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Effectiveness of colonoscopies questioned in new study – CTV News

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Colonoscopies are a dreaded rite of passage for many middle-age adults.

The promise has been that if you endure the awkwardness and invasiveness of having a camera travel the length of your large intestine once every decade after age 45, you have the best chance of catching — and perhaps preventing — colorectal cancer. It’s the second most common cause of cancer death in the United States. Some 15 million colonoscopies are performed in the U.S. each year.

Now, a landmark study suggests the benefits of colonoscopies for cancer screening may be overestimated.

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The study marks the first time colonoscopies have been compared head-to-head to no cancer screening in a randomized trial. The study found only meagre benefits for the group of people invited to get the procedure: an 18 per cent lower risk of getting colorectal cancer, and no significant reduction in the risk of cancer death. It was published Sunday in The New England Journal of Medicine.

Study researcher Dr. Michael Bretthauer, a gastroenterologist who leads the clinical effectiveness group at the University of Oslo in Norway, said he found the results disappointing.

But as a researcher, he has to follow the science, “so I think we have to embrace it,” he said. “And we may have oversold the message for the last 10 years or so, and we have to wind it back a little.”

Other experts say that as good as this study was, it has important limitations, and these results shouldn’t deter people from getting colonoscopies.

“I think it’s just hard to know the value of a screening test when the majority of people in the screening didn’t get it done,” said Dr. William Dahut, chief scientific officer at the American Cancer Society, who was not involved in the study.

Less than half of people invited to get a colonoscopy in the study — just 42 per cent — actually got one.

When the study authors restricted the results to the people who actually received colonoscopies — about 12,000 out of the more than 28,000 who were invited to do so — the procedure was found to be more effective. It reduced the risk of colorectal cancer by 31 per cent and cut the risk of dying of that cancer by 50 per cent.

Bretthauer said the true benefits of colonoscopy probably lie somewhere in the middle. He said he thinks of the results of the full study — including people who did and didn’t get colonoscopies after they were invited — as the minimum amount of benefit colonoscopies provide to a screened population. He thinks of the results from the subset of people who actually got the test as the maximum benefit people could expect from the procedure.

Based on his results, then, he expects that screening colonoscopy probably reduces a person’s chances of colorectal cancer by 18 per cent to 31 per cent, and their risk of death from 0 per cent to as much as 50 per cent.

But, he said, even 50 per cent is “on the low end what what I think everybody thought it would be.”

Other studies have estimated larger benefits for colonoscopies, reporting that these procedures could reduce the risk of dying of colorectal cancer by as much as 68%.

THE FIRST RANDOMIZED TRIAL OF COLONOSCOPY

The NordICC study, which stands for Northern-European Initiative on Colon Cancer, included more 84,000 men and women ages 55 to 64 from Poland, Norway and Sweden. None had gotten a colonoscopy before. The participants were randomly invited to have a screening colonoscopy between June 2009 and June 2014, or they were followed for the study without getting screened.

In the 10 years after enrollment, the group invited to get colonoscopies had an 18% lower risk of colorectal cancers than the group that wasn’t screened. Overall, the group invited to screening also had a small reduction in their risk of death from colorectal cancer, but that difference was not statistically significant — meaning it could simply be due to chance.

Before the NordiCC trial, the benefits of colonoscopies had been measured by observational studies that looked back in time to compare how often colorectal cancer is diagnosed in people who received colonoscopies versus those who did not.

These studies can be subject to bias, however, so scientists look to randomized trials that blindly sort people into two groups: those who are assigned to get an intervention, and those who are not. These studies then follow both groups forward in time to see if there are differences. Those studies have been difficult to do for colon cancer, which can be slow growing and may take years to be diagnosed.

The researchers say they’re going to continue to follow participants for another five years. It could be that because colon cancers can be slow-growing, more time will help refine their results and may show bigger benefits for colonoscopy screening.

RESULTS NEED CAREFUL INTERPRETATION

Normally, those kinds of disappointing results from such a large, strong study would be considered definitive enough to change medical practice.

But this study has some limitations that experts say need to be sorted out before doctors and patients give up on colonoscopies for cancer screening.

“I don’t think anyone should be canceling their colonoscopy,” said Dr. Jason Dominitz is the national director of gastroenterology for the Veterans Health Administration.

“We know that colon cancer screening works,” he said in an interview with CNN. Dominitiz co-authored an editorial which ran alongside the study.

There are several options for colorectal cancer screening. Those include stool tests which check for the presence of blood or cancer cells, and a test called sigmoidoscopy, which looks only at the lower part of the colon. Both have been shown to reduce both cancer incidence and colorectal cancer deaths.

“Those other tests work through colonoscopy,” Dominitz said. “They identify people at high risk who would benefit from colonoscopy, then the colonoscopy is done and removes polyps, for example, that prevents the individual from getting colon cancer in the first place, or it identifies colon cancer at a treatable stage.”

Polyps are benign growths that can turn into cancers. They are typically removed when identified during a screening colonoscopy, which can lower a person’s risk of colorectal cancer in the future.

Studies are underway in Spain and the U.S. testing colonoscopy head-to-head against stool tests to see which is most effective.

THE BEST WAY TO SCREEN FOR COLORECTAL CANCER

Dominitz said this randomized controlled trial was a test of advice as much as it was a test of the value of colonoscopy.

“If you ask the population to do something, how much of an impact will it have?” he said.

Overall, the study found that just inviting people to get a colonoscopy didn’t have a large beneficial impact across these countries, partly because so many people didn’t do it.

Dominitz thinks the low participation can be partly explained by the study’s setting. Colonoscopies are not as common in the countries involved in the study as they are in the United States. In Norway, he said, official colorectal cancer screening recommendations didn’t come until this past year.

“They don’t see the public service announcements. They don’t hear Katie Couric talking about getting screened for colon cancer. They don’t see the billboards in the airport and whatnot,” he said. “So an invitation to be screened in Europe is, I think, likely to be somewhat different than an invitation to be screened in the U.S.”

In the U.S., according to data from the U.S. Centers for Disease Control and Prevention, about 1 in 5 adults between the ages of 50 and 75 have never been screened for colorectal cancer.

If you feel squeamish about getting a colonoscopy, the U.S. Preventive Services Task Force says a variety of methods and regimens work to detect colorectal cancer. It recommends screening with tests that check for blood and/or cancer cells in stool every one to three years, a CT scan of the colon every five years, a flexible sigmoidoscopy every five years, a flexible sigmoidoscopy every 10 years paired with stool tests to check for blood annually, or a colonoscopy every 10 years.

In 2021, the task force lowered the recommended age to start routine screening for colorectal cancer from 50 to 45 because the cancer is becoming more common in younger adults.

When it comes to colorectal cancer, he said, tests can only be effective if people are willing to do them.

As proof, he points to early results from a large randomized trial from Sweden that’s testing colonoscopy, FIT testing and no screening at all.

Results collected from more than 278,000 people enrolled between March 2014 and the end of 2020 found that 35 per cent of the group assigned to get a colonoscopy actually got one, compared with 55 per cent who were assigned to the stool test group.

To date, slightly more cancers have been detected in the group assigned to stool testing than in the group assigned to get a colonoscopy — “so participation with screening really is key!” Dominitz said.

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Measles case reported locally turns out to be negative: health unit

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NEWS RELEASE
SIMCOE MUSKOKA DISTRICT HEALTH UNIT
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On March 26, the Simcoe Muskoka District Health Unit (SMDHU) was notified by Public Health Ontario’s (PHO) laboratory that due to laboratory error, the case of measles that had been lab-confirmed positive on March 12, based on symptoms and a positive urine measles laboratory result by PHO’s laboratory, is in fact negative for the measles virus.

“With this new information of the negative lab result, we believe that that individual was not infected with measles and that there has not been any public exposure to measles resulting from this individual’s illness,” said Dr. Charles Gardner, medical officer of health. “We recognize that notifying the public of what we believed to be a positive measles case in our area created worry, anxiety and disruption for some, and we regret this.

“We do know that, despite best efforts, on rare occasions laboratory errors can occur. We are working closely with the PHO’s laboratory to do all that we can to ensure that such an incident does not occur again.”

Measles is a highly contagious viral infection that spreads very easily through airborne transmission. The measles virus can live in the air or on surfaces for up to two hours.

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Symptoms of measles begin seven to 21 days after exposure and include fever, runny nose, cough, drowsiness, and red eyes. Small white spots appear on the inside of the mouth and throat but are not always present. Three to seven days after symptoms begin, a red, blotchy rash appears on the face and then progresses down the body.

The risk of transmission to those vaccinated with two doses is low, and when it does occur tends to show a reduction in the severity of these symptoms.

“Although we are relieved for the individual involved, and for all Simcoe-Muskoka residents, that this case has now been confirmed as negative, we know that measles is still active in Ontario at this time and the potential remains for new cases to arise, especially given the increase in Ontarians travelling to areas in the world that have higher numbers of measles cases,” said Dr. Gardner. “This is why we continue to advise individuals to keep up to date with their routine immunizations, including measles, mumps and rubella (MMR) vaccination.”

The risk of measles is low for people who have been fully immunized with two doses of measles vaccine or those born before 1970; however, many children have been delayed in receiving their routine childhood immunizations and people who have not had two doses of measles vaccine are at higher risk of contracting the disease.

People who do get sick usually recover without treatment, but measles can be more severe for infants, pregnant women, and those with compromised immune systems. Possible complications include middle-ear infections, pneumonia, diarrhea, or encephalitis (swelling of the brain) and occasionally death in the very young. Even individuals who are up to date with the measles vaccine should watch for symptoms of measles for 21 days after exposure.

For more information about measles, please visit smdhu.org or call Health Connection at 705-721-7520 or 1-877-721-7520, Monday to Friday between 8:30 a.m. and 4:30 p.m. to speak with a public health professional.

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Kate Middleton Not Alone. Cancer On Rise For People Under 50, Say Experts

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Kate Middleton revealed on Friday that her cancer was discovered after she received abdominal surgery

London:

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When Catherine, Princess of Wales, revealed she was being treated for cancer last week, part of the shock was that an otherwise healthy 42-year-old has a disease that mostly plagues older people.

However, researchers have been increasingly sounding the alarm that more and more people under 50 are getting cancer — and no one knows why.

Across the world, the rate of under-50s diagnosed with 29 common cancers surged by nearly 80 percent between 1990 and 2019, a large study in BMJ Oncology found last year.

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The researchers predicted the number of new cancer cases among younger adults will rise another 30 percent by the end of this decade, with wealthy countries particularly affected.

The increase in cases — and soaring global population — means that the number of deaths among under 50s from cancer has risen by nearly 28 percent over the last 30 years.

This occurred even as the odds of people of all ages surviving cancer have roughly doubled over the last half century.

Shivan Sivakumar, a cancer researcher at the UK’s University of Birmingham, called it an “epidemic” of young adult cancer.

Since Kate Middleton revealed on Friday that her cancer was discovered after she received abdominal surgery earlier this year, Sivakumar and other doctors have spoken out about the uptick in younger cancer patients they have been seeing at their clinics.

While breast cancer remains the most common for people under 50, the researchers expressed particular concern about the rise of gastrointestinal cancers — such as of the colon, pancreas, liver and oesophagus — in younger adults.

Colon cancer is now the leading cause of cancer deaths in men under 50 in the United States, according to the American Cancer Society. For women, it is number two — behind only breast cancer.

One high profile case of colorectal cancer was “Black Panther” actor Chadwick Boseman, who died at the age of 43 in 2020.

Why is this happening?

“We just don’t have the evidence yet” to say exactly what is causing this rise, Sivakumar told AFP, adding it was likely a combination of factors.

Helen Coleman, a cancer epidemiology professor at Queen’s University Belfast who has studied early onset cancer in Northern Ireland, told AFP there were two potential explanations.

One is that people in their 40s were exposed to factors known to cause cancer — such tobacco smoke, alcohol or being obese — at an earlier age than previous generations.

She pointed out that the “obesity epidemic” did not start until the 1980s.

Sivakumar felt that at least part of the puzzle could be explained by obesity.

However, there is “another wave” of under-50 patients who are neither obese nor genetically predisposed still getting cancer, he emphasised, adding that this could not be put down to “statistical chance”.

The other theory, Coleman said, is that “something different” has been going on with her generation.

Fingers have been pointed out a range of possible culprits — including chemicals, new drugs and microplastics — but none have been proven.

Some have suggested that so-called ultra-processed foods could be to blame. “But there’s very little data to back any of that up,” Coleman said.

Another theory is that the food we eat could be changing our gut microbiome.

While there is nothing conclusive yet, Coleman said her own research suggested that cancer causes changes to the microbiome, not the other way around.

Anti-vaxx conspiracy theorists have even tried to blame Covid-19 vaccines.

This is easily disproven, because the rise in young adult cancer has taken place over decades, but the vaccines have only been around for a few years.

What can be done?

To address the rise in younger colorectal cancer, in 2021 the US lowered the recommended age for screening to 45. Other countries have yet to follow suit.

But the researchers hoped that Catherine’s experience would remind people at home that they should consult their doctor if they sense anything is wrong.

“People know their bodies really well,” Sivakumar said.

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“If you really feel that something isn’t right, don’t delay — just get yourself checked out.”

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Almost 3,000 students suspended in Waterloo Region over immunization issues

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Close to 3,000 children attending elementary school across Waterloo Region were suspended from school on Wednesday morning for not having up-to-date immunization records.

The region says Waterloo Public Health suspended 2,969 students under the Immunization of School Pupils Act (ISPA).

For several months, the region has been campaigning for people to get their children’s vaccinations up to date, including sending letters home to parents on a couple of occasions, warning that students’ records needed to be up to date or they would be suspended.

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It announced in January that 32,000 students did not have up-to-date records: 22,000 elementary students and 10,000 high school students.


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“We have made remarkable progress from the original 27,567 immunization notices we sent to parents in November and December 2023,” Dr. Hsiu-Li Wang, medical officer of health, stated.

“Since that time, we have resolved more than 24,500 outdated vaccination records, providing students with valuable protection against these serious and preventable diseases.”

The high school students still have a few weeks to get their records up to date or else face suspension.

The ISPA requires students to have proof-of-vaccination records for diphtheria, polio, tetanus, pertussis, measles, mumps, rubella, varicella (chickenpox) and meningitis, which must be on file with public health.

Public health says caregivers whose children are suspended will need to book an appointment at regionofwaterloo.ca/vaccines for clinics, which will be held in Cambridge and Waterloo on weekdays.

“Given the high number of suspensions, it may take several days before you can be seen at an appointment and return your child to school,” a release from the region warns.

“Record submission and questions must be done in person to ensure immediate resolution.”

The last time suspensions over immunizations were issued was in 2019, when 1,032 students were suspended.

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