Colorectal Cancer: Simple Screenings Save Lives

We’ll be blunt. Colorectal cancer is one of the most common cancers, and the second leading cause of cancer deaths in the United States. It will kill more than 50,000 Americans this year – more than die in car crashes.

But it doesn’t have to be so deadly. Ninety percent of colorectal cancers are completely curable, if diagnosed early, but the odds plummet to just 10 percent if tumors are found late. Many are; only about 30 percent of Americans over age 50 have had a simple colonoscopy.

The encouraging news about this lethal cancer is that a little education and adopting a few healthful habits can go a long way in conferring protection. Consider the expert advice below:

• When you turn 50, schedule your first colonoscopy screening and repeat it every five years. If your primary care physician doesn’t suggest it, you should. In this preventive scan, you’ll be sedated while a small, lighted endoscope inspects your colon and rectum for polyps – mushroom-like growths at risk for turning cancerous. If discovered during the scan, the polyps can be removed immediately, greatly diminishing your future risk.
  

  A polyp.

• Eat grilled meats in moderation, and avoid smoking and chewing tobacco. Whether inhaled or swallowed, carcinogens in charred or smoked meats, tobacco smoke and “chew” all eventually pass through the colon, where they can up your risk for cancer.
• Balance your diet between “red” and “green” foods. Over-indulgence in red meats (eating more than a pound a week) has been linked to increased risk for colon cancer; on the contrary, adding more green, leafy vegetables to your diet and reducing your intake of foods with high-carb, high-fat, high-cholesterol content, has been shown to reduce risk.
• Stay active. Incorporating more physical activity – walking a pet, taking the stairs over the elevators, cleaning your house – helps stimulate your body’s waste to keep moving along (the longer stool sits in your rectum or colon, the more time toxic chemicals have to leach out into the surrounding tissues).
• Maintain a healthy weight, and know your shape. Obese men and women are at greater risk for colon cancer; “apple” shapes, which gain weight around the waist and vital organs, tend to be at greater risk than “pear” shapes, which store fat in their thighs and hips.
• Learn the obvious symptoms. Through colorectal cancer is a notoriously “quiet” killer, in the later stages, it can give undeniable clues. If you experience bloody stools, diarrhea, cramping and unexplained weight loss, call your doctor immediately.

Put simply, colorectal screening can save your life. If all Americans were screened regularly, colorectal cancer deaths could be cut in half. March is Colorectal Cancer Awareness Month, so why not schedule your test today?

No health insurance? Learn how we can still help you get screened.

We originally published these tips last year, courtesy of Dr. John Monson, chief of the Division of Colorectal Surgery at URMC. His areas of expertise include minimally invasive technologies for colorectal cancer treatment, in addition to basic research exploring a broad range of cancer-related subjects.

For more information about colon cancer screening, talk to your primary care physician. You can also find doctor videos, patient stories, health facts and more on our colorectal cancer information site.

Breast Density: Radiologist Puts New Notification Law into Perspective

A healthy lifestyle means knowing a few things about your body – even if you’d rather ignore those facts. Weight, cholesterol readings, hormonal cycles, and osteoporosis risk are starting points for many women. Now you can add something else to the list – breast density.

Density refers to the amount of fibroglandular tissue (tissue besides fat or muscle, including milk ducts and lobules, connective tissue, etc.)  in the breast. On a mammogram (which looks like an x-ray to the untrained eye), dense tissue appears white and opaque, while the fatty tissue appears black.

The problem is that breast tumors or benign masses also appear white on the mammogram. So, for radiologists, searching for very small lesions in dense breasts is like looking for a snowman in a blizzard. Most women don’t know what type of tissue they have, and therefore don’t have enough information to start a conversation with their doctors.

A new law in New York changes everything. As of Jan. 19, 2013, providers are required to notify women if more than 50 percent of their breast tissue is dense. To learn more about why this is important, we spoke with Dr. Avice O’Connell, director of Women’s Imaging at the University of Rochester Medical Center and Highland Breast Imaging.

Scripts: It seems that many women might not realize that density is an issue in breast health. Is this true, in your experience?

O’Connell: Yes, absolutely. I see many women who are not familiar with their own breasts. They may not do monthly self-breast exams, and they often don’t ask questions during their routine mammograms. Awareness of breast density is low.  However, later, if women do find out that they have very dense tissue, they’ll say, ‘if I only had known this.’ The new law gives women more information – and in my opinion, more information is usually a good thing.

Scripts: Why do some people have dense breast tissue?

O’Connell: We’re not sure why some people have dense breasts. You can’t tell from the outside. In other words, it’s not related to a person’s size, age, or any other characteristic. We do know that density tends to ebb slightly with age (50s and post-menopause) – but only a mammogram can give us that information.

Scripts: Why is dense breast tissue a health hazard?

O’Connell: It’s a problem for two main reasons. First and foremost, small cancers can hide more easily in dense tissue. And simply having dense breasts slightly increases the risk of cancer.

The latter issue, however, is still being investigated and the risk is slight. In general we still have many questions about the impact of breast density on breast health. But from a practical standpoint as a radiologist who reviews thousands of films a year, I can say with certainty that detecting breast cancer in dense tissue is more difficult. A cancerous mass appears white and can be obscured by the white dense breast tissue and the spidery-looking fibrous glands surrounding it.

Scripts: Can you explain how the new law works — and why it’s important?

O’Connell: When a woman gets a routine, screening mammogram and we find no problems – other than dense breast tissue – she’ll receive a letter in a few days notifying her that her tissue is dense. The law’s intention is to boost awareness, not necessarily to prompt more testing. At that point, most healthy women with few or no risk factors for cancer will choose to do nothing. Radiologists are not required to make any recommendations on testing, either.

However, if you get one of those letters, we’re urging women to talk to their primary care physician or ob/gyn about their personal risk for breast cancer. Discuss family history, start of menstruation and early menopause (an early start and late finish are both risk factors), childbirth (if you’re older with your first pregnancy, that’s also a risk factor), and lifestyle habits such as overeating and excessive drinking. Based on an assessment of your personal risk for breast cancer, coupled with your dense breasts, your physician may recommend supplemental testing with a screening ultrasound or an MRI.

But this isn’t a simple decision, or a perfect solution. Sometimes an ultrasound opens a Pandora’s Box. Plus, additional testing takes time and money. The law doesn’t require insurance to cover screening breast ultrasounds, but most insurers have indicated they’ll pay for it with a physician’s referral.

Scripts: By ‘Pandora’s Box,’ you must mean that more information will cause needless worry for some women, correct?

O’Connell:  Yes. The main drawback is that the more ultrasounds we do, the greater likelihood of finding small, solid masses that need to be biopsied and followed up.  More than 90 percent of the time they will turn out to be benign. But an ultrasound provides a different view of the breast tissue, and studies show that ultrasounds will detect about three more cancers per thousand patients with an otherwise normal mammogram. And when cancer is detected earlier, it’s often more treatable. So, I like to say: “A little worry is better than a little cancer.”

Avice O’Connell, M.D., has practiced radiology for over 30 years in Rochester, New York. To contact Dr. O’Connell or to make an appointment at University Breast Imaging, please call 585-334-5519. Locations include 500 Red Creek Drive, Suite 130, in Henrietta; and Highland Breast Imaging at Highland Hospital, 1000 South Ave., Rochester

To learn more about good breast health and protective breast screening exams, watch Dr. O’Connell in this video clip, produced by URMC-based Peri-FACTS Academy, a multimedia continuing education program for OB/GYN healthcare providers.

.

Ladies: Do You Really Need a Yearly Pap?

New guidelines out just last month are welcome news for women who dread their annual Pap test.

That’s because, after a cautious review of the science, the U.S. Preventive Services Task Force – together with a collaborative team of experts from the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology – is now officially advising that most women be screened only every three to five years. According to experts evaluating the data, spacing tests out this much further seems to be equally effective at detecting cervical cancers early.

Eager to make sense of the new recommendations, we spoke with gynecologic oncologist Brent DuBeshter, who directs the division of gynecologic oncology at the University of Rochester Medical Center. (Of course, it’s always best to work directly with your physician and develop a care plan that best fits your unique health history!)

Scripts: Why are Pap smears so important in the first place? Isn’t cervical cancer fairly rare?

DuBeshter:  In the U.S., it is rare now – but that’s a direct benefit we reap thanks to better treatment, combined with the dawn of the Pap test. Invented in the 1940s by its namesake, George Papanicolaou, the screening test quickly vaulted into first place as the most widely-used preventive cancer test ever developed. It’s routine adoption is the biggest reason why, in the U.S. this year, we only anticipate 12,000 cases of cervical cancer – a far cry from the situation eighty years back, when cervical cancer was the deadliest women’s cancer in America, claiming more lives each year than even breast or lung cancers.

Scripts: In a loose sense, is it safe to say that because cervical cancers are slow-moving, less frequent screenings are just as helpful as annual ones?

DuBeshter: To a degree, that’s true. Precancerous changes in the cervix are usually present for years before an invasive cancer actually develops. Conceivably, this lag means that screening tests performed annually – or even every few years – afford sufficient time to detect a precancerous state long before a cancer even develops.

Scripts: As a physician, what do you personally make of the recommendations – and what do you generally advise your patients?

DuBeshter: I routinely tell my patients that they no longer require annual Pap tests, because it’s been determined safe practice to screen for cervical cancer at less frequent intervals. That said, many of my patients still prefer to get annual screening, simply because it’s what they’ve been used to for many years. This really is a personal decision best discussed between a patient and her doctor – especially since new combined testing options (which can blend the traditional Pap lab work-up with a check for human papillomavirus, or HPV) allow physicians to design screening programs tailored to each patient’s unique level of cervical cancer risk.

Scripts: The new guidelines also mention that spacing out screening would reduce the number of false positives turning up – and a great deal of unnecessary testing that follows. How common are false positives, currently? Is it really that big of a burden?

DuBeshter: First, we should step back and define what we mean by “false positive.” For Pap smears, it’s an instance in which cells look concerning to the cytologist studying the specimen in the lab, when in fact no precancerous change is actually present on the cervix. This occurs about 5 to 10 percent of the time (that is, 5 to 10 percent of the “positives” are actually “false positives”), so it’s certainly not uncommon. Unfortunately, it can cause quite a bit of needless anxiety, cost, and time (as it requires additional testing). So, in the grand scheme, less frequent screening ultimately may help reduce unnecessary worry for a significant number of women.

Scripts: That’s a good point. But for many, isn’t the Pap test one of the most compelling reasons to see their gynecologist regularly? If the guidelines are indeed adopted by most practices, do you think this will change the frequency with which women need to (or will perceive a need to) see their doctor?

DuBeshter: An annual physical exam is still recommended for women, even if a Pap test isn’t always a part of it. I suspect most women will continue to follow this guideline, although admittedly, some will probably choose to see their gynecologist less frequently. 

Looking for a good doctor?

This year alone, more than 80,000 women will discover that they have some form of gynecologic cancer affecting their ovaries, uterus, cervix, vulva, vagina, or fallopian tubes. The good news is that, in many cases, women can take steps to prevent some types of cancer – or to detect them early enough to make a difference. Members of URMC’s division of gynecologic oncology are committed to giving patients the information they need to choose appropriate medical care and positively influence their futures. Learn more about the team, here.

Colon Cancer: Silent Killer is Gaining Voice

What did Audrey Hepburn, Ronald Reagan, and Peanuts’ cartoonist Charles Shultz all have in common?

Colon cancer.

This week, in light of March being Colorectal Cancer Awareness Month, we’re sharing a heartfelt message from URMC colorectal surgeon Dr. John Monson, who writes to underscore the importance of routine screenings and other health habits that can help protect you from the deadly disease. For his insights, read on.

Simple Screenings Save Lives

Colorectal cancer, which affects the colon (the large intestine) and/or the rectum, has historically been a ‘silent’ disease – both in the sense that it rarely manifests obvious symptoms, but also in that, until earlier recent years, it was little talked of. Not only did the subject seem taboo for dinner table conversation, but it affected an older population and failed to elicit the same attention enjoyed by other diseases, such as breast cancer – the awareness and prevention of which was enthusiastically championed by women’s magazines, pink-ribbon fundraisers, and a passionate surge of young survivors.

But the message about the danger of colorectal cancer is raising its voice, as it should. It will kill more than 50,000 Americans this year – more than die in car crashes. Three times as many Americans will be diagnosed, making it the third most common cancer (not counting skin cancer), and the second leading cause of cancer deaths nationwide. But perhaps what’s most staggering is that, despite these daunting numbers, the cancer is nearly 90 percent curable if caught early.

As visible public figures have battled the disease – including Sharon Osbourne, Audrey Hepburn, Ronald Reagan, and Peanuts’ cartoonist, Charles Shultz – its prominence has been lifted in the public eye, freeing the topic for more open discussion. In fact, in 2000, Katie Couric televised her first colonoscopy live on the set of the Today Show, having a powerful influence on viewers. Inspired by the premature death of her 42-year-old husband, who fought the cancer for nearly a year, Couric urged viewers to take these screening tests more seriously. The number of colonoscopies shot up 20 percent in the months that followed – a phenomenon dubbed the “Katie Couric effect.”

The encouraging news about this deadly cancer is that a little education and adopting a few healthful habits can go a long way in conferring protection. Consider the advice below:

• When you turn 50, schedule your first colonoscopy screening and repeat it every five years. If your primary care physician doesn’t suggest it, you should. Cancers caught early are five times as curable as those that have advanced (and possibly spread). In this preventive scan, you’ll be sedated while a small, lighted endoscope inspects your colon and rectum for polyps – mushroom-like growths at risk for turning cancerous. If discovered during the scan, the polyps can be removed immediately, greatly diminishing your future risk.
• Eat grilled meats in moderation, and avoid smoking and chewing tobacco. Whether inhaled or swallowed, carcinogens in charred/smoked meats, tobacco smoke and “chew” all eventually pass through the colon, where they can up your risk for cancer.
• Balance your diet between “red” and “green” foods. Over-indulgence in red meats (eating more than a pound a week) has been linked to increased risk for colon cancer; on the contrary, adding more green, leafy vegetables to your diet and reducing your intake of foods with high-carb, high-fat, high-cholesterol content, has been shown to reduce risk.
• Stay active. Incorporating more physical activity – walking a pet, taking the stairs over the elevators, cleaning your house – helps stimulate your body’s waste to keep moving along (the longer stool sits in your rectum or colon, the more time toxic chemicals have to leech out into the surrounding tissues).
• Maintain a healthy weight, and know your shape. Obese men and women are at greater risk for colon cancer; “apple” shapes, which gain weight around the waist and vital organs, tend to be at greater risk than “pear” shapes, which store fat in their thighs and hips.
• Know the obvious symptoms. Through colorectal cancer is a notoriously “quiet” killer, in the later stages, it can give undeniable clues. If you experience bloody stools, diarrhea, cramping and unexplained weight loss, call your doctor immediately.

Remember, as many as half of people diagnosed with colon cancer will die from the disease, usually because it is caught so late. Simple screenings practices, if implemented unilaterally (once every five years starting at 50), could wipe out more than 80 percent of these diagnoses.

Dr. Monson serves as the chief of the Division of Colorectal Surgery at URMC. His areas of expertise include minimally invasive technologies for colorectal cancer treatment, in addition to basic research exploring a broad range of cancer-related subjects.

For more information about colon cancer screening, talk to your primary care physician, or learn more at http://www.urmc.rochester.edu/cancer-center/colon/.

Why Mammograms Really Matter

Sparky needing an urgent appointment at the vet. A flat tire. A child sick at school. That last-minute presentation that crept up on you at work.

As wives, daughters, sisters and mothers, there are so many urgent demands on today’s women’s schedules. And unfortunately, that too often relegates routine health screenings, like mammograms, to the back burner.

With October in full swing, pink ribbons abound and many women are talking – rather candidly – about the importance of good breast health. The recurring question, it seems, is always the same: Do you really need to bother with a regular mammogram? Even if you’re already vigilant about self-exams?

Yes, experts agree, you do. But don’t take our word for it — in the clip below, URMC’s Dr. Avice O’Connell, director of Women’s Imaging Services at URMC, joins to together with breast cancer patients and survivors to underscore the life-saving value of mammograms.

To learn more about the comprehensive breast health services available at URMC, visit mammo.urmc.com.

Ready to make your appointment? Call 585-487-3300, or send an e-mail  to University Breast Imaging detailing the best times for you, and a representative will call you back.