Scientists urge Europe to shift focus to bowel cancer screening

By Kate Kelland

AMSTERDAM | Sat Sep 28, 2013 10:32am EDT

AMSTERDAM (Reuters) - European governments should divert funds to routine bowel cancer tests from less effective breast and prostate screening programs, scientists said on Saturday, presenting what they called "irrefutable" evidence that bowel screening saves lives.

Many governments devote significant funds to breast cancer screening, but studies in recent years have found that routine breast mammograms can also lead to so-called "over-diagnosis" when tests pick up tumors that would not have caused a problem.

And a new study presented at the European Cancer Conference (ECC) in Amsterdam at the weekend showed men experience more harm than good from routine prostate cancer screening tests.

In bowel cancer screening, however, the risk of over-diagnosis is very low, while gains in terms of reducing deaths are large - making routine testing cost-effective, Philippe Autier, a professor at France's International Prevention Research Institute (IPPR), told the conference.

"There is now an irrefutable case for devoting some of the resources from breast and prostate cancer screening to the early detection of colorectal (bowel) cancer," he said.

A large European study published last year found that breast screening programs over-diagnose about four cases for every 1,000 women aged between 50 and 69 who are screened.

The IPPR's research director Mathieu Boniol, who studied the impact of prostate screening, said his results showed routine use of prostate-specific antigen (PSA) tests creates more harm in terms of incontinence, impotence and other side-effects from prostate cancer treatments than benefit in terms of detecting life-threatening cancers.

"PSA testing should be reduced and more attention should be given to the harmful effects of screening," he told delegates.

Meanwhile, results of a study conducted by Autier using data from 11 European countries between 1989 and 2010 showed that the greater the proportions of men and women routinely screened for bowel cancer, the greater the reductions in death rates.

Colorectal cancer kills more than 600,000 people a year worldwide, according to the World Health Organization. In Europe some 400,000 people are diagnosed with the disease each year.

In Austria, for example, where 61 percent of those studied reported having had colorectal screening tests, deaths from this form of cancer dropped by 39 percent for men and 47 percent for women over the decade.

Meanwhile in Greece, where only 8 percent of males had had bowel cancer screening, death rates rose by 30 percent for men.

In the light of the results, Cornelis van de Velde, an oncologist at Leiden University Medical Centre in the Netherlands and president of the European Cancer Organisation, said it was "very disappointing" there are such wide differences in European governments' approaches to colorectal screening.

"People over 50 should be informed of the availability of the test, and pressure should be put on national health services to put more effort into organizing screening programs," he told the conference.

Screening for early signs of bowel cancer involves either a fecal occult blood test, which checks a sample of feces for hidden blood, or endoscopy, where a tiny camera is introduced into the large bowel to look for the polyps that can be a precursor of cancer.

In some European countries, such as France, Germany and Austria, many men and women over the age of 50 have regular colorectal screening examinations, while in others, such as The Netherlands and Britain, screening is much less common.

(Editing by David Evans)

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Scientists urge Europe to shift focus to bowel cancer screening

By Kate Kelland

AMSTERDAM | Sat Sep 28, 2013 10:32am EDT

AMSTERDAM (Reuters) - European governments should divert funds to routine bowel cancer tests from less effective breast and prostate screening programs, scientists said on Saturday, presenting what they called "irrefutable" evidence that bowel screening saves lives.

Many governments devote significant funds to breast cancer screening, but studies in recent years have found that routine breast mammograms can also lead to so-called "over-diagnosis" when tests pick up tumors that would not have caused a problem.

And a new study presented at the European Cancer Conference (ECC) in Amsterdam at the weekend showed men experience more harm than good from routine prostate cancer screening tests.

In bowel cancer screening, however, the risk of over-diagnosis is very low, while gains in terms of reducing deaths are large - making routine testing cost-effective, Philippe Autier, a professor at France's International Prevention Research Institute (IPPR), told the conference.

"There is now an irrefutable case for devoting some of the resources from breast and prostate cancer screening to the early detection of colorectal (bowel) cancer," he said.

A large European study published last year found that breast screening programs over-diagnose about four cases for every 1,000 women aged between 50 and 69 who are screened.

The IPPR's research director Mathieu Boniol, who studied the impact of prostate screening, said his results showed routine use of prostate-specific antigen (PSA) tests creates more harm in terms of incontinence, impotence and other side-effects from prostate cancer treatments than benefit in terms of detecting life-threatening cancers.

"PSA testing should be reduced and more attention should be given to the harmful effects of screening," he told delegates.

Meanwhile, results of a study conducted by Autier using data from 11 European countries between 1989 and 2010 showed that the greater the proportions of men and women routinely screened for bowel cancer, the greater the reductions in death rates.

Colorectal cancer kills more than 600,000 people a year worldwide, according to the World Health Organization. In Europe some 400,000 people are diagnosed with the disease each year.

In Austria, for example, where 61 percent of those studied reported having had colorectal screening tests, deaths from this form of cancer dropped by 39 percent for men and 47 percent for women over the decade.

Meanwhile in Greece, where only 8 percent of males had had bowel cancer screening, death rates rose by 30 percent for men.

In the light of the results, Cornelis van de Velde, an oncologist at Leiden University Medical Centre in the Netherlands and president of the European Cancer Organisation, said it was "very disappointing" there are such wide differences in European governments' approaches to colorectal screening.

"People over 50 should be informed of the availability of the test, and pressure should be put on national health services to put more effort into organizing screening programs," he told the conference.

Screening for early signs of bowel cancer involves either a fecal occult blood test, which checks a sample of feces for hidden blood, or endoscopy, where a tiny camera is introduced into the large bowel to look for the polyps that can be a precursor of cancer.

In some European countries, such as France, Germany and Austria, many men and women over the age of 50 have regular colorectal screening examinations, while in others, such as The Netherlands and Britain, screening is much less common.

(Editing by David Evans)

View the original article here

Republicans shift focus to Medicaid complaints

A day after President Obama said he would support amending the health-care law so states can opt out of key provisions sooner, Republicans sought to shift the rhetorical battle back to an issue that would be largely unaffected by the president's proposal: the impact of the law's Medicaid requirements on state budgets.

Testifying at a hearing of the House Energy and Commerce Committee on Tuesday, two Republican governors returned to themes that had dominated the discussion at the National Governors Association's semiannual meeting over the weekend.

Mississippi Gov. Haley Barbour and Utah Gov. Gary R. Herbert complained that by prohibiting states from limiting who is eligible for Medicaid, the law has locked them into unsustainable spending at a time of fiscal crisis.

"Worst of all," added Herbert, is the law's mandatory expansion of Medicaid to cover a larger share of the poor beginning in 2014.

"Medicaid is poised to wreak havoc on the state's budget for years to come," he said, "threatening our ability to fund critical services, such as transportation and education."

To buttress that argument, congressional Republicans unveiled a report by the committee's majority staff estimating that the Medicaid expansion would cost states $118 billion through 2023 - a substantially larger amount than recent estimates by the Congressional Budget Office and independent analysts that consider a shorter time frame.

At the hearing, the committee's chairman, Rep. Fred Upton (R-Mich), pronounced the finding "sobering."

But administration officials countered that the additional expense to states will be largely offset because the law also enables states to save on Medicaid.

"It's important to remember that the Affordable Care Act will cover the overwhelming majority of the costs associated with the Medicaid expansion and will, in fact, reduce the amount states spend to care for the uninsured," White House spokesman Jay Carney told reporters.

Massachusetts Gov. Deval L. Patrick, the only Democrat invited to speak at the hearing, sounded a similar note in his testimony. "Federal reform is good for Massachusetts," he said. "It has given us an affordable way to extend the promise of coverage to Massachusetts residents."

Medicaid, which is jointly funded by states and the federal government, now provides health insurance to 53 million poor Americans. Starting in 2014, the law will require states to open eligibility to an anticipated 20 million more people with slightly higher incomes.

At first, the federal government will fully fund the extra cost. But beginning in 2017, the states' share will gradually increase to 10 percent by 2020.

The report released Tuesday - which was jointly produced with Republican staff of the Senate Finance Committee - arrived at its grand total by compiling and extrapolating from separate estimates provided by governments of each state as well as outside experts.

These figures do not appear to include an analysis of several potential sources of savings to states identified by researchers. A recent report by analysts at the Urban Institute calculated these savings could range from $40.6 billion to $131.9 billion between 2014 and 2019.

For example, the expansion of Medicaid coverage to a greater share of the uninsured could enable states and local governments to cut back on funding they now provide hospitals and other providers for treating patients who are unable to pay. Similarly, states whose Medicaid programs now cover people with incomes above the minimum required by the law could shift those people to state-run marketplaces, through which they will be able to buy insurance plans with federal subsidies.

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