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Glimmers Of Hope
by Mary Barry, MD
I
have a feeling you all could use some good news. Well, don’ t hold your breath. But there is a tiny bit.
Four years ago, around when the actor Chadwick Boseman died of Stage 4 colon cancer at 43, the U. S. Preventive Services Task Force lowered the age for recommended colon cancer screening to 45 from 50. Mr. Boseman( who did not release any family history details) had been diagnosed with Stage 3 cancer in 2016, and he died in 2020. He was not the only one. As of 2020, colorectal cancer had become the leading cause of cancer death for men under 50 in this country, with over 2,100 deaths between the ages of 20 and 49, accounting for 17 % of male cancer deaths. The American Cancer Society had already in 2018 lowered its recommended age for first screening to age 45 as well, for both sexes. Over 1,200 women of the same age range had also died of colon cancer during this period.
In JAMA the week of 8 / 4 / 25 1, 2 an article highlighted a new study from the American Cancer Society, from lead author Elizabeth Schafer, MPH, who works for the ACS in the areas of health equity and surveillance science. She and coauthors addressed the question of whether the incidence of new disease is truly rising, or whether the more aggressive detection of such is the key factor.
Between 2004 and 2020, colorectal cancer cases found in those aged 20-54, as documented by the SEER program, rose steadily by 1.6 % annually for those under 40, and by up to 2.6 % annually for those aged 40-54. The SEER program is run by the National Cancer Institute and stands for Surveillance, Epidemiology and End Results for cancers reported in the U. S. The rate of screening for adults aged 45-49 jumped from 20 % in 2021 to 33 % in 2023. And in a companion study, the diagnoses of localized colorectal cancer increased by
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50 % from 2019 through 2022, after the guideline for the lower-aged screening had been ramped up in 2018. More cancer is good news, you say? Well of course, if diagnosed at Stage 1, when it is the most curable stage at 95 % five-year survival.
The Affordable Care Act had mandated that preventive services recommended by the U. S. Preventive Services Task Force would be covered by private health insurance, not just government funded insurance. With the age lowered to 45, all of a sudden 20 million more Americans became eligible for screening. A STAT article1 quotes Fola May, MD, a GI doctor and cancer researcher at UCLA.“ The task force that changed the guidelines in 2021 saved lives. They changed the lives of tens of thousands of people. It’ s a gift of life when you diagnose colorectal cancer at Stage 1.”
Dr. May wanted to figure out how best to capture this new huge population for successful screening. She found that directly mailing a fecal occult blood test to participants was the best, with 26 % screened compared to under 17 % for asking people to choose the type of screening.
In other good news for health research, the Government Accountability Office( an independent congressional office) has found that the recent abrupt federal cancellation of nearly two thousand NIH grants had violated the 1974 Congressional Budget and Impoundment Control Act. This law came about because President Nixon had refused to spend funds that Congress had appropriated. Per this act, the President can defer spending but not beyond the end of the fiscal year. Or, the President can request alterations in the funding, but unless Congress acts on the request within 45 days, the funds are released under the original conditions of the law. It remains to be seen if these illegally impounded funds will in fact be returned, and what
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