A Reporter Chronicles His Colonoscopy

When Nicholas St. Fleur’s mother was diagnosed with colorectal cancer at age 34, her doctors found the cancer early enough that she was able to undergo successful treatment. Just before his own 30th birthday, St. Fleur received his first colonoscopy, an experience that he documented in a video for STAT. St. Fleur, who is Black, notes that actor Chadwick Boseman’s death from colorectal cancer in 2020 at age 43 was the impetus for him to pursue screening. The U.S. Preventive Services Task Force recommends that average-risk Americans get their first colorectal cancer screening at age 45, but this recommendation does not apply to people at elevated risk of the cancer, such as people like St. Fleur whose family members were diagnosed with colorectal cancer at young ages. In a special report, also published in STAT, St. Fleur writes about the rising risks colorectal cancer poses to young Black men. Colorectal cancer incidence has been rising in young Americans, and there are 232 U.S. counties where men under 50 are at unusually high risk of dying from colorectal cancer, he writes. Boseman had lived in one of those counties, and Black men in these areas have particularly high colorectal cancer mortality. Black women are generally more likely to die from colorectal cancer than white women. St. Fleur was happy to report that his first colonoscopy showed no signs of polyps or cancer. He will get another one in five years.

Gender Equity in Clinical Trials

The gender of a patient can affect efficacy and safety of cancer therapy. Women were underrepresented in clinical trials that led to cancer drug approvals made by the Food and Drug Administration between 2014 and 2019, according to a study published June 23 in Cancer. Overall, 55% of cancer diagnoses in the U.S. are in men, while 45% are in women. However, the researchers found that 60% of people enrolled in cancer clinical trials were men, and 40% were women. Men were overrepresented in drug trials for 8 out of 14 cancer types. Men were most overrepresented in thyroid cancer clinical trials, while women were most overrepresented in trials testing treatments for soft tissue cancers. “Whether these potential disparities result in discrepant clinical outcomes remains to be seen and should be analyzed in future studies,” the researchers write.

A Blood Test for Cancer

Researchers have labored for years to develop a blood test that can detect various types of cancer earlier than they would otherwise have been diagnosed based on a patient’s symptoms or other cancer screening tests. A study published June 24 in Annals of Oncology found that a multi-cancer test developed by the biotechnology and pharmaceutical company Grail incorrectly identified cancers 0.5% of the time and caught just over half of known cancers in a group composed of 2,823 people who had been diagnosed with cancer and 1,254 people who had not received a cancer diagnosis. The test, which analyzes DNA shed from cancer cells in the bloodstream, is worse at catching early-stage cancers than cancers that have progressed to a later stage, catching just 17% of stage I cancers, compared to 90% of stage IV cancers. The test’s ability to detect cancers also varied depending on cancer type. “These data suggest that, if used alongside existing screening tests, the multi-cancer detection test could have a profound impact on how cancer is detected and, ultimately, on public health,” said study co-author Eric Klein, chairman of the Glickman Urological and Kidney Institute at the Cleveland Clinic, in a press release. Grail says that the test is meant for people who have an elevated cancer risk, such as adults over age 50, and is not intended as a replacement for other cancer screening. The company will seek approval of the test by the Food and Drug Administration in 2023, but it’s already available​ by prescription in the U.S. as of earlier this month. ​​​

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