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Colorectal cancer death rates are rising in whites under 55

new ACS study finds that colorectal cancer mortality rates have increased in white adults under 55 since the mid-2000s after falling for decades, strengthening evidence that previously reported increases in incidence in this age group are not solely the result of more screening.

Published in the Journal of the American Medical Association (JAMA), the report says: "Although the risk of colorectal cancer remains low for young and middle-aged adults, rising mortality strongly suggests that the increase in incidence is not only earlier detection of prevalent cancer, but a true and perplexing escalation in disease occurrence. It is especially surprising for people in their 50s, for whom screening is recommended, and highlights the need for interventions to improve use of age-appropriate screening and timely follow-up of symptoms."

ACS investigators led by Rebecca Siegel, MPH, analyzed colorectal cancer (CRC) mortality among persons aged 20 to 54 years, by race, from 1970 through 2014, using data from the National Center for Health Statistics. 

The analysis included 242,637 people ages 20 to 54 who died from CRC between 1970 and 2014. CRC mortality rates among those ages 20 to 54 declined from 6.3 per 100,000 in 1970 to 3.9 in 2004, at which point mortality rates began to increase by 1.0% annually, eventually reaching 4.3 per 100,000 in 2014.

The increase thus far is confined to white men and women and is most rapid for metastatic disease.

Breakdown by age

  • Mortality remained stable in white individuals ages 20 to 29 from 1988-2014
  • Mortality increased 1.6% per year in white men and women ages 30 to 39 years, from 1995-2014
  • Mortality increased by 1.9% per year in white men and women ages 40 to 49 years, from 2005-2014
  • Mortality rates increased by 0.9% per year for white men and women ages 50 to 54 years, from 2005-014. The report notes that "Increased mortality is particularly unexpected among those aged 50 to 54 years, for whom screening has been recommended since the 1970s."  However, according to Rebecca Siegel, while screening prevalence has increased for all age groups over 50, it is lower in people 50 to 54 than in those 55 and older, 44% versus 62% in 2013.

Conversely, rates declined in black individuals in every age group

The authors note that these disparate racial patterns are inconsistent with trends in major risk factors for colorectal cancer, like obesity, which is universally increasing.

Breakdown for non-whites

  • Among black individuals, mortality declined throughout the study period, at a rate of 0.4% to 1.1% annually, from 8.1 in 1970 to 6.1 in 2014.
  • Among other races combined, mortality rates declined from 1970-2006 and were stable thereafter.

The study notes that CRC mortality overall is declining rapidly, masking trends in young adults, making this an area ripe for more examination. 

Signs and symptoms

Because young people can and do get colon and rectal cancer, it is important for them -- and their doctors -- to pay attention to signs and symptoms, and be educated about the importance of healthy lifestyles.

The most common signs and symptoms include:

  • A change in bowel habits, such as diarrhea, constipation, or narrowing of the stool, that lasts for more than a few days
  • A feeling that you need to have a bowel movement that is not relieved by doing so
  • Rectal bleeding
  • Dark stools, or blood in the stool
  • Cramping or abdominal (belly) pain
  • Weakness and fatigue
  • Unintended weight loss

You can lower your colorectal cancer risk by:

  • Eating lots of vegetables, fruits, and whole grains and less red meat (beef, pork, or lamb) and processed meats (hot dogs and some luncheon meats)
  • Getting regular exercise
  • Watching your weight
  • Avoiding tobacco
  • Limiting alcohol. The American Cancer Society recommends no more than 2 drinks a day for men and 1 drink a day for women. 



  • Nominations now open for research stakeholders

    "Research saved my life and now I get to be a part of research without having to get my PhD," said Jemma Cabral, two-time cancer survivor and research stakeholder volunteer since 2012.

    Jemma is one of approximately 40 lay reviewers, or stakeholders as we call them, participating in the peer review process for the American Cancer Society's research program. Stakeholders are individuals without formal science or oncology training who have a strong interest in cancer research. Stakeholders bring with them a personal experience with the disease which could include being a survivor, having a family member with cancer, or serving as a caregiver for a person with cancer. Applications for this important volunteer role are currently being accepted.

    For Jemma, the experience needed for this role came from her journey with Hodgkin lymphoma in 2002, when she was just 23 years old. She relapsed a year later and underwent a stem cell transplant before going into remission. Jemma started her volunteer involvement 12 years ago, with the Society's Relay For Life program. Her service spanned 25 Relay events in 10 different states, Canada, and Puerto Rico. "It was 2009 and Relay was turning 25," explains Jemma. "I was turning 30 so I decided to go to 25 Relay events to celebrate."

    In 2012, Jemma took her volunteering to a new level when she applied for and was accepted to serve as a stakeholder. "Being a stakeholder, you actually get to see first-hand where the money is going," she said. "As someone who has had cancer, I get to speak up about what the experience was like, and how research can change it."

    Jemma started her role on the Health Policy and Health Services Committee. "I was very intimidated at first, sitting in a room with a group of people who I knew were very intelligent," said Jemma. 

    She realized her experience would come in handy when they started talking about access to treatment and screening. "When I had my stem cell transplant, I was working for a huge corporation and had outstanding benefits," she remembers. "I didn't pay anything except for co-pays. I didn't have the money in my back pocket to pay for the treatment if I didn't have such great benefits. I was lucky to have that coverage; others are not so fortunate," she said.

    Nominations for new stakeholders are being accepted through September 15

    To nominate an individual to serve as a stakeholder, please fill out this form and email it to Joe Cotter, Research Constituent Engagement manager, at joseph.cotter@cancer.org

    Since 1999, the Stakeholder Program has supported the Society's leadership role in advancing cancer-related research and health professional training by incorporating input from lay individuals about the cancer experience into discussions about scientific and health professional training funding. Additionally, by ensuring such input on Society-funded research, this Stakeholder Program offers an opportunity for volunteers to understand and share how the peer review process affects the development of new ideas and breakthroughs in cancer research, ultimately benefitting the lives of cancer patients and their families.

    Read more about the Stakeholder Program.

    Employees of the American Cancer Society are members of the Society's National Board of Directors are not eligible to serve. National Board members are the only volunteers who can’t apply, and that's because they ultimately approve research funding decisions.

    The two main goals of stakeholder participation on peer review committees are to:

    • Represent the cancer patient perspective in the peer review process.
    • Develop advocates who will return to their communities with a unique story to tell about the value of the American Cancer Society's Extramural Research and Training program.

    Desirable Characteristics of a Stakeholder
    A potential stakeholder should:

    • Possess a willingness to embrace the broad perspective of cancer research and training used by the Society in its grant funding.
    • Be able to participate in training for serving as a peer reviewer.
    • Have demonstrated effectiveness in interacting with groups as a leader or participant in a managerial, professional, or educational capacity.

    Stakeholders typically do not have advanced formal training in the biological, clinical, or social science topics reviewed by the peer review committees on which they serve.  In instances where stakeholders do have professional credentials, they should not expect to participate on a peer review committee focused in areas directly related to their cancer research or health professional training. This is especially important for nurses and medical doctors with training in oncology, or people with doctorate levels of education and expert training in the life sciences related to cancer research. Participation on peer review committees closely aligned with a stakeholder's profession is viewed as a possible conflict with the role of stakeholder.

    Stakeholder Time Commitment Requirements
    Potential stakeholders should be able to commit to:

    • Participating in Society-sponsored training for newly selected stakeholders – through participation in the e-learning modules on the Society's Volunteer Learning Center and by visiting Atlanta to observe actual peer review in January 2018.
    • Serving for two years as a member of a peer review committee, from June 2018-May 2020. This includes participating in peer review committee meetings each year in January and June.
    • Preparing for peer review committee meetings. This entails reading the sections of grant applications that deal with cancer relevance—and being prepared to comment on the cancer relevance—prior to the peer review committee meeting.

    Stakeholder Nomination and Selection Process

    Nominees will be asked to complete a short questionnaire and submit two letters of recommendation as part of the Selection Process. Each nominee will be interviewed over the phone. We anticipate that 13-15 stakeholders will be selected from the pool of nominees. Nominees and Divisions will be notified of the stakeholder selection results in October 2017.

    Questions about the Stakeholder program and the nomination process can be addressed to joseph.cotter@cancer.org.

    PHOTOS: Pictured in the top photo are attendees of the March 2017 Countil for Extramural Grants meeting. From left,Wafik El-Deiry, MD, PhD, FACP; Iswar K. Hariharan, MBBS, PhD; Carmen R. Green, MD; James R. Cerhan, MD, PhD; ACS CEO Gary Reedy; Jemma Cabral; Dave Wesley; and Sarah Gehlert, PhD. Pictured in the smaller image is Jemma Cabral. 

  • The facts about the American Cancer Society's position on red meat

    A new documentary "What the Health," by Kip Andersen and narrated by actor Joaquin Phoenix, was recently released to the public on Netflix. The film advocates a plant-based diet and is critical of several major nonprofits, including the American Cancer Society. 

    This is an area ACS has studied for years. ACS investigators did foundational work identifying red and processed meat's link to cancer. That work provided key evidence that contributed to the World Health Organization's determination of red meat as a Group 2A carcinogen (probably carcinogenic to humans), and processed meat as a Group 1 carcinogen (carcinogenic to humans - the same category as tobacco). 

    Our guidelines point to evidence of a significant link between high red and processed meat consumption and an increased risk of colorectal cancer as the primary reason for the recommendation to limit those products.

    Our dietary guidelines have recommended a diet rich in plant foods ever since we published our first special report on diet and cancer prevention in 1984. That's because evidence has suggested eating vegetables and fruit may lower the risk for some types of cancers.

    Our guidelines also note that vegetarian diets can be quite health-promoting. They tend to be low in saturated fat and high in fiber, vitamins, and phytochemicals, and do not include eating red and processed meats. Our guidelines do say that vegetarian diets may be helpful in lowering cancer risk, however, the data are not yet clear that vegetarian diets are more beneficial than a healthy diet that contains a small amount of animal products.

    Andersen approached the ACS about some discrepancies on our web site which we corrected, and we thanked him for pointing them out. The ACS was not asked to provide an interview for the film. 

    More  information about our dietary recommendations for reducing cancer risk can be found on cancer.org. 

  • $1 million gift will help us identify the genes that influence how difficult it is to quit smoking

    Thanks to the efforts of Kim Azar-Anderson (Major Gifts team - pictured above) and Chris Thomas (Principal Gifts team) as well as members of our Epidemiology Research Program, we secured a $1,025,000 commitment from a donor in Naples, FL, to fund a new research project that will use Cancer Prevention Study-3 data and blood samples to identify the genes that influence how difficult it is to quit smoking.

    Led by cancer epidemiologist Vicky Stevens, PhD, our strategic director of laboratory services, this research will provide important new insights into the biology that makes it especially difficult for many people to quit smoking. This in turn may lead to the development of new medications or other targeted smoking cessation aids based on information about a smoker's genes, and help to reduce death rates from smoking-related cancers and other diseases.

    This gift to support our own internal research efforts represents a great example of multiple teams in the new ACS working together to advance our mission.

    It all began when Kim was researching foundations in GuideStar. "Last November I stumbled upon a foundation in Naples that I was not familiar with, and after a review of their giving and who they give to, I decided to call them," she said.

    In December 2016, Kim and the potential donor, who wishes to remain anonymous, had a two-hour lunch, and over the next few months Kim shared with her the details of several pay-if projects – research that has been approved but is awaiting funding. Kim knew, though, that the woman had the assets to fund much bigger projects.

    Life events – surgeries and a wedding – slowed the conversation a bit, but during lunch at the woman's house in May of 2017, Kim learned that the woman's father, a smoker, had died of non-small cell lung cancer. She also learned that the woman and her husband had been smokers, and all of them had different experiences when trying to quit.

    "It was the meeting in May at her home at the kitchen table (with some baklava [pictured in the smaller image!]) that she shared that. I immediately redirected her interest to that of the smoking cessation program and said let's find out more, and I'll set up a call with our Intramural Research team - how about tomorrow?  I then circled back with Chris Thomas who got Susan Gapstur, MPH, PhD, our VP of Epidemiology, involved, along with Vicky Stevens and Alpa Patel, PhD, strategic director of CPS-3," Kim explained.

    Prior to the call, Kim shared with the donor Susan, Vicky, and Alpa's bios – along with photos of them. "I think photos with bios are a must . . . smiling faces mean a lot, especially when we are on the phone and not in person," Kim said.

    The call went well, with Chris Thomas sharing his personal background, and the researchers sharing theirs. The donor "asked many questions regarding the work and other clinical questions that would have been difficult for me to answer, and Susan and her team gave compelling answers," Kim said.

    Then the wait began. "Days went by and I tried to think of things I could do to get her to call me – should I make more baklava, no – or should I send her any more detail – no. I knew I just had a wait a few days. I asked about her time frame in my follow-up call to her and she said she would get with her brother and let me know in the next few days. Finally, on Friday of the following week, I left a message on her phone, and she called back that afternoon and said YES – they wanted to go ahead with the work!"

    Kim credits this great success with basic sales skills – building trust, likability, and matching donor needs with our needs. 

    Congratulations to all staff involved in this big win!


  • Nearly half of China cancer deaths attributable to potentially modifiable risk factors

    A new report finds more than half of all cancer deaths in men in 2013 in China and more than a third of those in women were attributable to a group of potentially modifiable risk factors: smoking, alcohol, nutrition, weight, physical activity, and infections. The study appears in Annals of Oncology, and concludes that effective public health interventions to eliminate or reduce exposure from these risk factors can have considerable impact on reducing the cancer burden in China.

    Cancer is the leading cause of death in China, with 4.3 million new cancer cases and 2.8 million cancer deaths estimated to occur each year. That burden is expected to increase in the coming decades because of aging of the population as well as changes in lifestyle that increase cancer risk, such as excessive calorie intake and physical inactivity.

    To investigate further, a multi-agency team of researchers led by Farhad Islami, MD, PhD of the American Cancer Society estimated the number and proportion of cancer deaths and cases attributable to ever-smoking, second-hand smoking, alcohol drinking, low fruit/vegetable intake, excess body weight, physical inactivity, and infections in China, using contemporary data from nationally representative surveys and cancer registries. Other investigators were from the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Cancer Council NSW, Sydney, Australia, the University of Sydney, Emory University, and Imperial College London.

    They found 717,910 (52%) cancer deaths in men and 283,130 (35%) in women in 2013 in China were attributable to the risk factors considered in the analysis. The corresponding numbers for cancer cases were 952,520 (47%) in men and 442,650 (28%) in women. Among both sexes combined, nearly one million (approximately 996,000) or almost half of all cancer deaths and 1,388,800, or 39% of all cancer cases in China in 2013 were attributable to the studied risk factors.

    "Our analysis likely underestimates the number of cancers attributable to modifiable risk factors because we were not able to include all potentially modifiable risk factors, notably indoor air pollution from using coal for cooking and heating, which is a major risk factor for lung cancer in women in China," said Dr. Islami.

    By risk factor, the greatest attributable proportions of cancer deaths in men were for ever-smoking (26%), hepatitis B (HBV) infection (12%), and low fruit/vegetable intake (7%). In women, HBV infection (7%), low fruit/vegetable intake (6%), and second-hand smoke exposure (5%) were the largest contributors.

    They conclude: "Our findings reinforce the need for broad implementation of known interventions and the development of new strategies to reduce exposures to established (smoking and carcinogenic infections) and emerging (alcohol drinking, excess body weight, and physical inactivity) risk factors in the country."

    NOTE: We do not have a figure for how many deaths in the U.S. are attributable to the exact same risk factors. We do know that an estimated 20% of all cancers diagnosed in the U.S. are caused by a combination of excess body weight, physical inactivity, excess alcohol consumption, and poor nutrition, and thus could also be prevented.


  • Common insurance plans often put care at America's top cancer hospitals out of reach

    A new study supported by the American Cancer Society, the National Cancer Institute, and the National Institute on Aging, finds that cancer patients in the U.S. may be unable to access care at the nation's top hospitals due to narrow insurance plan coverage.

    The study from the Perelman School of Medicine at the University of Pennsylvania shows common, so-called "narrow network" insurance plans – lower-premium plans with reduced access to certain providers – are more likely to exclude doctors associated with National Cancer Institute (NCI)-Designated Cancer Centers. Researchers published their findings July 5 in the Journal of Clinical Oncology.

    "Because cancer care and monitoring is costly, there are strong incentives for insurers to be selective when it comes to oncologists, excluding those who are most likely to attract the most complex and expensive cases," said the study's lead author Laura Yasaitis, PhD, a postdoctoral researcher at Penn's Leonard Davis Institute of Health Economics.

    "Consumers may benefit financially from the fact that these narrow networks generally have lower premiums, but they may face reduced access to the higher-quality providers in their market," added Daniel Polsky, PhD, the executive director of the Leonard Davis Institute of Health Economics and the study's co-senior author.

    The study authors examined cancer provider networks offered on the 2014 individual health insurance exchanges and then determined which oncologists were affiliated with NCI-Designated Cancer Centers or National Comprehensive Cancer Network (NCCN) Cancer Centers. These cancer hospitals are recognized for their scientific and research leadership, quality and safety initiatives, and access to expert physicians and clinical trials. NCCN Cancer Centers are particularly recognized for higher-quality care, and treatment at NCI-Designated Cancer Centers is associated with lower mortality than other hospitals, particularly among more severely ill patients and those with more advanced disease. Narrower networks were less likely to include physicians associated with NCI-Designated and NCCN Cancer Centers.   

    "To see such a robust result was surprising," Yasaitis said. "The finding that narrower networks were more likely to exclude NCI and NCCN oncologists was consistent no matter how we looked at it. This is not just a few networks. It's a clear trend."

    Researchers said the results point to two major problems: transparency and access.

    "Patients should be able to easily figure out whether the physicians they might need will be covered under a given plan," said the study's co-senior author Justin E. Bekelman, MD, an associate professor of Radiation Oncology and Medical Ethics and Health Policy, and a senior fellow in the Leonard Davis Institute for Health Economics. The authors suggest that insurers report doctor's affiliations with NCI and NCCN Cancer Centers so that consumers can make more informed choices. 

    The authors also suggest that insurers offer mechanisms that would allow patients to seek care out of network without incurring penalties in exceptional circumstances.  "If patients have narrow network plans and absolutely need the kind of complex cancer care that they can only receive from one of these providers, there should be a standard exception process to allow patients to access the care they need," Bekelman said.




  • One-third of the world now overweight

    ​About 30% of the world's population is affected by weight problems, with 10% obese, according to a new study published June 12 in the New England Journal of Medicine. (People were classified as overweight if their body mass index was in the 25 to 29 range, while obesity is defined as anyone with a BMI of 30 or more.)

    The study, compiled by the Institute for Health Metrics and Evaluation at the University of Washington in Seattle and funded by the Gates Foundation, looked at 195 countries, finding that rates of obesity at least doubled in 73 countries — including Turkey, Venezuela, and Bhutan — from 1980 to 2015, and “continuously increased in most other countries.”

    The findings represent "a growing and disturbing global public health crisis," said the authors. An accompanying editorial said: "The Global Burden of Disease (GBD) study. . . . offers a discouraging reminder that the global obesity epidemic is worsening in most parts of the world and that its implications regarding both physical health and economic health remain ominous."

    Among the 20 most-populous countries, the highest level of obesity among children and young adults was in the U.S., at nearly 13%. Egypt topped the list for adult obesity at about 35%, while the lowest rates were in Bangladesh and Vietnam, respectively, at 1%.

    “Excess body weight is one of the most challenging public health problems of our time, affecting nearly one in every three people,” said Dr. Ashkan Afshin, the paper’s lead author. Obesity and inactivity could someday account for more cancer deaths than smoking if current trends continue. 

    Researchers found that excess weight played a role in four million deaths in 2015, from heart disease, diabetes, kidney disease and other factors. The per capita death rate was up 28 percent since 1990 and 40 percent of the deaths were among people who were overweight but not heavy enough to be classified as obese.

    Combining children and adults, the U.S. had the largest increase in percentile points of any country, a jump of 16 percentage points to 26.5 percent of the overall population. But other countries had obesity rates that rose much faster, even though they remained lower as an overall percent of the population. Broadly, the fastest rises were found in Latin America, Africa, and China.

    In China, for example, less than 1 percent of the population was obese in 1980, but now more than 5 percent is, a fivefold increase. The rise in childhood obesity in China roughly paralleled that overall change.

    Three countries in Africa — Burkina Faso, Mali and Guinea-Bissau — had the fastest growth. Burkina Faso, the country with the fastest growth in the world in obesity, began in 1980 with around one-third of a percent of its population as obese. Its rate rose to nearly 7 percent of the population.

    The study did not go deeply into the causes of obesity, but the authors said the growing accessibility of inexpensive, nutrient-poor packaged foods was probably a major factor and the general slowdown in physical activity was probably not.

    “The change in physical activity preceded the global increase in obesity,” Dr. Afshin said. “We have more processed food, more energy-dense food, more intense marketing of food products, and these products are more available and more accessible,” he added. “The food environment seems to be the main driver of obesity.”


  • New report on liver cancer: The fastest growing cause of cancer death in U.S.

    A new report provides an overview of incidence, mortality, and survival rates and trends for liver cancer, a cancer for which death rates have doubled in the U.S. since the mid-1980s, the fastest rise of any cancer in the U.S.

    The report appears in CA: A Cancer Journal for Clinicians, and says differences in major risk factors as well as inequalities in access to care have led to significant racial disparities in liver cancer mortality.

    The American Cancer Society estimates that liver cancer will account for about 41,000 new cancer cases and 29,000 cancer deaths in the U.S. in 2017. It is the fifth leading cause of cancer death in men and the eighth leading cause of cancer death in women. About 1.0 percent of men and women will be diagnosed with liver cancer in their lifetimes.

    The report notes that liver cancer incidence has been rising in the U.S. since at least the mid-1970s, a trend that is expected to continue through at least 2030.

    Reasons

    • One major factor contributing to the increase is a higher rate of hepatitis C virus (HCV) infection among baby boomers (born between 1945 through 1965). Among this age group, HCV prevalence is approximately 2.6%, a rate 6-fold greater than that of other adults.
    • A rise in obesity and type II diabetes over the past several decades has also likely contributed to the trend.
    • Other risk factors include alcohol, which increases liver cancer risk by about 10% per drink per day, and tobacco use, which increases liver cancer risk by approximately 50%.

    Despite improvements in liver cancer survival in recent decades, only 1 in 5 patients survives five years after diagnosis.

    The report identifies substantial disparity in liver cancer death rates by race/ethnicity, ranging from 5.5 per 100,000 in non-Hispanic whites to 11.9 per 100,000 in American Indians/Alaska Natives. There are also wide disparities by state, with the lowest death rates in North Dakota (3.8 per 100,000), and the highest in the District of Columbia (9.6 per 100,000).

    The report says the wide racial and state disparities in liver cancer mortality reflect differences in the prevalence of major risk factors and, to some extent, inequalities in access to high-quality care. "However, most liver cancers are potentially preventable," write the authors. "Interventions to curb the rising burden of liver cancer and reduce racial/ethnic and geographic disparities should include the targeted application of existing knowledge in prevention, early detection, and treatment, including improvements in [hepatitis B virus] vaccination, screening and treatment of HCV, maintaining a healthy body weight, access to high-quality diabetes care, prevention of excessive alcohol drinking, and tobacco control.

  • Annual meeting of cancer specialists wraps up today

    More than 30,000 cancer specialists from around the world have been meeting in Chicago since Friday at the 53rd annual meeting of the American Society of Clinical Oncology (ASCO). The event, which closes today, highlights the latest advances in clinical cancer research, including the latest findings from clinical trials.

    The theme of this year’s meeting is "Making a Difference in Cancer Care With You," emphasizing ASCO's role in improving the care of people who are at risk for cancer, who have cancer, or who have survived cancer.

    News out of this year's meeting include positive findings about breast cancer and pregnancy, the benefits of an online program to report symptoms, how one dose of radiation may help spine pain in cancer patients, and how therapy can tackle an overlooked and undertreated side effect of cancer: fear. Another study that has gotten a lot of media coverage involves Johnson & Johnson's cancer treatment Zytiga. Data released at the meeting shows it significantly cut the death risk for newly diagnosed, advanced prostate cancer patients. Read more about that here

    Get the latest consumer news from ASCO at CURE and WebMD. You can also find more news on Twitter using the hashtag #ASCO17.

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