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    <recommendedItem id="20100101_19_304"
                     title="&apos;Virtual&apos; Colon Scans Effective in Seniors (CME/CE)"
                     score="0.005"
                     href="http://www.medpagetoday.com/HematologyOncology/ColonCancer/tb/18164?impressionId=1265752246913"
                     
      Patients 65 and older are as suitable as younger individuals for CT colonography, said researchers conducting a large retrospective study.&lt;br&gt;
&lt;br&gt;Advanced neoplasias were detected with CT colonography  --  often called &quot;virtual colonoscopy&quot;  --  in older patients at more than double the rate in the general screening population, reported David H. Kim, MD, of the University of Wisconsin in Madison, Wis., and colleagues in the February issue of &lt;em&gt;Radiology&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;They found that 7.6% of older patients had advanced neoplasias, compared with 3.2% of all patients screened in the university&apos;s clinic (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;On the basis of this and other findings in 577 individuals 65 and older versus the entire group of 3,120 patients undergoing the procedure, Kim and colleagues concluded that &quot;CT colonography performance is maintained in an older cohort.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Overall, the observations from this clinical experience confirm that CT colonography may be a valuable screening modality in the older population,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;On the other hand, the study did not address several objections raised by the Centers for Medicare and Medicaid Services (CMS) in its decision last year to deny Medicare coverage for the procedure. (See &lt;a href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/Medicare/14186&quot; mce_href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/Medicare/14186&quot; target=&quot;_blank&quot;&gt;Medicare Finalizes Denial of Virtual Colonoscopy Coverage&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;CMS had pointed to relatively low sensitivity of CT colonography compared with optical colonoscopy in prospective trials, especially for small lesions.&lt;/p&gt;
&lt;p&gt;The agency also determined that CT colonography increased the costs of positive findings, since abnormalities in the CT scans must be confirmed with optical colonoscopy. In addition, CMS said there was no evidence to support claims that the less invasive imaging procedure would be more acceptable to patients and therefore would raise screening rates.&lt;/p&gt;
&lt;p&gt;The data analyzed by Kim and colleagues did not allow for calculations of false-negative rates or predictive values of positive or negative findings. Nor did the researchers report cost information.&lt;/p&gt;
&lt;p&gt;Mean age of their older cohort was 69.2 (SD 3.8). The oldest was 79.&lt;/p&gt;
&lt;p&gt;The researchers reported that 15.3% of the older patients were referred for optical colonoscopy on the basis of the CT results, compared with 7.9% of the overall screening group.&lt;/p&gt;
&lt;p&gt;Less than 4% of positive findings were determined to be false with the optical procedure (3.6% for polyps 6 to 10 mm in diameter, 2.1% for larger lesions).&lt;/p&gt;
&lt;p&gt;Of the 59 advanced neoplasias identified in the older patients, all but three were at least 10 mm in size.&lt;/p&gt;
&lt;p&gt;The scans also suggested abnormalities outside the colon in 89 (15.4%) patients. Of these, 45 received a full workup, which revealed substantial and previously unsuspected diagnoses in 21 cases  -- 18 were vascular aneurysms. The other three included one lung tumor, a femoral hernia, and a malrotation.&lt;/p&gt;
&lt;p&gt;Kim and colleagues reported that no &quot;substantial complications&quot; such as perforations or major hemorrhage occurred in the older patients, either with the CT scan or follow-up colonoscopy.&lt;/p&gt;
&lt;p&gt;They also indicated that the ratio of large to small neoplasias was similar in the older patients compared with their CT screening group as a whole. Histologic and morphologic findings were similar as well.&lt;/p&gt;
&lt;p&gt;The researchers cited the observational nature of the study, in which negative findings were not corroborated with optical colonoscopy, and its restriction to a single center as its main limitations.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;No external funding for the study was reported.&lt;/p&gt;&lt;p&gt;Kim and one co-author reported relationships with Viatronix and Medicsight and are co-founders of a company called VirtuoCTC, which produces educational materials on CT colonography.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_1464"
                     title="Late-Stage Cancer: Big City, Big Risk"
                     score="-0.005"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/PublicHealth/tb/14158?impressionId=1265752246913"
                     
      HOUSTON, May 12 -- Confounding the common epidemiological wisdom, urban dwellers had a higher risk of four common, late-stage cancer diagnoses than their rural counterparts in a new, population-based analysis. 
              &lt;p&gt;
              &lt;p&gt;Residents of the most urbanized areas had the highest risk of breast, colorectal, lung, and prostate cancer, Sara McLafferty, Ph.D., and Fahui Wang, Ph.D., of the University of Illinois Urbana-Champaign, reported online in &lt;em&gt;Cancer&lt;/em&gt;. 
              &lt;p&gt;
              &lt;p&gt;Cancer risk decreased with increasingly rural residency, except for a slight upturn in the most isolated communities. 
              &lt;p&gt;
              &lt;p&gt;&quot;We observe a reversal of the commonly held view that risks are highest for rural residents,&quot; the authors concluded. 
              &lt;p&gt;
              &lt;p&gt;&quot;The concentration of health disadvantage in highly urbanized places emphasizes the need for more extensive urban-based cancer screening and education programs, especially programs targeted to the most vulnerable urban populations and neighborhoods.&quot; 
              &lt;p&gt;
              &lt;p&gt;The authors identified several variables that could account for some of the variability. However, some findings had no ready explanations. For example, residents of large towns in rural areas consistently had lower cancer risks. 
              &lt;p&gt;
              &lt;p&gt;Data on urban-rural cancer disparities have been mixed. Authorities in the field generally supported the notion that residents of rural areas had a greater risk of late-stage diagnosis because of reduced access to screening services. 
              &lt;p&gt;
              &lt;p&gt;The authors continued the assessment in an analysis that focused on the rural-urban gradient of late-stage cancer risk in Illinois for 1998 through 2002. Using data from the State of Illinois Cancer Registry, they limited the analysis to four major types of cancer: breast, colorectal, lung, and prostate. 
              &lt;p&gt;
              &lt;p&gt;For the study period, the authors determined that late-stage diagnosis accounted for 36.9% of breast cancers, 62.9% of breast cancers, 79.7% of lung cancers, and 15.6% of prostate cancers. 
              &lt;p&gt;
              &lt;p&gt;To analyze late-stage diagnosis by geographic area, the authors used a modified version of the Rural-Urban Commuting Areas (RUCA) classification system developed by the U.S. Office of Rural Health Policy. 
              &lt;p&gt;
              &lt;p&gt;The modifications resulted in five classifications: Chicago, Chicago suburbs, other metropolitan areas, large towns (population 10,000 to 50,000), and rural areas (population &amp;lt;10,000). 
              &lt;p&gt;
              &lt;p&gt;Analysis of late-stage cancer diagnosis by the five geographic areas revealed a &quot;clear and remarkably consistent rural-urban gradient in late-stage risk,&quot; the authors said. &quot;Risk is highest in Chicago, decreases in the less urbanized zones, and reaches a nadir in other metropolitan areas and large towns.&quot; 
              &lt;p&gt;
              &lt;p&gt;The risk increased somewhat among patients living in the areas classified as rural, resulting in a reverse-J gradient along the urban-rural continuum. The gradient held up for all four types of cancer. 
              &lt;p&gt;
              &lt;p&gt;The gradients were steepest for breast, colon, and lung cancer, all of which had the lowest odds ratios in large towns and the highest ratios in Chicago. As compared with Chicago, the odds ratio for large towns ranged between 0.71 and 0.79 for those three cancers. 
              &lt;p&gt;
              &lt;p&gt;Age and racial/ethnic variation accounted for some of the disparities. However, some of the disparities persisted in multivariate analysis that accounted for the differences. 
              &lt;p&gt;
              &lt;p&gt;As an example, the authors noted that &quot;all other factors being equal, patients who live outside the Chicago area are 25% to 35% less likely than their Chicago-area counterparts to present with late-stage lung cancer.&quot; 
              &lt;p&gt;
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The authors reported no competing interests. &lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
        
    </recommendedItem>
    <recommendedItem id="20090101_1_59"
                     title="Quality of American Cancer Care Viewed as Uneven"
                     score="-0.005"
                     href="