A year-by-year age analysis of colorectal cancer rates among U.S. adults finds a 46% increase in new diagnoses from ages 49 to 50, indicating that many latent cases of the disease are likely going undiagnosed until routine screenings begin at 50, according to a new study in  JAMA Network Open. 

Researchers found that almost 93% of the cases discovered at age 50 were invasive, meaning that most would require more aggressive treatment including surgery and were likely lingering for some time before diagnosis. 

“Our findings suggest a high case burden of preclinical, undetected early onset colorectal cancers in patients younger than 50 that is not reflected in observed incidence rates,” said lead study author Dr. Jordan Karlitz, associate clinical professor of medicine at Tulane University School of Medicine and staff gastroenterologist at the Southeast Louisiana Veterans Health Care System.

Colorectal cancer is the second leading cause of cancer deaths in the United States. As rates for younger adults continue to rise, there is considerable debate about whether to lower the age for recommended screenings. In 2018, the American Cancer Society called for routine screenings to start at 45. However, the U.S. Preventive Services Task Force, which sets federal screenings standards, currently recommends average risk screening begin at age 50. The agency is studying the issue to determine whether changes will improve outcomes.

Those against beginning screenings at age 45 have argued that incidence rates in those age 45 to 49 years have been considered relatively low compared to those aged 50 to 54 years. Study authors suspected the risks for those in their mid-to-late 40s are underestimated because incident data for those age ranges would likely only include cases caught because they presented symptoms and/or have a family history of cancer, in contrast to those 50 and older who have cancers also detected due to screening.

To assess this, they examined colorectal cancer incidence rates in one-year increments between the ages of 30 to 60 from the year 2000 to 2015. They suspected that if there were many asymptomatic cases of the disease undetected there would be a marked increase in cases between 49 and 50 when screenings begin. 

Researchers found a steep increase from 34.9 diagnoses per 100,000 people at age 49 to 51 cases per 100,000 at age 50. Sharp increases were also seen in both men (52.9%) and women (39.1%), in white (46.2%) and black (47.3%) populations in colon (51.4%) and rectal (37.6%) cancers in this one-year age transition. These incidence increases from age 49 to 50 were not seen in prior studies because only age group ranges were analyzed. 

Researchers also examined the stage at which the cancers were caught and found a spike in localized and regional cancers, which would require surgery and possibly chemotherapy and radiation treatment.  

The study adds fuel to the debate about whether screenings should begin at age 45. Karlitz said the combined burden of undetected and detected early onset colorectal cancer cases for those 45 to 49 may actually approach that of individuals in their early 50s.

“Our data support that the incidence of colorectal cancer increases substantially among individuals in their early 50s compared with individuals in their late 40s, not because rates are truly lower among those aged 45 to 49 years, but because colorectal cancers are present but undetected until diagnosed when screening is ultimately initiated,” he said.

 A limitation of the study is its population-based design, which limited researchers’ ability to determine exactly which patients had cancers detected at age 50 through screening versus diagnostic testing. 

“Nevertheless, the significantly high rate of invasive cases supports that almost all cancers accounted for in the rate increase from age 49 to 50 required aggressive treatment, regardless of how they were detected,” Karlitz said.

The study was co-authored by Dr. Wesal Abualkhair at Tulane and researchers from LSU Health Sciences Center and the University of Colorado School of Medicine.

The 7th Annual Gunning for a Cure takes place Saturday, March 7, at Stella Plantation in Braithwaite, LA.

This sporting clays competition and fundraiser exclusively benefits Tulane's Prostate Cancer Research Program and has raised a cumulative $1,033,000 since its inception in 2013.

"These dollars make a tremendous difference for our research efforts here at Tulane and beyond," said Oliver Sartor, MD, head of Tulane's Prostate Cancer Research Program. "It gives us flexibility that we could never have in the conventional grant world. It allows us to move in circles that are far, far beyond New Orleans. Something we could never do without the philanthropic support we receive. We don't waste money. This is all precious. It doesn't go to any of the administrative fees. We focus entirely on the research when we use these dollars."

The event was started by the family and friends of the late Chalin Perez, a former patient of Dr. Oliver Sartor's. Over the past seven years, it has grown to include the families of many more of Dr. Sartor's former and current patients, as well as many others passionate about helping those impacted by this disease. Their mission is to improve the health of men by helping to discover the means to better treat prostate cancer, while ultimately aiming to develop a cure.

"Dad passed away in 2003, after battling prostate cancer for many years," said son Chalyn, head of the Gunning for a Cure Organizing Committee. "He always attributed his quality of life over the years to Dr. Sartor. We continue to support Dr. Sartor's research because we believe he implements and continues to improve the best prostate cancer treatment available anywhere."

Event day will begin with a 25-station, four-man team sporting clays competition. Participants will also enjoy a catered lunch, live entertainment, raffles, an auction and awards. The family-friendly event also includes lots of fun activities for the kids, including a bounce house, kid-friendly raffle games, and adult-monitored fire trucks and swat vehicles to explore.

To sponsor, register a team, purchase a luncheon ticket or support the event in other ways, visit www.gunningforacure.org for details or call Shelby Daugherty at 504-919-7474.

Hope to see you at Stella!

The Department of Radiation Oncology recently welcomed Assistant Professor Audrey Dang, MD , back home to New Orleans and to Tulane! Dr. Dang treats all types of malignancies, with a particular interest in breast, prostate, central nervous system, and head and neck cancers.

"This is an exciting homecoming for me in a couple of ways," said Dr. Dang. "I'm a New Orleans native, and many of my family members are still here. So my mom is especially happy for me to be back! But I'm also coming home to my alma mater. I went to Tulane University as an undergrad - double-majoring in cell and molecular biology as well as Asian studies - and then went on to receive my medical degree from Tulane School of Medicine."

Following medical school, Dr. Dang completed a preliminary Internal Medicine intern year at Ochsner Clinic Foundation, followed by a residency in radiation oncology at the University of California, Los Angeles, where she served as a chief resident in her final year.

Clinical research is a priority for Dr. Dang. One area of focus is stereotactic body radiation therapy (SBRT) for prostate cancer and the possibility for it to condense the standard course of radiation treatment for this disease.

"The conventional treatment for patients with intact prostates is 8-9 weeks of radiation, once a day, Monday through Friday," said Dr. Dang. "It's a long and burdensome schedule for our patients. But with SBRT we are trying to condense radiation to five treatments delivered over two weeks, once a day every other day. Data shows that prostate cancer biology tends to respond better to a higher dose of radiation with each treatment. SBRT takes advantage of that while also making the treatment schedule less burdensome." Dr. Dang won an award from the Radiosurgery Society for her research in this area in 2018

She says that SBRT has been widely used to treat other disease sites, but not commonly in prostate. "We are working toward possibly bringing that treatment option here. That's a definite goal," she says.

Dr. Dang has presented numerous research abstracts at regional, national and international meetings. Additionally, she has authored and co-authored multiple publications in high-impact journals.

"At Tulane, we strive to offer our patients the most effective multidisciplinary cancer care available, as well as the most modern treatment technologies," said Dr. Dang. "We have an excellent team here that collaborates across the disciplines, and I am thrilled to be a member."

For more information on Tulane's Radiation Oncology Department, please click here . To make an appointment to see Dr. Dang, please call 504-988-7444.

"We are a passionate and devoted group believing that the little people of the world can make a difference," said Carol Osborne, Krewe de Pink's president, following the overwhelming success of their inaugural Death by Chocolate event, held recently at Schoen Mansion.

The sold-out fundraiser benefits Tulane Cancer Center's Breast Cancer Research Fund. In addition to honoring six local cancer survivors - Breanne Kostyk, Carol Cukell Neff, Lisa Picone Love, Norma Jane Sabiston, Kim Sport, and Julie Stokes - for their courage and determination, the event also featured a culinary competition among the students of Delgado Community College's Culinary Arts Program.

While enjoying a variety of champagnes, guests had the privilege of sampling 12 incredible chocolate-inspired bites - six sweet and six savory - prepared by the young chefs-in-training and then voting for their favorites at the end of the evening. First-place winner in the savory category was the carnitas taco by Donald Smith, and taking first in the sweet category was Stacey Jackson, whose chocolate espresso truffle was a crowd favorite!

"What a wonderful night! On behalf of the patients who will benefit from the important research this event will help to support, I deeply thank the folks at Schoen Mansion, Delgado Culinary Arts, the Delgado Music Department, Callebaut Chocolate, and of course Event Chair Hillery Moise and the other members of Krewe de Pink for hosting an incredibly unique, delicious and meaningful event," said Prescott Deininger, PhD, Tulane Cancer Center director. "What all of you do to support breast cancer research is invaluable to our progress, and we couldn't be more grateful."

Krewe de Pink is a team of concerned and passionate volunteers who produce two other fundraising events per year: the Pink Bra Run and the Krewe de Pink Prom. KDP members have all been affected by breast cancer in one way or another and are dedicated to fighting back by raising funds to support research through events with a uniquely New Orleans flair. For more information on Krewe de Pink or to participate in their upcoming events, please visit www.krewedepink.org.

(Photos by Krewe de Pink & Delgado Culinary Arts Program)

Tulane Cancer Center recently welcomed student athletes from Archbishop Chapelle High School, Cabrini High School, Mount Carmel Academy, St. Mary’s Dominican High School, St. Scholastica Academy, and Archbishop Shaw to celebrate a milestone - a new record in funds raised through the Pink Games initiative - $43,679!

The Pink Games were started at Tulane seven years ago through the efforts of David Mocklin, head athletic trainer at the Tulane Institute of Sports Medicine (TISM) in the Department of Orthopaedics. David wanted to involve the student athletes from several of the schools that TISM provides sports medicine coverage for in an ongoing project that would not only underscore the importance of "service to others" but also make an important difference in the lives of local cancer patients.

The Pink Games are a series of volleyball games, swim meets and other fundraising activities - often involving friendly competitions among grade levels at the participating schools - that benefit Tulane Cancer Center's Patient Relief Fund (PRF).

"It truly amazes me to watch this Pink Games effort continue to grow each and every year," said Mocklin. "Our schools share different thoughts and ideas about fundraising for this event. This is a very large group effort from each of these amazing schools, and when you hear from cancer patients who have been directly helped over the years, it warms your heart. We are all so happy to be able to help others in need."

The PRF was established in 1998 to help patients meet unexpected expenses associated with their care. It's often the only source available to our social worker to solve an urgent problem that could become an impediment to cancer care. Over the years, this fund has provided help with everything from transportation, meals, and short-term housing to rental assistance for those facing eviction. These funds are an important source of financial as well as emotional relief for needy patients who are often overwhelmed by a cancer diagnosis and treatment schedule. 

 

"In every way possible, these funds represent HOPE to those who are in the fight of their lives," said Prescott Deininger, PhD, Cancer Center director. "HOPE because they can now travel to their treatment appointments without worrying about the cost. HOPE because they can continue taking their prescribed medications without wondering where the next co-pay will come from. HOPE because that hotel room stay, which seemed so out of reach on a budget that is already strained, is suddenly covered.  HOPE because somebody else cares and has gone the extra mile to lend a helping hand! That’s what the coaches, student athletes, parents and everyone else involved in Pink Games has provided."

 

Over the last seven years, Pink Games proceeds total $198,985! Loyola University's volleyball program has also been a valued contributor through the years.

"These students are creating a legacy of giving back that will not only help those in need in our community but also inspire the students who will walk their schools' halls long after them. We couldn’t be prouder or more grateful," said Deininger.

Saturday, March 7

Stella Plantation

4881 Highway 39, Braithwaite, LA

Monday, March 30

Bayou Oaks at City Park -

South Course