Recently in Screening Category

Marta Davila, M.D., continues to see the benefits of colorectal cancer screening.

A physician in MD Anderson's Endoscopy Center, Davila recently treated a presumably healthy 52-year-old man who responded to his wife's encouragement to get a colonoscopy.

"The patient kept postponing his colonoscopy appointment because he felt well. He was diagnosed with early stage colon cancer, underwent surgery and is now cured," says Davila, professor in the Department of Gastroenterology, Hepatology and Nutrition. "He was one of the lucky ones."  

According to Davila, preventive colorectal cancer screening is particularly important, especially since patients rarely experience symptoms until the cancer is at an advanced stage.

"The reality is we need to encourage our patients to get a screening test. It's the right thing to do," she says.

Research shows screening saves lives
A recent article published in the New England Journal of Medicine underscored the effectiveness of colonoscopy and colon polyp removal in saving lives. Researchers learned the death rate from colorectal cancer was cut by 53% in patients whose doctors had removed precancerous polyps.

Continue reading Colorectal Cancer Screening Saves Lives.

Kimberly Tripp was 12 years old when her grandmother died of gastrointestinal cancer. The loss of the person she most admired led her to a career in health care and, eventually, to MD Anderson.

"My first position here was as a post-op surgical nurse on the GI floor," says Tripp, currently administrative director of Acute Care Services. "I ended up taking care of these very same patients."

She eventually became a research nurse in the Department of Gastrointestinal Medical Oncology, where she worked with colorectal and pancreatic cancer patients. About the same time (in 2002), Cathy Eng, M.D., associate professor, joined GI Medical Oncology, and Tripp began working on a number of her colorectal cancer trials.

A stroll through a "colon"
According to the American Cancer Society, colorectal cancer is the third most common cause of cancer in men and women and the second leading cause of cancer death. However, colorectal cancer, relative to other malignancies, is a preventable cancer.

Continue reading Colorectal Cancer 5K Drives Home Importance of Education and Screening.

By Katrina Burton, MD Anderson Staff Writer

Lung cancer is the leading cause of death for men and women in the United States, with more than 157,000 deaths reported last year, according to the National Cancer Institute. Most lung cancers are caused by tobacco smoke. The longer a person is exposed to the smoke the greater the risk for developing the disease.

Continue reading New Screening Tool for Lung Cancer Brings Hope.

Gottumukkala S. Raju, M.D., professor in the Department of Gastroenterology, Hepatology and Nutrition at MD Anderson, set aside time to address some misconceptions and answer questions about colonoscopy screening. He reviewed a number of questions from MD Anderson's Facebook fans and recorded six video responses.

The questions

Lynda Ebanks Harrison said, "I know intellectually the why of how important this is, but how do you help the patient not have the "I'd rather stick needles in my eyes than let someone do that to me" kind of fear? And what about the new non-invasive procedure that was recently announced -- is that widely available and comparably priced?"

Continue reading Colonoscopy Questions Answered.

Anticipation. You've been there at some point in your life. As an expectant mother, I worried about labor pains.

The day before my second marathon, I asked myself, "Why am I doing this?" when I heard weather reports about possible thunderstorms.

So here I am the day before my first colonoscopy. Friends and colleagues readily offer their chagrin about the disgusting flavor of the solution offered in the bowel preparation, the necessary step preceding the procedure.

Continue reading Diary of a Colon Screening Prep.

By Lucy Richardson, MD Anderson Staff Writer

As an intern in External Communications at MD Anderson Cancer Center, I spend the majority of my time reading and learning about others' experiences with cancer. Since March is Colon Cancer Awareness Month, I have been tirelessly researching colon cancer facts and prevention methods.

Last night as I was having dinner with my family I learned my grandmother had colon cancer and her son, my father who is over 50 (sorry dad), has never had a colonoscopy.
"How could you not do this?" I asked, completely shocked and outraged at this information. "How could someone with a history of this devastating disease not get routine checkups?" My mother admitted that she has bugged him on many occasions to get it done. But he, like many people, never visits a doctor unless his arm is falling off.

Continue reading Bugging My Dad to Save His Life.

If you suspect that cancer "runs in your family," you may be curious about -- or even considering -- genetic testing.

This testing, which involves having a blood sample taken, can reveal DNA mutations that have been identified as causing certain types of cancer.

For some, the tests provide crucial knowledge. Those who test positive for a known cancer-causing mutation can address the risks head on with increased vigilance and screenings.

But testing is not for everyone, says Banu Arun, M.D., professor in the Department of Breast Medical Oncology and co-director of the Clinical Cancer Genetics Program at MD Anderson.

"Most cancers are not hereditary," she says. "For example, only about 10% of breast cancers are inherited. The rest are "sporadic" -- that is, they occur because of a confluence of factors."

That's why Arun suggests that before deciding to be tested, you consult a genetic counselor.

Counselors help assess the chances that a person will develop a disease such as cancer. Often, the first step in the process is making a family tree, then looking for such "red flags" as having had many relatives who:

• contracted cancer before age 50
• contracted more than one primary cancer, or
• had the same or a related cancer (for example, breast and ovarian).

She recommends that women who've been diagnosed with breast cancer and suspect it's hereditary get tested before beginning treatment.

"The results might indicate the risk of contralateral breast cancer (second new primary in the opposite breast) and help with surgical decision making, for example, considering bilateral mastectomy," she says.

"Also, new targeted drugs are in development that specifically target hereditary (BRCA-related) breast cancer, and patients might be eligible for these studies."

Read more about genetic testing in the Winter issue of Network.

It's a simple fact that bears repeating this Colorectal Cancer Awareness Month: Colorectal cancer screening saves lives. If found early, these diseases, which include colon, rectal and anal cancer, often can be treated successfully.

While traditional colonoscopy has been the method of choice for decades, virtual colonoscopy (VC), also called CT colonography, is a relatively new alternative that offers a less-invasive option for some people.

David Vining, M.D., professor in the Department of Diagnostic Radiology at MD Anderson, who invented the procedure in 1993, answers questions about virtual colonoscopy.

What exactly is VC? How is it performed?

In virtual colonoscopy, a CT (computed tomography) scanner is used to examine the abdomen and pelvis. Then the images are analyzed with sophisticated two- and three-dimensional viewing techniques.

We can literally fly inside the computer-generated model of a patient's colon, looking for polyps (growths on the wall of the colon) that are the precursors to cancer.

The process has four steps:

• Cleansing the bowel with laxatives the day before the procedure
•  Inserting a small tube into the rectum to inflate the colon with carbon dioxide gas; room air may also be used, but it makes the procedure less comfortable
• CT scanning of the abdomen and pelvis, which takes less than 10 seconds
• Image analysis using specialized computers
  

What are some of the advantages of VC compared to traditional colonoscopy?

No sedation is required for VC, and that is a huge advantage. Another plus is that we can look beyond lesions that might be obstructing the colon or examine a tortuous colon (a longer than normal colon that may become twisted or coiled).

Since VC is less invasive, the risk of bleeding and tearing of the colon is significantly less.

What are some of the disadvantages and criticisms of VC?

The main disadvantage is that, while VC screens for precancerous polyps and cancers, they cannot be removed during the exam. So a follow-up colonoscopy might be required. Some physicians discourage VC on those grounds, saying, "If you get a VC and a polyp is found, you will have to have a colonoscopy. So why not have a colonoscopy in the first place?"

That is partly true, but only 20% of people have significant lesions that warrant biopsy or removal. So, if we screen everyone with colonoscopy, 80% will undergo colonoscopy -- with its inherent risks of bowel perforation and the need for anesthesia -- unnecessarily.

Since the CT scan covers all the organs in the abdomen and pelvis, VC often can detect disease outside the colon. Significant lesions of this type are found in about 10% of cases. This can be a blessing and a curse due to the potential for unnecessary workups of benign lesions. Rather than discarding VC, I think we need better practice management guidelines on what to do with these findings outside the colon.

Another criticism has been that the process gives the patient a low dose of radiation. However, most VCs use ultra-low dose techniques with an extremely small radiation risk.

Who might be a candidate for virtual colonoscopy?

I think average-risk asymptomatic adults age 50 and older should consider VC. It's a good idea to discuss the alternatives with your doctor.

How common is the technology?

Even though VC is endorsed by the American Cancer Society and other national groups, its adoption has been slow for several reasons including:

• limited insurance coverage,
• few well-trained providers and 
• the public's general reluctance to comply with colon cancer screening recommendations
  

However, as insurance coverage increases, availability should follow.

The best VC exams generally are performed at large academic medical centers. It's a matter of the volume of cases a facility performs and the radiologist's experience in performing and interpreting VC examinations. The technology is available at most medical centers, but the devil is in the details in how to conduct the examinations.

What should people look for in choosing a facility?

Ask how many cases the facility has performed and the radiologist has interpreted. The American College of Radiology and the American Gastroenterological Association recommend that physicians who interpret VC exams have done at least 75, but I suggest that the more the better.

What types of research is MD Anderson doing?

Since bowel preparation is the largest barrier to most people seeking colon cancer screening, my research involves the development of new bowel cleansing approaches. These include solutions to dissolve feces and remove it from below without the need to drink the usual cleansing agents.

MD Anderson resources:
MD Anderson Colorectal Screening Guidelines

Additional resources:
American Cancer Society
American College of Radiology
American College of Gastroenterology

Your family's history of past events and life experiences is invaluable. Family medical history is no different.

Cancer in my family medical history includes the loss of a brother to non-Hodgkin's lymphoma at the age of 37, and a cousin who is living through it, thanks to advances in medicine over the years. My mother died of melanoma.

My sons' history includes renal cancer, because it claimed the life of their father, featured in Caregiver Chronicles.

Easy to Do
So, with that in mind, taking MD Anderson's Cancer Risk Check was a simple process. Is there a history of breast or colon cancer? How many fruits and vegetables do I eat daily? Do I smoke? Do I drink? How many drinks per day? How much do I exercise?

Based on my responses, I got personalized recommendations, which suggest changes I should consider making in my daily life.

It's My Choice to Take Action
Because my mother died of melanoma, my check list profile suggests I make frequent visits to a dermatologist. Thankfully, I've already worked in bi-annual visits with Carol Drucker, M.D., an associate professor in the Department of Dermatology at MD Anderson. Exercise already is part of my lifestyle, too. Eating more fruits and vegetables daily is something I need to work on.

Now It's Your Turn
Since you now know the Cancer Risk Check is simple, will you take it?

Therese Bevers, M.D., medical director of the Cancer Prevention Center and Prevention Outreach Programs, recently was quoted in MD Anderson's 2009-2010 Annual Report saying, "We created Cancer Risk Check to be simple to use and to empower people to take actions for a more healthful lifestyle."

And she adds, "Our goal is to have screening guidelines that are a resource. It's what we're doing to keep people from dying of cancer."

So, no doubt you'll take the Cancer Risk Check, especially if you're like me and you only have the memory of the smile, voice or touch of your brother, mother or spouse.


Take the Cancer Risk Check

Jacqueline Miller is one of MD Anderson's inflammatory breast cancer ambassadors. She is not an IBC patient, but is on the board of directors for the Inflammatory Breast Cancer Foundation and is active in spreading the word about IBC in the African-American community.

By Jacqueline Porterfield Miller, Inflammatory Breast Cancer Foundation, Board of Directors

Inflammatory breast cancer (IBC) is the most aggressive (fast growing) and deadly form of breast cancer. It is a rare malignancy that is often initially misdiagnosed as an infection or rash. 

Clinician says colonoscopy and great treatment saved his life

Renato Lenzi, M.D., gets to the heart of the matter when I tell him I perpetually postpone my colonoscopy.

"Without regular colonoscopies and the great treatment I received at MD Anderson, I would be dead," says Lenzi, a clinical associate professor in GI Medical Oncology.

After he was diagnosed with colon cancer in 2002 during a screening, Lenzi endured months of treatment that included surgery, six months of chemotherapy and five weeks of chemotherapy with radiation.

Although he may be a nine-year cancer survivor, Lenzi's haunted daily with side effects of the treatments, including body image changes, fatigue, difficulty sleeping and occasional increased anxiety related to medical testing.


 
The difference between talking about war and living it.
"As a doctor, you basically know what the side effects are," Lenzi says. "You've seen a number of patients, so you know the data. You understand the meaning to a point."

But when the tables turn and the symptoms and the issues become your own, he says, you know exactly what you're talking about.


"I have a better idea than I did before of the implications of the medication we give to people and what they're going to feel like. It's like talking about the war, and then having been in it."

This cancer warrior is being recognized by his colleagues as the honoree of the 2011 Sprint for Colorectal Cancer Prevention and Education (SCOPE) 5K, Saturday, March 26, 8:00 a.m., on the MD Anderson campus.









Race for education and prevention
The goal of SCOPE is to educate the general public about colorectal cancer. Excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in both men and women in the United States. The American Cancer Society says in 2010 there were:

• 102,900 new cases of colon cancer (49,470 in men and 53,430 in women)
• 39,670 new cases of rectal cancer (22,620 in men and 17,050 in women)

Learn more about colon cancer, colonoscopies and colonoscopy preparation.

To participate in the SCOPE 5K, visit mdanderson.org/scope.

Make healthier choices in your 20s, 30s, 40s, 50s and 60s
by: Colleen Martin, MD Anderson Staff Writer

Misty Howell was diagnosed with human papillomavirus (HPV) when she was only 16. Ten years later, doctors diagnosed her with cervical cancer.

"Learning about HPV and its effects really helped me understand what was happening to my body and why," Misty says. Misty also believes that her HPV diagnosis helped her doctors discover and treat her cancer at the earliest possible stage, which ultimately saved her life.

Misty's story offers women an important reminder during Cervical Cancer Awareness Month in January: cancer screening exams save lives.

"Practicing healthy behaviors, like getting a screening exam, is important for all women, regardless of age," says Therese Bevers, M.D., medical directior of MD Anderson's Cancer Prevention Center. 

Complete Bevers' screening checklist in this month's issue of Focused on Health. Then, take it with you to your next doctor's appointment to start your personalized health plan.

Also in this month's issue, learn about the Pap test, HPV vaccine and HPV testing. Find out how to age-proof your health in your 20s, 30s, 40s, 50s and 60s. Plus, our expert will clear up the confusion about menopause and cancer risk.

For more tips on women's health, follow us on Twitter and join our conversations on Facebook.