers concluded that calcium supplements provide a moderate protective effect against development of colorectal adenomatous polyps -- small, usually benign polyps found in about 30 percent of middle-aged and older Americans. However, "this does not constitute sufficient evidence to recommend the general use of calcium supplements to prevent colorectal cancer," the investigators concluded. Their findings appear in the current issue of the journal The Cochrane Library.

Previous research in animals and surveys of people with high-calcium diets suggested that the mineral may offer some protection against colorectal cancer, one of the leading cancers in both men and women. "Calcium supplementation is relatively cheap, likely to be safe, readily available and has other positive metabolic effects on conditions that occur with aging," such as osteoporosis, high blood pressure, kidney stones and weight gain, Dr. Anca Zalmanovici, one of the review authors, said in a prepared statement.

If further studies do confirm that calcium is effective, it could be given to people who've previously had polyps and are therefore at increased risk for colorectal cancer, the review authors said.

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Chinese most prone to colorectal cancer in Asia (Reuters18/07/2005)

A study spanning 14 cities across Asia has found the highest incidence of colorectal cancer among ethnic Chinese, a trend which researchers in Hong Kong blamed on a more westernized diet. Between October 2004 and April 2005, doctors performed colonoscopies on 5,055 people and found polyps in 19.4 percent of the subjects. Of these, four percent had cancer. A further analysis found that colorectal polyps and cancers were found in more than 18 percent of ethnic Chinese, followed by just over 12 percent of Indonesians, 12 percent of Malaysians, 10 percent of Thais and eight percent of Filipinos. Ethnic Indians were the healthiest in this regard, with only five percent suffering the same condition.

A leading researcher in the study blamed the phenomenon on the genetic makeup of ethnic Chinese and their changing diet. "The prevalence of colorectal polyps and cancer among ethnic Chinese is very high, as high as in Caucasian populations," Leung Wai-keung, professor at the Chinese University's Institute of Digestive Diseases, told Reuters in an interview. "Our belief is that the Chinese genetic makeup is very susceptible to colorectal cancer but this race has been protected by traditional Chinese diet. But now, with lifestyle changes, a westernized diet, this genetic susceptibility has been brought out," he said, adding that diets rich in fat and red meat were the chief culprits.

Asked about the growing popularity in Asia of weight-loss programs from western nations which advocated diets that were low in carbohydrates and high in fat and meat, Leung said they would have to be followed over the long term to be harmful. The study covered the cities of Guangzhou, Hong Kong, Delhi, Jakarta, Fukuoka, Kitasato, Kurume, Seoul, Kuala Lumpur, Manila, Singapore, Taipei, Kaohsiung and Bangkok. Among ethnic Chinese examined in the survey, researchers found those in Hong Kong the most susceptible to advanced colorectal polyps and cancer -- 11 percent of them were diagnosed with the condition. Eight percent of Chinese in the southern Chinese city of Guangzhou were found with the illness, compared to four percent of ethnic Chinese in Singapore and just over two percent of ethnic Chinese in Taiwan. The study also found that the incidence of colorectal problems was highest among people over 50 years old. "If you are above 50, we would advise some kind of screening," Leung said

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Sigmoidoscopy Helps Catch Colon Cancer-(HealthDay News-05/07/2005)

Patients have a high acceptance of flexible sigmoidoscopy screening for colorectal cancer, according to the results of the initial colorectal cancer screening of thousands of volunteers in the Prostate, Lung, Colorectal and Ovarian cancer screening trial. The trial is evaluating the effect of flexible sigmoidoscopy screening on colorectal cancer deaths when the screening is used once and then repeated three to five years later. Of the nearly 65,000 volunteers who had flexible sigmoidoscopy screening, at least one polyp was detected in 15,150 (23.4 percent). Of those, almost 75 percent had follow-up lower endoscopy. Cancer and adenoma detection rates were similar to those in other studies.

The researchers, from the University of Pittsburgh Cancer Institute, said the high acceptance rates and observed detection rates in this group of volunteers should approximate the results that could be expected from a flexible sigmoidoscopy screening program in the general U.S. population.

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Bowel cancer risk higher for men with diabetes-(Reuters Health-05/07/2005)

Having diabetes apparently raises men's risk of developing colorectal cancer, Swedish researchers report. As lead investigator Susanna C. Larsson told Reuters Health, "Our findings suggest that colorectal cancer may be added to the list of diabetes complications." Ms. Larsson of the Karolinska Institute, Stockholm, and her colleagues note in the journal Diabetes Care that some, but not all, epidemiological studies have detected an increased risk of colorectal cancer in people with diabetes.

To investigate further, the researchers followed 45,550 men who were enrolled in a population-based study in 1997 when they were 45 to 79 years of age. During an average follow-up of 6 years, there were 411 cases of colorectal cancers. After factoring in age and other variables, the researchers found that diabetes was associated with a 49 percent higher likelihood of developing both colon and rectal cancer. These findings, the team concludes, "support the hypothesis" that high insulin levels or factors related to insulin resistance may play a role in triggering colon cancer.

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Hispanics, Blacks at Raised Colon Cancer Risk-(HealthDay News-27/06/2005)

Members of Hispanic, black and other U.S. ethnic groups face a 10 to 60 percent greater risk of being diagnosed with advanced colorectal cancer and a 20 to 30 percent higher risk of dying from the disease compared to non-Hispanic whites, a new study finds. The study, by investigators at the Fred Hutchinson Cancer Research Center in Seattle, reviewed data from the federal Surveillance, Epidemiology and End Results (SEER) program. Researchers compared colorectal cancer stage and death among people from 18 different racial and ethnic groups.

They found that blacks, Native Americans, Asians/Pacific Islanders and Hispanics were more likely than non-Hispanic whites to be diagnosed with advanced colorectal cancer. Blacks, Native Americans and Hispanics faced a greater risk of dying from colorectal cancer compared to non-Hispanic whites, while Asians/Pacific Islanders were at a lower risk. There were variations within these broad racial categories. For example, among Asian/Pacific Islanders, the risk of stage IV colorectal cancer and/or death was lower for Americans of Chinese, Japanese and Indian/Pakistani descent but higher for Filipino Americans and Hawaiians, compared to non-Hispanic whites.

Among Hispanics, the risk of stage IV colorectal cancer and/or death was similar for Cubans and Puerto Ricans but higher for Mexicans and South/Central Americans compared to non-Hispanic whites. "We observed numerous differences in the risks of advanced-stage colorectal cancer and mortality across individuals in different Asian/Pacific Islander and Hispanic subgroups," the researchers wrote, suggesting that experts need to take these variations into account when they evaluate cancer risk in minority populations.

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Western and Japanese diets up colon cancer risk-(Reuters Health-23/06/2005)

Both the meat-laden "Western" diet and the traditional, salty diet of the Japanese apparently increase the risk of colon cancer -- at least for women -- findings from a large study suggest. Researchers in Japan found that among more than 42,000 adults followed for 10 years, women (but not men) with either a Western pattern of eating or a diet heavy in traditional Japanese foods like salted fish and pickled vegetables had a higher risk of colon cancer compared with women who were deemed healthy eaters.

For their study, the investigators defined three different dietary patterns based on survey respondents' reported eating habits. One was dubbed the Western dietary pattern, and was marked by high intakes of meat, poultry, cheese and bread and butter. A second category, the "traditional" dietary pattern, was built around rice, miso soup, salted fish and pickled vegetables. The third dietary pattern was the "healthy" one, and it included high amounts of fruits, vegetables, soy products, beans and dairy. Overall, women whose diets were the most Western had more than double the risk of developing colon cancer as women with the least Westernized diets. Similarly, women who ate the most traditional foods were twice as likely as those who ate the fewest to be diagnosed with colon cancer.

The healthy eating pattern was not linked to colon cancer risk at all. Dr. Mi Kyung Kim and colleagues at the National Cancer Center in Tokyo report the findings in the July 10th issue of the International Journal of Cancer. A number of studies have suggested that diets high in animal products and saturated fat may raise the risk of colon cancer. A large European study published last week found that people who regularly ate hefty servings of red or processed meat had an elevated risk of the disease, as did people who got little fiber in their diets. In that study, fish consumption in general was tied to a lower risk of colon cancer.

In addition, heavy consumption of salted fish and vegetables, staples of the traditional Japanese diet in the current study, has been tied to higher colon cancer risk. The reasons are unclear, but research in lab animals has shown that substances in salt-preserved foods called nitrosamines may promote cancerous changes in cells, Kim's team points out. Why the various diets in their study were linked to colon cancer only among women is uncertain. It's possible, the team suggests, that smoking and habitual drinking -- two habits associated with colon cancer -- weighed more heavily than diet in men's risk of the disease. The American Cancer Society recommends that people exercise regularly and follow a diet rich in fruits, vegetables and whole grains as one way to lower the risk of colon cancer.

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Study advises cutting back on red meat: Heavy doses can add to risk of colon cancer -(Yahoo News-20/01/2005)

Men who eat a hamburger-sized portion of red meat most days of the week can have a heightened risk of colon cancer, according to an American Cancer Society study published this month. The same risk exists for women who eat red meat two to three times a week. The national study of nearly 150,000 adults older than 50 said those who reported eating the most red meat in a 10-year period were 30 percent more likely to develop colon cancer than those who reported eating little or no red meat. Processed meat increased the risk to 50 percent in those eating at least 1 ounce per day. That's similar to a slice of bologna up to six days a week for men and three days a week for women.
The risk posed by eating red and processed meat multiple days a week for 10 years, according to the Cancer Society, is slightly less than the risk factors of physical inactivity and obesity.

"The fortunate side is that some of those factors are within our control, such as lifestyle and dietary choices," said Liz Swords, director of clinical research at the Cancer Care Institute in Decatur. "For instance, populations that have diets high in fat, protein, high calories, alcohol and low folate are more likely to develop colorectal cancer than those populations that are low in fat but high in fiber, fruits and vegetables." Other choices that can help decrease the risk of colorectal cancer include quitting smoking and avoiding diets high in saturated fats combined with sedentary lifestyles. Yet, Swords added, avoiding the controllable risk factors does not guarantee immunity.

Colorectal cancer was the second leading cause of cancer death in Illinois between 1996 and 2000, according to the Illinois Department of Public Health. It was the third most commonly diagnosed in Illinois during that period. The Cancer Society described colon cancer and rectal cancer as similar, developing slowly over several years. The five-year survival rate is as high as 90 percent for those who catch the cancer in its early stages, such as through colorectal screenings. However, only 37 percent of colorectal cancers are found at the early stage, according to the American Cancer Society's Illinois Cancer Facts and Figures 2004. Screenings should begin at age 50 and include fecal occult blood test every year, flexible sigmoidoscopy every five years, double-contrast barium enema every five years and colonoscopy every 10 years.

Laura Sechrest, director of St. Mary's Hospital Food and Nutrition Services, said there are ways to reduce the risk of colorectal cancer without cutting out red meat or animal fat completely:

*Limit meat intake and eat low-fat meats, such as eye round, top round, round tip, top sirloin, bottom round, top loin, tenderloin and flank.

*For processed meats, limit bacon, hot dogs and luncheon meats or buy the 95 percent fat-free versions.

*Use cooking methods that limit or eliminate extra fat: broiling, grilling, roasting, stewing, steaming and stir-fry.

* Use nonstick pans or a thin coat of vegetable oil spray.

* Trim all visible fat before cooking.

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Calcium Cuts Women's Colorectal Cancer Risk -Study-(Reuters-20/01/2005)

Diets rich in calcium reduce women's risk of colorectal cancer, and women who also take calcium supplements can cut their risk even more, researchers said. The protective effect of calcium likely works in men as well as women, though dairy products rich in calcium are also known to heighten the risk of prostate cancer, doctors from the University of Minnesota Cancer Center said. Roughly 150,000 people in the United States are diagnosed with colorectal cancer annually, and it ranks second to lung cancer as the leading cause of cancer death, the report published in the journal Cancer Epidemiology, Biomarkers and Prevention said.

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Selenium May Reduce Colon Cancer Risk-(HealthDayNews-16/11/2004)

High levels of selenium in the blood may reduce the risk of colorectal cancer, according to a new study that suggests but doesn't prove the mineral's role as a preventive. Selenium is a trace mineral found in meats, grains, seafood and some nuts. However, how much you get varies according to where you live, because different areas have different concentrations of selenium in the soil. Those who live in areas where selenium intake is low have higher rates of colorectal and other cancers. "Your risk of colorectal cancer can vary by the amount of selenium you consume," said lead researcher Elizabeth T. Jacobs, from the Arizona Cancer Center. "People with higher blood selenium levels tended to have a decreased risk of a recurrence of colon cancer." Selenium may protect against not only colon cancer but also prostate cancer and lung cancer, Jacobs added.

Jacobs and her colleagues collected data from three randomized trials of colon cancer patients: the Wheat Bran Fiber Trial, the Polyp Prevention Trial and the Polyp Prevention Study. Looking at the data from these trials, they were able to determine the effect of selenium in the development of new cancerous colon polyps in patients. The researchers found that those with the highest selenium levels had a 34 percent lower risk of developing a new colon cancer, compared with those who had the lowest selenium levels. Their report appears in the Nov. 17 issue of the Journal of the National Cancer Institute. Whether increasing your selenium intake will actually be beneficial is not clear. Jacobs said that increasing selenium consumption will help people who have low levels of the element. "It will benefit those whose intake of selenium is low," she said. "However, it may not benefit those who already have adequate selenium levels."

The risks of having too much selenium are not known but are being studied, Jacobs said. In addition, studies are under way to determine the optimum selenium levels needed to prevent colon cancer and prostate cancer. Jacobs also said there are ongoing studies to see if selenium can help treat patients with prostate cancer. "Selenium is a promising preventive agent for colorectal cancer, but we are hopefully going to confirm this," Jacobs said.

"This study is not definitive," said Dr. Scott M. Lippman, chairman of the department of clinical cancer prevention at the University of Texas M.D. Anderson Cancer Center, "because it is not from a large randomized control trial of selenium." Based on this study, Lippman believes that such trials should be done to test the benefit of selenium in preventing colon cancer. Data from ongoing trials may provide an answer, he said: "I believe that over the next five to 10 years, we will have some very compelling data one way or the other regarding selenium's ability to suppress colorectal cancer." Lippman, who co-wrote an accompanying journal editorial, said there are biological reasons that may make selenium effective in preventing colon cancer. 

"There is laboratory information that suggests that selenium might prevent colorectal cancer," he said. One of these mechanisms is selenium's role in turning on genes that prevent cancer. Another is the mineral's effect in altering the metabolism of polyunsaturated fatty acids found in red meats, which are involved in the development of colorectal cancer, Lippman said. "Not only are the epidemiological data very consistent and supportive, but there are actually fairly strong biologic plausibility for selenium's ability to protect against colorectal cancer," he said. However, Lippman cautioned that the results of this study do not mean that people should start taking selenium supplements in the hope of preventing cancers. "The epidemiological and biological data strongly support going to the next step of a definitive randomized trial to find out if in fact it does work," he said.

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FDA Approves Wider Use for Sanofi Cancer Drug-(Reuters-07/11/2004)

Sanofi-Aventis said on Friday that U.S. regulators have approved wider use for its colon cancer drug Eloxatin. The drug, currently used to treat patients whose cancer has spread to other parts of the body, can now be used following surgery and before the disease has spread, the company said. The news was expected as Eloxatin has already been approved for wider use in Europe.

Recently introduced drugs such as Genentech Inc.'s Avastin and ImClone Inc.'s Erbitux are currently used to treat patients in the later stages of the disease. Patients who have recently had surgery are typically treated with standard chemotherapies. Dr. Sunil Gupta, senior director of clinical development, oncology at Sanofi-Aventis, said he believes about 40 percent of colon cancer patients fall within the category that Eloxatin is now approved for -- post surgery but before the disease has spread to other organs.

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 A treatment breakthrough should mean many more people with bowel cancer can be cured, say experts.When caught early and treated, there is already a good chance of survival, but in some patients the cancer can return. In trials, surgery combined with a new mix of chemotherapy drugs improved the chance of a complete cure by 25% compared to standard chemotherapy. The data was presented by its Paris-based author at a European Society for Medical Oncology meeting in Vienna.

Bowel cancer affects about 38,000 people in the UK each year - mainly over 60s - killing about 14,000. While it is obvious that picking up the disease and treating it as early as possible is the best way to ensure a cure, the success rates have not been high enough. Dr Rob Glynne-Jones, Macmillan lead clinician at the Mount Vernon Cancer Centre in Middlesex, said: "This is the first time for years that we have had a major advance where patients are actually going to be cured." He said for about 50 years there had been only one chemotherapy treatment available to treat bowel cancer, which was based on a drug called 5-FU. Giving this treatment after surgery to remove the tumour reduces the risk of the cancer coming back by about 30%, he said. In the trials on 2,246 patients with colon cancer, adding another drug, called oxaliplatin, reduced the risk by a further 25%.

Dr Glynne-Jones explained: "I know that may not sound very much, but when you think there are 38,000 patients getting colon cancer a year and probably 10 or 15,000 of them having chemotherapy afterwards, you are going to save quite a lot of lives. "For the 30% of those who would have relapsed you are going to reduce that by a quarter. That's quite a big issue," he said. He said adding in the extra drug did make the chemotherapy side-effects worse, but he said patients tended to accept that as a trade off for the increased likelihood of a cure. In particular, the treatment can cause numbness or tingling in hands by affecting the nerve endings.

Oxaliplatin chemotherapy is available in some places in the UK. The National Institute for Clinical Excellence is looking at its availability and is expected to make recommendations in May 2006. The patients in the study all had stage three bowel cancer, which means the tumour is confined to the bowel and has not spread. Author of the research, Dr Aimery de Gramont, from the St Antoine Hospital in Paris, told the Vienna conference the findings confirmed the importance of treating early with chemotherapy and surgery. 

Jola Gore-Booth, chief executive of Colon Cancer Concern, said: "Lack of awareness is one of the main reasons colon cancer remains a killer. "There is still considerable lack of knowledge and embarrassment surrounding this condition, which means that many people do not recognise the symptoms or do not act upon them. "We need to get across the message that colon cancer is curable if caught through early diagnosis and treated appropriately, and encourage patients to act upon their symptoms as early as possible."

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Doctors Advise Chemo Before Rectal Cancer Surgery-(Reuter News- 20/10/2004)

Administering chemotherapy and radiation before surgery for rectal cancer may not help patients live longer, but it produces fewer side effects than when it is given afterward, doctors reported on Wednesday. The new finding, published in The New England Journal of Medicine, could translate into less suffering for people with rectal cancer, which affects about 42,000 people in the U.S. each year. Traditionally, doctors have performed surgery first. "Preoperative chemoradiotherapy is the preferred treatment for patients with locally advanced rectal cancer," said a team led by Rolf Sauer of the University of Erlangen in Germany. Giving chemotherapy and radiation first may make chemotherapy more tolerable and may shrink the tumor, making it easier to remove with less damage to the rest of the body, they said.

Nearly 800 volunteers and doctors in 26 hospitals were involved in the test, which followed each patient for an average of four years. The Sauer team found that the five-year survival rate was about 75 percent, whether or not surgery was done first. The rate of complications during surgery was about 35 percent in each group. But far more people who had their surgery first suffered from side effects when they eventually received their radiation and chemotherapy. The rate of short-term side effects such as diarrhea was 40 percent among patients who got surgery first, versus 27 percent for those who got it after drug and radiation treatment. Having surgery after chemoradiation cut the risk of long-term side effects nearly in half. In an editorial in the Journal, Robert Madoff of the University of Minnesota in Minneapolis said the Sauer team has provided "convincing evidence" that it's better to have surgery last with that type of cancer. He said evidence has been steadily accumulating from other studies supporting the conclusion of the Sauer group.

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Obese Men More Prone to Colon Cancer-(Yahoo News-18/08/2004)

Obese adult men are more prone to colon cancer, according to research conducted by a university team. Assistance professor Kim Chang-sup of Ulsan University Medical School on Friday released the results of research on 618 adult men in their 40s-70s conducted for two months last year. Kim discovered that obese men have a higher risk of developing large intestine polyps, which may develop into cancer. The finding is the first of its kind to show a close link between obesity and colon cancer.

Kim's research team divided the participants into one obese and two normal groups for the study. According to the research on all three groups, 142 adults or 23 percent were found to have lower polyps in the colon, while 99 men or 16 percent had adenomatous polyps, which are more likely to develop into colon cancer. However, in the obese group, 32.7 percent were found to have large intestine polyps, while only 18.6 percent of the first normal group and 17.7 percent of the second normal group tested positive for them. Obese men also turned out to have a higher chance of having adenomatous polyps with 22.5 percent while 15.3 percent of the first normal group and 14.4 percent of the second group tested positive.

The research reported that those who smoke heavily and are older or particularly obese around their waist and hips have higher chances of having large intestine polyps. ``Colon cancer is quite prevalent, ranking fourth among all the cancers as the main killer in terms of fatality and occurrence rates,¡¯¡¯ Kim said, adding that adults should stay in shape because obesity is closely related to the occurrence of large intestine polyps.

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Clue to 'blocking' bowel cancer-(Yahoo News-18/08/2004)

The removal of a cell "switch" in mice stopped growth of lesions in the bowel that can turn cancerous with time. The Vanderbilt University team hopes a drug that blocks this switch, which has been developed in France, could have the same effect in humans. The scientists told Cancer Cell journal they planned to test this drug in mice. Cancer Research UK said it was a long way from human therapy. Cells have receptors that can be turned on and off to control different processes in the body.

A receptor called PPARdelta is thought to be important for the development of tag-like lesions of bowel tissue called polyps. Bowel polyps are generally harmless but can become cancerous with time, leading to full-blown bowel cancer. A hormone-like substance called prostaglandin E2 (PGE2) has also been linked to the development of polyps and bowel cancer. Dr Raymond DuBois and colleagues investigated the relationship of these receptors and substances in mice. They bred mice with a certain genetic mutation that made them prone to developing polyps in the bowel. When these mice were exposed to PGE2 they had many more polyps than they normally would have. The scientists then mated these mice with mice that lacked a gene for PPARdelta. The offspring would then be able to develop polyps but these polyps would not contain any PPARdelta receptor, they reasoned. When these mice were exposed to PGE2 they had the usual number of polyps. This shows PPARdelta is important for PGE2 to encourage polyp growth and, therefore, cancer growth, according to the scientists. "Now we can really focus on key components," said Dr DuBois.

His team plan to test a French drug that has the same effect as knocking out the gene for PPARdelta. This work will begin in mice. Dr Elaine Vickers, science information officer at Cancer Research UK, said: "Several scientific studies have suggested a role for PPARdelta in the development of polyps in the bowel. "This work has increased the evidence that PPARdelta is important in polyp formation. But this research is still at an early stage, and there is a long way to go before this work could be applied to humans."

Colon Cancer Concern welcomed the study and said it would be important for people who are prone to bowel cancer. A spokeswoman said: "Genetic or familial cancers are particularly challenging and require as much research as possible to improve the long term survival for these specific patients."

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Cancer Drug Warning Won't Change Its Use--(HealthDayNews-16/08/2004)

Government advisory that colorectal cancer drug Avastin had adverse side effects was based on updated trial data. Last week's warning that the colorectal cancer drug Avastin has life-threatening side effects seems unlikely to change its application, experts say. "We will continue to use the drug," said Dr. Peter Kozuch, an attending physician at St. Luke's-Roosevelt Hospital and Continuum Cancer Centers of New York in New York City. "It represents an important option in the treatment of metastatic colorectal cancer."

The U.S. Food and Drug Administration approved the drug in February to treat colorectal cancer that had spread to other parts of the body. According to product information, Avastin is a monoclonal antibody that cuts off blood supply to cancer cells. In pre-approval studies, researchers found Avastin, in combination with chemotherapy, gave patients an extra five months of life. But last week, the FDA and Avastin's manufacturer, Genentech Inc., alerted health-care providers that the drug carried with it a heightened risk of blood clots, which can lead to stroke, heart attack and chest pain. The warning letter to doctors, to be followed by new drug labeling, said the risk of serious heart problems was doubled for cancer patients who took Avastin with their chemotherapy.

In the research on which the approval was based, a small number of such "events" was noted, Dr. David Ross, deputy director of the FDA's Office for Drug Evaluation 6, said. Recently, newer study data showed that, in a trial of 200 people, 10 of those on Avastin (5 percent) had an adverse effect, compared to five in a control group. Ross noted, however, that the newer group of people was older and more frail than those in the initial study. But, he added, "The company's analysis of the data and the FDA's analysis, which is ongoing, is that there is enough data to update the labeling and focus on arterial [heart attacks and strokes] versus venous events. This is important information for providers to have."

"There were a small number of cases before, and now a small number of cases in a different patient population," added FDA spokesman Jason Brodsky. "Taken together, the prudent thing to do was to issue a warning and follow up with labeling revisions to reflect the new information."

Because labels take time to update and distribute, Genentech sent a letter to health-care providers on Aug. 12. As the first monoclonal antibody approved for this type of cancer, Avastin is, in a way, a breakthrough drug. It is considered a "biologic" drug, meaning it's more targeted than previous generations of drugs. Still, Avastin is only approved for use in combination with traditional chemotherapy. It is still not proven that the side effects seen are related to the drug or represent a statistical anomaly, Kozuch pointed out. Regardless, any decision to use Avastin will clearly have to consider both risks and benefits. "Avastin is indicated for a life-threatening disease, but these side effects are also life-threatening," Ross said. "The challenge is to individualize the decision for a particular patient."

Colon cancer is the third most common cancer among men and women in the United States, according to the American Cancer Society. ACS estimates say there will be 106,370 new cases in 2004. Kozuch said, however, that even though colorectal cancer is extremely grave, there are patients who are asymptomatic. And the new warning may need to be addressed. "They may have many months of good quality of life left and we would hate to diminish that for something catastrophic like a stroke," he said. "This is not a matter of killing the horse twice. We will have to have very careful discussions with patients regarding chest pain, heart attack and stroke," he added. "In patients who have recently had a heart attack or stroke, they may not want to take this drug at all."

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Researchers locate gene that promotes cancer growth-(Japan Times-06/07/2004)

A university research group has discovered a particular gene that frequently leads to malignant tumors in the colon, rectum or liver, possibly paving the way for the development of a new treatment. Cancer can stem from genetic abnormalities and the gene involved in the proliferation of cancer cells--SMYD3--could provide researchers with valuable information. The discovery was made by a research group led by Prof. Yusuke Nakamura and assistant researcher Ryuji Hamamoto at the Institute of Medical Science at Tokyo University and was reported Sunday in the online edition of the British journal Nature Cell Biology.

According to the researchers, SMYD3 is a class of enzyme called methyltransferase. Their study suggests that the gene contributes to the proliferation of cancer cells through its interaction with the oncogenes, homeobox genes and other genes associated with cell-cycle regulation. The study found that SMYD3 enhanced cell growth and was a contributing factor in increasing not only ordinary cell-growth, but that of cancer cells as well. But the researchers confirmed the effects of SMYD3 on colorectal and liver cancer could be significant suppressed and believe that SMYD3 is one of the main enzymes that trigger extraordinary cell growth.

According to statistics compiled by the Health, Labor and Welfare Ministry in 2003, cancer was the main cause of death in the country, while colorectal cancer ranked fourth as the cause of death for men and top for women. Liver cancer ranked third among men and ranked fourth for women. "It (the study) may be instrumental in curing colorectal and hepatocellular cancer," Nakamura said.

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Milk May Lower Risk of Colorectal Cancer-(Yahoo News-06/07/2004)

Drinking at least a glass of milk a day may lower the risk of colorectal cancer,
say researchers who pooled some of the world's largest studies on the long-believed link. Calcium, from milk or other sources, has long been thought to play a role in preventing colorectal cancer, the nation's second-leading cancer killer. Studies show high calcium intake reduces the occurrence of polyps that can turn cancerous. But diet-tracking studies stopped short of finding final proof of a truly lowered cancer risk.

To better define that link, scientists at Boston's Brigham and Women's Hospital analyzed 10 studies that together tracked nutrient consumption of more than half a million people, nearly 5,000 of whom eventually got colorectal cancer. People who consumed 6 to 8 ounces of milk a day had a 12 percent lower risk of later developing colorectal cancer than those who drank less than two glasses a week, the researchers report in the Journal of the National Cancer Institute. With more than a glass a day, the risk reduction was 15 percent. Other dairy foods didn't show a statistically significant relationship.

A total calcium intake — from diet plus calcium supplements — of 1,000 milligrams a day was protective, too. The researchers calculated that if all study participants had consumed that much, the women may have suffered 15 percent fewer cases of colorectal cancer and the men 10 percent fewer. Vitamin D, commonly added to milk, also is thought to play a role, either alone or because it helps the body absorb calcium. The study couldn't tease out vitamin D's role, but found the biggest protective effect with the highest doses of both nutrients.

Health Tip: Eat Grilled Meat Only Occasionally

Despite their luscious taste, grilled meats should only be eaten occasionally, according to the American Institute for Cancer Research. This is because grilling and other high-heat cooking methods can produce compounds on meat and fish that are suspected of causing cancer. There are other foods that make great grilling options and don't form the compounds, says the University of Texas Health Science Center. Vegetables, such as corn, asparagus, squash, and broccoli, are great on the barbeque, as are some fruits. Brush fruit and veggies with a little olive oil and grill them over medium heat, the institute suggests.

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Combination of CAMPTOSAR(r) (Irinotecan HCL Injection) and AVASTIN(tm) (Bevacizumab) Shows Survival Benefit in First-Line Treatment of Advanced Colorectal Cancer-(AScribe Newswire- 28/06/2004)   

Data presented today at the annual meeting of the American Society of Clinical Oncology (ASCO) showed that first-line therapy with a combination of CAMPTOSAR (irinotecan HCL injection) plus bolus 5-flouruocil/leucovrin (5-FU/LV) (IFL) and Avastin (bevacizumab) prolongs survival in patients with metastatic colorectal cancer (MCRC) when compared with a standard first-line MCRC therapy. In a separate report, data from a trial of combination therapy of Erbitux (cetuximab) and CAMPTOSAR plus infusional 5-FU/LV (FOLFIRI) showed the combination to be generally safe and well-tolerated, and active as a first-line MCRC treatment. "The body of scientific evidence demonstrating the safety and efficacy of CAMPTOSAR combinations with select targeted agents continues to grow," said Paulo Hoff, MD, associate professor in the Department of Gastrointestinal Medical Oncology at the University of Texas, M. D. Anderson Cancer Center in Houston. "The survival advantage of CAMPTOSAR combinations in the treatment of MCRC seems to be further improved when coupled with these promising targeted therapies, making CAMPTOSAR-containing regimens one of the preferred choices for treatment and an excellent candidate for further clinical research."

Data from patients enrolled in a Phase III trial that compared the survival impact of IFL plus Avastin therapy with IFL plus placebo therapy in the first-line treatment of MCRC, who continued to be monitored throughout post-progression therapy (PPT), showed that patients who received first-line treatment with Avastin and IFL, followed by second-line treatment with an oxaliplatin-containing regimen, lived an average of 25.1 months compared with patients who received first-line IFL plus placebo therapy and second-line treatment with a non-oxaliplatin regimen who lived an average of 15.8 months. In separate subgroup analysis, researchers found the first-line survival benefit observed with IFL plus Avastin therapy was present among all pre-defined subgroups with the largest increases in survival noted among patients with rectal cancer and among male subjects.

"It appears from the post-progression analysis that the sequencing of therapeutic regimens may play an important role in further extending survival in advanced colorectal cancer patients," said S. Hariharan, MD, Medical Director at Pfizer Oncology. "The survival data showing an average survival of 25.1 months is the highest we have seen with any sequence of first- and second-line therapies in MCRC."

In another first-line therapy study, preliminary results from a Phase II trial of combination therapy with Erbitux plus CAMPTOSAR and infusional 5-FU/LV (FOLFIRI) in the treatment of EGFR-expressing MCRC indicate the combination is effective, with 10 patients (46 percent) achieving partial response and 9 patients (41 percent) achieving stable disease. Safety analysis from additional patients (enrolled later) show the regimen to be well-tolerated.

"CAMPTOSAR is currently being studied in more combinations with targeted therapies than any other chemotherapy agent," added Dr. Hariharan. "With the proven survival advantage of CAMPTOSAR at their core, these new combinations have already increased survival for patients with advanced colorectal cancer beyond what was thought possible only a few years ago and with continued research may one day transform advanced cancers from deadly killers to manageable diseases."

About the Avastin + IFL Trial (No. 3517)

The randomized Phase III trial (AVF2107) evaluated the safety and efficacy of a combination regimen of Avastin plus CAMPTOSAR and 5-FU/leucovorin (using the bolus IFL regimen) as a first-line treatment for patients with MCRC compared with IFL plus placebo. Interim results from this study were used to support the recent FDA approval of Avastin for use in the first-line treatment of MCRC after demonstrating that the combination provides significant improvement in survival (20.34 months) compared with IFL alone (15.61 months) (p=0.00004). Patients from the trial also were monitored for survival based on their first-line therapy (IFL + Avastin or IFL + placebo) and whether they received second-line therapy with a regimen containing oxaliplatin.

815 patients were enrolled in two treatment arms for first-line treatment (IFL/Avastin or IFL/placebo). Following disease progression, patients who continued on in the study were divided based on their first-line therapy (IFL + Avastin or IFL + placebo) and their second-line therapy (oxaliplatin, no-oxaliplatin) resulting 4 groups: IFL + placebo and non-oxaliplatin group (122 patients); IFL + placebo and oxaliplatin group (109 patients); IFL + Avastin and non-oxaliplatin group (125 patients); IFL + Avastin and oxaliplatin group (97 patients). Following first-line treatment, patients who received IFL + Avastin had an overall progression free survival of 10.6 months compared with 6.2 months for IFL alone (p<0.00001). Patients in both treatment arms who received second-line treatment with oxaliplatin had higher overall survival than patients who received the same first-line therapy (IFL + Avastin: non-ox 19.6 months, ox 25.1 months (p<0.05): IFL: non-ox 15.8 months, ox 22.2 (p<0.01). The highest overall survival, 25.1 months, was achieved by patients, who received first-line therapy with IFL + Avastin and second-line treatment with an oxaliplatin containing regimen.

About the Erbitux Trial (No. 3513)

The Phase II study evaluated the safety and efficacy of combination therapy with Erbitux plus CAMPTOSAR, and 5-FU/LV administered via the FOLFIRI regimen in the first-line treatment of EGFR-expressing MCRC. All patients received a 400 mg/m2 initial dose of Erbitux and 250 mg/m2 Erbitux weekly for the remainder of the study period. Patients were divided into two treatment arms and received either low-dose FOLFIRI (LD) (180 mg/m2 CAMPTOSAR plus 400 mg/m2 leucovorin (bolus) and 300 mg/m2 5-FU (bolus) followed by 2,000 mg/m2 5-FU (via 46-hour infusion)) or high-dose FOLFIRI (HD) (180 mg/m2 CAMPTOSAR plus 400 mg/m2 leucovorin (bolus) and 300 mg/m2 5-FU (bolus) followed by 2,400 mg/m2 5-FU (via 46-hour infusion)) therapy every two weeks.

The study initially enrolled 10 patients in the LD group and 13 patients in the HD group, who were monitored for dose-limiting toxicities (DLTs), response, and time-to-tumor progression (TTP), and adverse events. Following a low incidence of DLTs in both groups, the HD group was expanded to include an additional 29 patients. No DLTs were observed in the LD arm and 3 DLTs were reported in the HD arm (grade 3 diarrhea, grade 3 allergy, grade 4 neutropenia).

Among the initial 23 patients enrolled, 22 were evaluable for efficacy. Ten patients (46 percent) achieved partial response, 9 (41 percent) achieved stable disease, 3 (14 percent) had progressive disease. Median TTP stands at 10.9 months. Additional safety analysis from the 42 patients in the HD arm show the most frequent grade 3-4 adverse events to be diarrhea (14.3 percent), neutropenia (11.9 percent), rash (11.9 percent), and nausea/vomiting (9.5 percent).

About CAMPTOSAR(r) (irinotecan hydrochloride injection)

CAMPTOSAR(r) is approved in combination with 5-fluorouracil/leucovorin (5-FU/LV) as initial, or first-line, therapy for the treatment of advanced (metastatic) colorectal cancer. The combination shown to increase survival in multiple studies has demonstrated consistent success in first-line treatment in objective tumor response rates and time to tumor progression. CAMPTOSAR is also a central component of combination therapy playing a primary role in the studies that supported the FDA approvals of molecular targeted agents, Avastin(tm) and Erbitux(tm).

CAMPTOSAR is associated with neutropenia and both early and late forms of diarrhea, which can be life threatening if not managed properly. Full prescribing and safety information, including black box warning, can be found at http://www.pfizeroncology.com/camptosar

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Calcium More Protective Against Some Polyps-(Yahoo News-15/06/2004)

High-Fiber, Low-Fat Diet Helps Calcium Prevent Colon Cancer. Calcium supplements could cut colon polyp risk -- especially advanced polyps that lead to colon cancer, new research suggests. The report appears in the latest issue of the Journal of the National Cancer Institute. "Our results suggest that calcium supplementation may have a more pronounced ... effect on advanced [colon polyps] than on other types of polyps," writes lead researcher Kristin Wallace, MS, with Dartmouth Medical School in Lebanon, N.H.

While some research has looked at this link, few have addressed it in any detail -- to look for the effects of calcium on different types of colon polyps, Wallace explains. These studies make no distinction on the effects of calcium supplements on polyp size or other characteristics. Also, what are the effects of calcium in the diet and from pills? One study has suggested that a 700 mg supplement daily may prevent polyps. However, it's not been clear whether a high-calcium diet boosts or hinders that effect, she writes.

The researchers analyzed data from patients involved in the large Calcium Polyp Prevention Study. The analysis involved 913 patients whose average age was 61 and who were followed for at least four years. They had been randomly assigned to take either 1,200 mg calcium supplements or a placebo. Each volunteer was asked about the calcium, fat, and fiber they typically got in their diet. Each participant had a history of having a polyp removed at least three years prior to the start of the study. They also had a colonoscopy at the beginning of the study to document no remaining polyps in the colon.

After four years the calcium group had 18% fewer noncancerous polyps and 35% fewer advanced polyps -- those with features that have a higher potential to become colorectal cancer -- compared with the placebo group.

There was another interesting pattern: Those with fewest polyps ate a high-calcium, high-fiber, low-fat diet. However, the numbers did not tally up as a definitive finding, notes Wallace. In all, her study suggests that total calcium intake over 1,200 mg daily is necessary for colon protection -- and that a high-fiber diet with modest levels of fat will boost the protective effects, she writes.

Wallace's findings are in line with similar studies but fall short of proving a preventive link between calcium, colon polyps, and colon cancer, writes Arthur Schatzkin, PhD, with the National Cancer Institute, in an editorial. However, studies are in place that could prove that this one nutritional factor -- calcium -- could offer protection against colon cancer. "That would be a tremendous advance," writes Schatzkin.

It's not clear how calcium acts to reduce colon polyps, writes Wallace. It may be that calcium binds "irritants" like bile acids and other fats in the bowel that are carcinogenic -- acting as a sort of "soap," possibly preventing colon cancer.

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Diseases share common lifestyle factors, study suggests-(Yahoo News-12/06/2004)

 Diabetics may have three times the normal risk of developing colorectal cancer, researchers said. They found that a marker for raised sugar levels in blood samples could be an indicator of people more likely to develop the cancer that kills more than 490,000 people each year.

In a study of 10,000 people, those with the highest blood sugar levels, even if they were below amounts diagnosed for diabetes, were more likely six years later to have bowel cancer. “Raised levels of blood glucose, even in the absence of diabetes, is still associated with an increased risk of colorectal cancer,” Professor Kay-Tee Khaw, of the University of Cambridge in England, said in an interview. She and her colleagues are not suggesting that diabetes, which affects 194 million people worldwide, causes colorectal cancer but that it may be a marker for something else that increases the risk. “We think the interpretation of this is that there are common lifestyle factors that appear to predispose to both diabetes and to colorectal cancer, such as diet or physical activity,” Khaw said.

People can have raised glucose levels without having diabetes but those with the highest levels are considered to be diabetic. “Even levels below those (of diabetics) seem to be associated with increases in colorectal cancer,” she added. The research, which was published in the journal Cancer Epidemiology and Biomarkers, was part of the European Prospective Investigation into Cancer study and looked into whether abnormal glucose metabolism increases the risk of bowel cancer.

Participants in the study filled in questionnaires about their health and lifestyle and blood samples were taken and analyzed. Six years later they were followed up and 67 had developed bowel cancer. The people who had the most raised blood sugar levels had the highest rates of colorectal cancer -- or about three times the risk of people with the lowest blood sugar levels. Dietary changes, losing weight and physical exercise can reduce blood glucose levels, Khaw said.

“This is giving us some clues as to what the causes of colorectal cancer might be, particularly the lifestyle factors. Diabetes and colorectal cancer may share common lifestyle causes,” she said. “If we can identify what these factors are, then we can slow down the growth of tumors. It (the research) is providing potential in terms of identifying future treatments and potential for screening.” But she stressed that it was a small study and that the findings must be replicated in larger research projects.

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Drugs Improve Outlook for Colon Cancer Patients-(HealthDay News-02/06/2004)

Two new drugs improve the outlook for patients with very different cases of colorectal cancer, researchers in the United States and Europe report. One prolongs life in advanced cases, and the other prevents recurrence, new research says. One drug buys some precious extra months of life when the cancer has spread throughout the body. The other provides a significant increase in the rate of disease-free survival when the cancer is detected early enough to be removed surgically. The one thing both treatments have in common is that each drug is added to the standard regimen for cancer of the colon and rectum -- a combination of fluorouracil and leucovorin, say separate reports in the June 3 issue of the New England Journal of Medicine.

The American trial probably will get most public attention, since the drug it used, bevacizumab, has been widely acclaimed as the first example of a unique attack against cancer proposed years ago by Dr. Judah Folkman of Harvard University. That process is called antiangiogenesis, which tries to stop the growth of new blood vessels that a cancer needs to flourish. The study covered just one use of the drug, for patients whose cancers have spread so much that surgery is not possible. Their survival time usually is measured in months. "Our study demonstrated several things," said study author Dr. Herbert I. Hurwitz, an associate professor of medicine at Duke University. "The first is that the addition of bevacizumab to first-line therapy conferred a significant benefit in terms of survival, tumor control and tumor shrinkage."

The study also appears to provide "the first blue-chip data set to validate the antiangiogenesis hypothesis," Hurwitz said. But he leaves open the possibility that the drug might act in a different way. The 402 patients who were given bevacizumab in addition to other cancer drugs survived for an average of 20.3 months, compared to 15.6 months for those who got the standard regimen. "We hope that the validation of the drug's value with one target can be expanded to provide better benefits against other targets," Hurwitz said. A number of studies using the drug, whose brand name is Avastin, have already begun, he said.

In the European study, the rate of disease-free survival for patients who got a different new agent, oxaliplatin, in addition to standard therapy after surgery was 78.2 percent after three years, compared to 72.9 percent for those who got only the standard regimen, said a report by a group led by Dr. Aimery de Gramont of the Hospital San Antoine in Paris.

The improvement is statistically significant, said Dr. Robert J. Mayer, director of the center for gastrointestinal oncology at the Dana-Farber Cancer Institute in Boston. He grumbled somewhat about the failure of the European researchers to provide data on survival for more than the three years covered in the report, but said he stood by the title of an editorial he wrote in the same issue: "Two Steps Forward in the Treatment of Colorectal Cancer." Mayer urged caution about Avastin, noting there has been "a great deal of publicity about this molecule. Many patients come to me with the understanding that it is a cure. We need to be clear in exactly what settings it should be used."

Given the need for carefully controlled trials, progress is inevitably slow, Hurwitz said, but it is being made. "In 2004, we have seen approval of three drugs for colorectal cancer," he said. "If this pace of progress continues, then we will be doing very well."

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Women's Preference for Women Physicians is a Barrier to Colorectal Cancer Screening-(AACR Annual Meeting)

Female patients tend to prefer seeing female physicians in most specialties of medicine. A study presented by researchers at the University of Michigan found that for colorectal screenings in particular, women patients' preference for a female health care professional is strong enough to delay the procedure and incur additional expenses, as there is a lack of available female endoscopists. To confirm their hypothesis, researchers administered a questionnaire to a prospective cohort of 202 female patients between the ages of 40 and 70 at four primary care offices.Forty-three percent of the respondents preferred a female endoscopist. Of those, 87 percent were willing to wait more than 30 days for the female and 14 percent were willing to pay additional costs for one. Five percent of respondents said they would not undergo the procedure unless guaranteed a female endoscopist.

Analysis of the questionnaires showed that the preference for a female endoscopist was most often predicted by the gender of the primary care physician, younger patient age and employment status. The sole independent factor associated with adherence to screening was doctor recommendation. Other barriers to the colonoscopy procedure included dislike of preparation and test (31%) and discomfort (18%). "Colorectal cancer can be treated and lives can be saved if the disease is caught early," according to Stacy Menees, M.D., lead author of the study. "The preferred screening method for identifying colorectal cancer is colonoscopy. Our research shows that seventy-five percent of women report embarrassment as a reason for female gender preference and in five percent of women, not guaranteeing a female endoscopist at the time of a colonoscopy is an absolute barrier to having the procedure performed. Interventions to improve adherence to colorectal screening must address gender preference with women patients."

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Diabetes Mellitus is a Risk Factor for Colon Cancer: A Case Control Study -(AACR Annual Meeting)

Researchers at the Overton Brooks VA Medical Center in Louisiana have found a strong association between diabetes and the risk of developing colon cancer, according to a conclusive study of more than 50,000 US veterans. In the retrospective, cross-sectional, case-control study, researchers evaluated the medical records of 60,697 patients between October of 1998 and June 2003 using regression analysis and adjusting for obesity, smoking, use of aspirin and alcohol. The 17.7 percent of patients in the study who had diabetes (8,974 patients) were 32 percent more likely to develop colon cancer than patients without diabetes.

"Given the increasing prevalence of diabetes and the serious mortality associated with colon cancer, we cannot ignore the strong possibility that the two diseases are related in some way and hope to confirm this theory with further study," said Rambabu Chalasani, M.D., lead author of the study. "However, our results should be viewed with caution due to the limitations of a case-control study and the population in the database." Duration and degree of control of diabetes was not factored into the analysis and some factors known to increase the risk of colon cancer, such as family history of colon cancer and personal history of inflammatory bowel disease were not incorporated.

However, their effects were limited by the large size of the patient population. The incidence of insulin resistance is rising in the US and colon cancer remains the second leading cause of cancer death. The geographic patterns of the two diseases are extremely similar; both were considered relatively rare before industrialization and the incidence has increased in regions undergoing economic development. Insulin resistance has been associated with hyperinsulinemia, increased levels of growth factors and alterations in receptor signaling, which may promote colon cancer.

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Screening Can Cut Bowel Cancer Deaths-Scientist-(Reuters-18/05/2004)

A national screening program in Britain to detect bowel cancer could save lives but the government must make sure there are enough trained staff to ensure it runs efficiently, a cancer expert said. "Over the past 15 years dramatic reductions in incidence rates of bowel cancer in the United States have been attributed to screening," Dr Wendy Atkin, of St Mark's Hospital in London, told a science conference. "During the same period in the UK incidence rates have remained unchanged in women and have even increased in men." Bowel cancer is now the second highest cause of cancer death in Britain and the government has been considering introducing a screening system to detect the disease early when it is most treatable. A national screening program is expected to be introduced within the next five years.

Atkin said she has no doubt that the program will reduce deaths from the disease but said it is essential that the state-funded National Health Service (NHS) can cope with it. Britain is considering two screening options for the program, Atkin told a meeting of the charity Cancer Research UK. One test will detect hidden blood in the stool, which can be an early sign of the cancer, and another is a more invasive method, to look for precancerous growths in the lower part of the bowel. Trained staff to conduct the tests are in short supply, according to Atkin. She found wide variations in detection rates in a study in trial centers testing for precancerous growths. "Making sure that the NHS is ready for the implementation of a bowel screening program in terms of staffing, resources and access to services should be a high priority for the government," Atkin told the meeting.

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Drug Route Doesn't Affect Colon Cancer Survival-(Reuters Health-18/05/2004)

Chemotherapy drugs are often given after surgery for colon cancer. New research now indicates that the route these drugs take in entering the body doesn't affect survival. Chemotherapy can be injected into veins to deliver the drugs throughout the body, known as systemic delivery, or into veins that largely limit delivery to the liver, called intraportal delivery. Doctors have been unable to reach a consensus regarding which method is best. The current findings are based on a study of 1,084 patients who underwent surgery for colon cancer and were randomly selected to receive chemotherapy delivered systemically, intraportally, or by both routes. The results are published in the Journal of the National Cancer Institute.

During a follow-up period of more than 8 years, 389 adverse events, including recurrences, new cancers, or deaths, were observed, Dr. Roldano Fossati, from Istituto Mario Negri in Milan, Italy, and colleagues note. A total of 361 patients died. Despite the different drug routes, the survival rates for the three groups were similar--about 74 percent, the authors note. Moreover, the body regions where cancers returned were comparable in the groups. "To our knowledge, this is the largest study of patients with colon cancer that has compared the efficacy" of this form of chemotherapy delivered by these methods, the investigators state. The main finding is that combining the intraportal and systemic drug delivery methods did not provide an increase benefit to patients, and that the results were similar to those seen when the individual routes were used separately.

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Protein promotes cancer metastasis and survival-(Yahoo News-19/04/2004)

A new study demonstrates that a protein called periostin promotes deadly spreading and late stage progression of colon cancer. The research results demonstrate that periostin promotes metastatic growth of colon cancer by activating signaling molecules that encourage cell survival and identify the protein as a potential therapeutic target for the control of colon cancer. Colorectal cancer commonly metastasizes to the liver and is the second leading cause of death from cancer in the United States. As with most cancers, it is the metastasis and not the primary tumor that is responsible for cancer fatality. However, the complex mechanisms associated with tumor metastasis are not very well understood.

Dr. Xiao-Fan Wang from Duke University Medical Center and colleagues searched for genes associated with metastatic tumors in samples from primary and metastatic colon cancers and found that periostin was highly expressed in metastatic tumors. When periostin was introduced into human colon cancer cells grown in the laboratory, the cells were much more likely to metastasize to the liver when subsequently introduced into mice. The researchers went on to show that the underlying molecular mechanism for periostin-mediated tumor metastasis is related to an increase in survival of cancer and blood vessel cells under stressful conditions. The researchers conclude that periostin plays a critical role in the progression of colon cancers and may be involved in metastasis of other cancers as well. "Metastasis accounts for the majority of the mortality associated with colorectal cancer, making control of metastasis an attractive treatment goal," explains Dr. Wang. "Our findings identify periostin as a potent promoter of late stage tumor progression. It is likely that periostin and similar types of proteins enable tumor cells to thrive in distant organs and grow under conditions that normally would be inhospitable. Targeting these proteins may prove to be a highly effective strategy for preventing late-stage progression of deadly metastatic cancers."

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Baylor wins $1.3 million grant to study virus related to colon cancer-(Yahoo News-19/04/2004)

The National Institutes of Health recently awarded Baylor Research Institute a $1.3 million grant to study a common virus suspected to play a role in causing colon cancer. C. Richard "Rick" Boland, M.D., chief of gastroenterology at Baylor University Medical Center at Dallas, will lead the research effort. Colon cancer, one the most common cancers in America, affects about 150,000 people yearly. Although lethal in late stages, with a cure rate less than 10 percent for advanced metastatic cancer, 90 to 100 percent of early stage colorectal cancers are curable.

In the research study, Boland will examine the JC virus, a common virus carried by approximately 80 percent of healthy people in their colons. People who carry the virus, which is caught during childhood, show no obvious ill effects. "Since most of us carry the virus, the virus itself is not the culprit," Boland said. "It seems to exist in a latent state in most people. But when the virus replicates, it can make mistakes or mutate. We think it very likely causes a problem called chromosomal instability and could be a trigger that starts the process that leads to colorectal cancer." If the study experiments are successful in determining the role of the JC virus, Dr. Boland plans to propose clinical trials that would seek to develop an immunization strategy for colon cancer. These clinical trials would be conducted in collaboration with Jacques Banchereau, director of the Baylor Institute for Immunology Research in Dallas. "Ultimately, we hope to develop a vaccine that might delay or prevent the emergence of neoplastic lesions in the colon," Boland said. "Our success could have significant implications for public health."

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'Key-Hole' Surgery Appears Safe for Colorectal Cancer-(Reuters Health-09/04/2004)

Several reports have shown that recovery after surgery is more rapid when patients with colorectal cancer undergo a less-invasive laparoscopic, or "key-hole" procedure, rather than conventional surgery. Now, new research indicates that the laparoscopic approach does not adversely affect disease control or jeopardize survival. There has been concern about the adequacy of surgery with the laparoscopic approach after reports linked the procedure with early recurrence at the site of incision. Until the long-term effects were clear, it was recommended that laparoscopic surgery be limited to the clinical trial setting.During laparoscopic surgery for colorectal cancer, a tiny scope and instruments are inserted through small incisions. A surgeon then draws the cancerous tissue through a small incision, removes it, and then reconnects the colon.

In a study reported in the medical journal The Lancet, Dr. Ka Lau Leung, from the Chinese University of Hong Kong, and colleagues describe the outcomes of 403 patients with colorectal cancer who were assigned to undergo laparoscopic or conventional open surgery between 1993 and 2002. After the procedures, the probability of survival after 5 years in the laparoscopic group was 76.1-percent higher, but not significantly different from the 72.9-percent rate in the conventional group, the researchers note. The probability of being disease-free after 5-years for the laparoscopic and conventional groups were 75.3 and 78.3 percent, respectively.

Consistent with previous reports, the laparoscopic surgery took longer to perform than open surgery. The average operating time for laparoscopic surgery was 189.9 minutes-about 45 minutes longer than the time needed for open surgery. Postoperative recovery, as determined by factors such as time to first bowel movement and hospital stay, was significantly accelerated in the laparoscopic group. However, this benefit came at the expense of a higher direct cost--$9297 per patient for laparoscopic procedure versus $7148 per patient for open surgery. No differences were seen between the groups in overall illness or operative mortality, the investigators point out. Laparoscopic surgery did not worsen survival or disease control for patients with colorectal cancer compared with open resection, and "its benefits in reducing pain and allowing earlier postoperative recovery were confirmed," the authors conclude.

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Currying Favor-(Health Sciences Institute e-Alert-04/03/2004)

Last week the FDA approved a new drug called Avastin; a breakthrough therapy that fights cancer by impeding the blood supply that tumors need to survive. Apparently this remarkable drug will help some patients add months or even years to their lives. But Avastin may have some competition - not market competition from another brand, but competition for effectiveness. Because the most popular prescription drug on the market today (taken by millions of people worldwide) actually stimulates the growth of new blood vessels. Miracle drugs won't work many miracles if they simply undo one another.

Cancer cells thrive and multiply when they prompt the body to create new blood vessels; a process called angiogenesis. When anti-angiogenesis therapy was first conceived of more than 40 years ago it was dismissed as a farfetched idea. Today it's considered the future of mainstream cancer therapy, and as of last week Avastin is leading the vanguard of this new class of drugs. The FDA approved Avastin specifically to treat cases of colorectal cancer where the cancer has metastasized and spread to other areas of the body. While additional trials are underway to determine Avastin's effectiveness against other types of cancer, you can be certain that some oncologists will want to prescribe Avastin for a variety of cancer types right away. The question is: Will insurance companies cover off-label use of the drug? That could be a sticking point, because a patient who takes Avastin for a year can expect to pay more than $100 per day. Given that 150,000 new cases of colorectal cancer are diagnosed each year in the U.S., it's no wonder that analysts are predicting that Avastin's sales may approach $2 billion a year for Genentech, Inc., the maker of the drug.

As with most drugs, Avastin use comes with a formidable list of possible side effects, including high blood pressure, diarrhea, blood clots and a lowered white blood cell count, which can increase the risk of infection. Some patients have also reported internal bleeding and ruptures in the colon. And Avastin has been shown to be effective only when used with a program of traditional chemotherapy, which often subjects the body to alarming stresses. Of course, for most cancer patients, the side effects and the exorbitant cost of Avastin will be tolerable trade offs in exchange for the promise of additional months or years of life. So it would be a particular shame if they were taking another medication that actually worked against their best efforts to survive. In the e-Alert "Missing the Forest" (7/23/03), I told you about the concern that cholesterol-lowering statin drugs may promote cancer. Few studies have been conducted in this area, and so far the results are conflicting. One of the primary reasons that further research needs to explore the statin/cancer question is this: Statins have been shown to stimulate the growth of new blood vessels - the very situation that Avastin is designed to reverse. It's impossible to predict which drug would win out in such a confrontation. But with the number of statin prescriptions estimated at well over 100 million worldwide, you can be sure that there will be statin-users who will also end up using Avastin.

Avastin is not a preventive therapy, of course. But there is a natural botanical that may provide protection against cancer in the same way that Avastin fights cancer. In 2002 I received a newsletter from well-known cancer researcher, Ralph W. Moss, Ph.D., in which he noted that in Sri Lanka the cancer mortality rate per 100,000 is 26.1 for females and 29.3 for males. The comparison of these numbers to America is unsettling: Cancer mortality per 100,000 in the U.S. is 138.6 for women and an astounding 206.0 for men. He adds that this difference is probably not due to genetic or hereditary factors, for two reasons: 1) the population of Sri Lanka has a wide diversity of ethnic backgrounds, and 2) the cancer rates of emigres from Sri Lanka to North America and Europe rise considerably within just a generation or two. Researchers believe that one nutritional element might be the key to the differences of these cancer statistics. In Sri Lanka a typical diet includes large amounts of turmeric -a spice that contains curcumin, used in curry powders. In his article, Dr. Moss lists the following as the three important benefits of curcumin intake: * Rich in antioxidants * A natural anti-inflammatory * Inhibits growth of new blood vessels in tumors. It seems that the people of Sri Lanka may be centuries ahead of the Western world in taking advantage of the cancer-fighting benefits of an anti-angiogenesis agent.

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FDA OKs First-Of-A-Kind Colon Cancer Drug-(ET-27/02/2004)

Genentech Inc. began shipping its widely anticipated colon cancer-fighting drug just hours after the government approved the novel biotechnology treatment. Avastin is designed to choke the blood supply that feeds tumors and is the first drug of its kind to be approved by the FDA. When used with chemotherapy, has been found to extend the life of the sickest patients by an average of about five months. Some 30 other experimental drugs based on similar technology are in various states of human testing and large drug makers such as Novartis, Bayer and Pfizer are in advanced development. Genentech also said it's experimenting with Avastin in several other forms of cancer, including kidney and lung.

The idea is that tumors must form a network of blood vessels to survive - and that shutting down that process, called angiogenesis, could fight cancer in a manner completely differently than other treatments. That theory was pioneered by Harvard University's Dr. Judah Folkman, who made front-page news in 1998 with reports that his anti-angiogenesis drugs had cured mice of cancer. But attempt after attempt to make such drugs work in people failed. Genentech Inc. saw its stock plummet as recently as 2002 when the drug failed to help breast cancer patients. But in May, the South San Francisco-based company surprised Wall Street when it announced that Avastin showed promise after doctors tried it in the sickest of colon cancer patients. Analysts expect the drug, which will cost each patient about $4,400 per month, to surpass $1 billion in sales in the next few years.

In a study of 800 people, half received intravenous Avastin in addition to routine chemotherapy. Not only was tumor growth delayed in those getting Avastin, but the Avastin patients lived about 20 months, five months longer than those getting standard treatment. It was the first time in three decades of research that an anti-angiogenesis drug was proven to help people. Avastin occasionally causes some serious side effects, including formation of holes in the colon that may require surgery to fix, impaired wound healing and internal bleeding, the FDA said. More common side effects are high blood pressure, fatigue, blood clots, diarrhea, appetite loss and increased risk of infection because of decreased white blood cells.

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Hormone Use May Cut Colon Cancer Risk in Women-(Reuters Health-03/03/2004)

Hormone replacement therapy (HRT) with estrogen and progestin seems to reduce the risk of colon cancer in women who are past menopause, new research shows. However, the cancers that do occur seem to be more advanced than those seen in non-HRT users. Most of the news regarding HRT in recent years has been bad. Just this week, the National Institutes of Health announced that the estrogen-only arm of the Women's Health Initiative (WHI) trial was being stopped early after the therapy was tied to an increased risk of stroke. This follows the termination of the estrogen/progestin arm in 2002 due to an observed increase in breast cancer, thrombosis, stroke, and heart disease events among HRT users. However, when the estrogen/progestin arm was stopped, the WHI researchers did notice one potentially beneficial effect for HRT-a decreased risk of colon cancer, according to a report in The New England Journal of Medicine.

To better understand the link between HRT use and colon cancer, Dr. Rowan T. Chlebowski, from Harbor-UCLA Medical Center in Torrance, California, and colleagues analyzed data from 16,608 women who participated in the estrogen/progestin arm of WHI. Overall, HRT users were 44 percent less likely to develop colon cancer than non-users, the researchers found. "We were quite surprised to find that colon cancers in HRT users were of higher stage than those seen in controls," Chlebowski told Reuters Health. The cancers that occurred in HRT users usually affected more lymph nodes and were more likely to have spread to other organs, the results indicate.

"Our findings are somewhat similar to what was seen (last year) in the trial with Proscar (finasteride) and prostate cancer-overall risk is decreased but severe disease is more likely," Chlebowski noted. "Interestingly, among HRT users with colon cancer, those with antecedent vaginal bleeding were the ones most likely to have advanced...disease," Chlebowski pointed out. This bleeding may have slowed the clinical work-up so that the cancer wasn't diagnosed until a more advanced state, he added. Despite all the unfavorable reports, Chlebowski believes that HRT could still be a viable therapy. "One strategy would be to see if the risks of HRT could be modulated with other agents."

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More Evidence Vegetarian Diet May Cut Cancer Risk- (Reuters Health-16/02/2004)

Eating a meat-free, vegetarian diet may reduce the risk of colorectal cancer, new research suggests. After following more than 10,000 people for 17 years, investigators found that vegetarians were 15 percent less likely to develop colorectal cancer than meat-eaters. This study adds to the "increasing scientific evidence" that a diet rich in fruit, vegetables and fiber and low in meat-especially red and processed meat-can prevent colorectal cancer, study author Dr. Miguel Sanjoaquin of the University of Oxford, UK, told Reuters Health. However, Sanjoaquin cautioned that only a small number of study participants -95--developed colorectal cancer, making it impossible to determine if fewer vegetarians developed cancer simply due to chance. Sanjoaquin noted that a previous study featuring more cases of colorectal cancer confirmed these findings, and he added that it makes sense that eating vegetarian could cut cancer risk.

The fat in red meat increases the excretion of substances called bile acids, he explained, which in turn produce other substances that encourage tumor growth. Furthermore, meat contains natural compounds and substances formed during processing and high-temperature cooking that can disrupt the normal balance of cell growth in the colon, potentially triggering the cancer, Sanjoaquin noted. Alternatively, substances in fruits and vegetables-staples of the vegetarian diet-"may inhibit these adverse effects," he added. During the current study, Sanjoaquin and his colleagues asked 10,998 adults about their eating habits and other health parameters, then noted who developed colorectal cancer. People were classified as non-vegetarians if they ate meat or fish. Vegetarians included vegans, who avoid all dairy and meat products.

Along with a decreased risk of cancer from eating vegetarian, the investigators found that frequent fruit eaters - consuming more than 5 servings of fruit per week-were over 40 percent less likely to develop colorectal cancer. Smoking, drinking alcohol and eating more than 15 slices of white bread per week appeared to increase the risk of colorectal cancer, according to the British Journal of Cancer report. Sanjoaquin said the fact that white bread appeared to reduce cancer risk was "unexpected," and suggested that people who ate large amounts of white bread might have simply had a less healthy diet overall. Alternatively, he added researchers have noted that eating large quantities of refined carbohydrates, such as those found in white bread, may raise colorectal cancer risk, suggesting that white bread itself may also play a role. "More research will be needed to clarify this," Sanjoaquin said

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Erbitux Lifts Hopes of Colon Cancer Patients-(Reuters-13/02/2004)

Advocacy groups said patients with advanced colon cancer are hoping ImClone Systems Inc's new drug, Erbitux, will improve their lives and help some survive until more effective drugs come along. Patients typically live only 12 to 18 months after colon cancer has spread to other parts of their body. Although Erbitux did not prolong the lives of such patients in clinical trials, it did shrink tumors in 23 percent of those who had exhausted other drug options. Erbitux, which was approved by U.S. regulators and will be co-marketed by Bristol-Myers Squibb Co., works by blocking receptors to a protein called epidermal growth factor that are found in large numbers on the surface of many types of tumor cells. It is less toxic than many older chemotherapy drugs, which tend to harm healthy tissues as they go after cancer cells. "If you can shrink tumors and slow down their growth, there's always a potential of extending a patient's life, and that's what patients are hoping for," said Ernestine Hambrick, founder of Stop Colon/Rectal Cancer Foundation.

Hambrick, a former colon cancer surgeon whose education and prevention group is based in Chicago, said patients diagnosed with advanced colon cancer for decades could only be helped by one drug, called 5-FU. But survival times have doubled in the past decade with the addition of Pfizer Inc's Camptosar and Sanofi-Synthelabo's Eloxatine. "Erbitux was tested in the very sickest colon cancer patients, but now that it's approved, many doctors will begin prescribing it for less-advanced patients in various combinations with these other drugs," said Carolyn Aldige, president and founder of the Cancer Research and Prevention Foundation.

Aldige, whose group is based in Alexandria, Virginia, said new combinations using Erbitux might extend patient lives additional months, even though no trials have yet demonstrated that. "It's not necessarily a breakthrough drug, but by shrinking tumors, it can reduce pain, and that's a clear potential benefit," Aldige said. Eribitux has also spurred some enthusiasm in Canada, where it is awaiting approval. Barry Stein, president of the Colorectal Cancer Association of Canada, has survived eight years after being diagnosed with advanced colon cancer. "I'm not supposed to be here, but I am thanks to numerous surgeries to remove tumors" and treatments approved in recent years, Stein said. He said each new approved drug has the potential to extend life a bit longer. "And the longer you live with the disease, the greater chance you'll be around until better drugs are found." "Every new advance lifts your spirits and gives you the encouragement to keep on fighting, which influences your quality of life," Stein said.

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Colorectal Cancer: A Family Matter-(ET-10/02/2004)

It's a medical detective story that starts with the emigration of a married couple from Germany to Pennsylvania in the early 1700s and ends with implications for today's programs to screen for the risk of colorectal cancer. The couple had 11 children, a typically large family for that era. Those children married and had families of their own, until their descendants numbered in the thousands, a new study reports. And over the decades and centuries, an unexpectedly large number of those descendants were diagnosed with cancer. Most were cancers of the colon and rectum, but there also were other tumors such as endometrial cancer and ovarian cancer among the women. It wasn't until recently that researchers, armed with the tools of modern genetics, were able to establish the link.

The original German immigrants brought with them a mutation of a gene designated MSH2, a mutation that predisposes people to develop some cancers, particularly colorectal cancer. The mutation appears to have originated with one of the married pair. Each of their children had a 50-50 chance of inheriting what is called the "founder mutation," and each person with that mutation had a 50 percent chance of passing it on to a child. The existence of the mutation was first noticed in 1997 by Riccardo Frodde, a geneticist then at Leiden University in the Netherlands, who found evidence of it in more than 50 families there. The story then moved to the United States, where a group of researchers headed by Dr. Henry T. Lynch, a professor of preventive medicine at the Creighton University School of Medicine in Nebraska, found the same mutation in members of seven apparently unrelated families with a history of colorectal cancer. That discovery indicated the families might, in fact, be related, says Stephanie M. Coronel, a genetic research assistant in Lynch's laboratory. "That is how we started doing genealogical work, looking at different sites on the Web," Coronel says.

Those studies pointed toward a common origin of the mutation, and they drew in another researcher, Dr. Albert de la Chapelle, a professor of cancer genetics at Ohio State University. He had found the same mutation in two other families. "It was pure coincidence that Dr. Lynch and I, who knew each other, identified the same mutation in some of his patients and some of my patients," de la Chapelle says. "It was not very difficult to start putting two and two together." The result, reported in the Journal of the American Medical Association, was detection of the founder mutation in 61 members of the nine families in admittedly partial testing; only 137 of 566 members of the families have been tested. "We have shown by now that four of the nine families descended from the founder couple, and we are almost 100 percent certain that all do," de la Chapelle says. This is a big surprise, he says, because founder mutations traditionally have been seen only in relatively small, isolated populations, such as Icelanders and Ashkenazi Jews. "You do not expect to see it in a mixed population, such as we have in the United States," de la Chapelle says.

The implications of the discovery may extend to many Americans outside the tested families, Coronel says, since it is estimated that 10 percent of all colorectal cancers are hereditary. The presence of colorectal cancer in a family can indicate a need for genetic testing, she says. "If you have a family history of colorectal cancer, or a parent or sibling diagnosed at an early age, you can call your local genetic counselor," Coronel says. "If a mutation is found, it can be referred to us." The fact that the mutation appears to be widespread could help make genetic screening more efficient, de la Chapelle says. Researchers could start by running a test for the suspect gene, skipping more costly testing for a variety of genes. Testing for all cancer-causing mutations costs about $2,500, he says, so it would be less expensive to start by looking for just one mutation. "If this is as common as we think, all testing should look at this first," de la Chapelle says

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Catching the Culprit in Colon Cancer-(HealthDayNews-03/02/2004)

The activation of a particular cellular receptor greatly increases the development of precancerous polyps in the intestine, says a Vanderbilt-Ingram Cancer Center study in online edition of Nature.This is the first time that scientists have found evidence of this activation process. The findings may suggest a new strategy for preventing colorectal cancer by preventing activation of this cellular receptor.The results also raise caution about a possible increased risk of colorectal cancer among people who take drugs that activate this receptor. Such drugs are currently in clinical development to treat obesity and atherosclerosis.In this study, researchers found that mice with a specific genetic mutation - one that's found in 80 percent of people with colorectal cancer - had a fivefold increase in the number of larger colon polyps when they were given a compound that binds to the peroxisome proliferator-activated receptor delta (PPAR-delta)."This is extremely significant because it is these larger polyps that are most likely to develop into intestinal cancer," Dr. Raymond N. DuBois, associate director of cancer prevention, control and population-based research at Vanderbilt-Ingram, says in a prepared statemnent

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High-carb diets may increase cancer risk-(USA TODAY-04/02/2004)

Diets filled with certain high-carbohydrate foods may increase the risk of colorectal cancer in women, according to a