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Year delay between abnormal, at-home screening and colonoscopy increases cancer risk

Study finds risk of late-stage colon cancer increased at 16 months by approximately 33% Credit: UC San Diego Health Sciences Colorectal cancer is the second most common cause of cancer-related mortality among men and women in the United States, according.

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Study finds risk of late-stage colon cancer increased at 16 months by approximately 33%

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Credit: UC San Diego Health Sciences

Colorectal cancer is the second most common cause of cancer-related mortality among men and women in the United States, according to the American Cancer Society. At-home tests, which measure blood in stool as a potential marker for colon cancer, are often used for colorectal cancer screening.

Usage of these tests has increased during the COVID-19 pandemic as people try to avoid clinical visits. However, effectiveness of these screening tools, along with all colon cancer screenings, requires a follow-up colonoscopy if an abnormal test result occurs. The problem is that experts say current follow-up rates are low.

A new study, led by researchers at University of California San Diego School of Medicine, Veterans Affairs San Diego Healthcare System (VASDHS), Veterans Affairs Greater Los Angeles Healthcare System and University of California Los Angeles, found delayed time between abnormal stool-based screening and subsequent colonoscopy was associated with an increased risk of a cancer diagnosis and death from colorectal cancer.

The study, published in the February 2, 2021 online edition of Gastroenterology, found those who delayed a colonoscopy by more than twelve months after an abnormal screening test result were at an increased risk of being diagnosed with colorectal cancer. The odds of being diagnosed with late-stage colon cancer increased at 16 months by approximately 33 percent.

“Many colon cancers are asymptomatic and can be growing without the patient even knowing. That is why it is so important to screen. But as our study shows, it is also critical to follow up with a colonoscopy if the screening result is abnormal,” said Samir Gupta, MD, corresponding author of the study and professor of medicine in the Division of Gastroenterology at UC San Diego School of Medicine and VASDHS.

“Early detection means less invasive treatments and excellent outcomes. When detected early, patients have a 90 percent survival rate with a low risk of recurrence. Late-stage colorectal cancer means more invasive and complex treatment with less than a 15 percent survival rate. As usage of more non-invasive tests for colorectal cancer screening continue to rise during the pandemic, and as more non-invasive screening tests come onto the market in the future, it is critical to ensure all patients with abnormal colorectal cancer screening tests get a timely colonoscopy.”

The national study involved 204,733 veterans ages 50 to 75 with an abnormal screening test. A limitation of the study was a high proportion of men; 5,453 women were included.

“There are no national standards or mandates to guide patients, providers or health care systems on the clinically acceptable period of time between abnormal screening and colonoscopy,” said Folasade May MD, PhD, senior author of the study and assistant professor of medicine at UCLA. “We hope our findings will inform national standards for appropriate time intervals and interventions to improve timely colonoscopies and colorectal cancer outcomes.”

A family history, smoking and poor diet are significant risk factors of colon cancer. Symptoms include rectal bleeding, low-iron anemia, a change in bowel habits and unexplained weight loss.

In 2018, the American Cancer Society updated guidelines for colorectal cancer screening. It is now recommended that those age 45 with an average risk of colon cancer begin regular screenings. Previously, the guideline recommended screening begin at age 50 for people at average risk.

“In general, prevention and early detection efforts have substantially dropped death rates in the United States. However, the pandemic has resulted in many people missing cancer screenings or not doing follow-up colonoscopies after abnormal at-home screenings,” said Gupta. “We strongly encourage patients to schedule an appointment if they receive an abnormal screening test. Our hospital and clinical settings are following all COVID-19 safety guidelines. Hesitancy to follow up on your health care could have fatal consequences.”

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Co-authors of the study include: Yazmin San Miguel, Joshua Demb and Maria Elena Martinez, all with UC San Diego.

Media Contact
Michelle Brubaker
mmbrubaker@ucsd.edu

Related Journal Article

http://dx.doi.org/10.1053/j.gastro.2021.01.219

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$500 Per Hour Tutors Are Back In Vogue Now That Colleges Have Decided SATs Are, In Fact, A Necessity

$500 Per Hour Tutors Are Back In Vogue Now That Colleges Have Decided SATs Are, In Fact, A Necessity

It was just about a month ago we noted…

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$500 Per Hour Tutors Are Back In Vogue Now That Colleges Have Decided SATs Are, In Fact, A Necessity

It was just about a month ago we noted that SATs were once again being reconsidered by colleges who had reduced or eliminated their requirement due to (pick one: diversity, racism, climate change, equity, gender affirmation). 

As a result of the comeback, Bloomberg noted this week that tutors, sometimes costing $500 per hour, are all of a sudden back in vogue. 

Bloomberg wrote that demand for SAT tutoring and prep centers is surging as several top colleges reintroduce mandatory SATs, and students adapt to the SAT's new digital format.

Kaplan reported a significant enrollment increase, attributed to digital testing and the reinstatement of testing requirements by institutions and three Ivy League schools—Yale, Dartmouth, and Brown—have reinstated mandatory SATs, alongside MIT and the University of Texas at Austin. This shift has left many students scrambling for preparation before early application deadlines.

Companies like The Princeton Review have also seen a spike in interest for prep services.


Parents Bloomberg profiled are once again investing in tutoring services for their children to improve their chances of success. The debate over standardized testing's fairness persists however, with critics arguing it favors wealthier students who can afford extensive prep. But those winning the argument still claims that standardized tests provide valuable benchmarks for admissions, potentially aiding in diversifying the applicant pool.

We noted last month in a piece from American Greatness, that according to Axios, multiple colleges used the Chinese Coronavirus pandemic as an excuse to weaken the importance of SAT and ACT test scores in most student applications. But in recent weeks, several schools have reversed course; Yale is considering repealing its prior policy of making SAT/ACT requirements optional, with Dartmouth already reinstating the requirements earlier this month. MIT reversed a similar policy back in 2022.

Other schools that have eliminated SAT/ACT requirements include Harvard and Columbia. Harvard, along with Cornell and Princeton, have extended their policy of making the scores optional, while Columbia’s policy remains permanent.

One of the motivating factors behind the reversal is ongoing research showing a clear correlation between students’ standardized test scores, and their subsequent academic performance and graduation rates in college. Some schools had previously opposed the test requirements for reasons of “diversity,” baselessly accusing the tests of being “racist” and against minority students.

Tyler Durden Wed, 03/20/2024 - 17:20

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Study: Life’s building blocks are surprisingly stable in Venus-like conditions

If there is life in the solar system beyond Earth, it might be found in the clouds of Venus. In contrast to the planet’s blisteringly inhospitable surface,…

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If there is life in the solar system beyond Earth, it might be found in the clouds of Venus. In contrast to the planet’s blisteringly inhospitable surface, Venus’ cloud layer, which extends from 30 to 40 miles above the surface, hosts milder temperatures that could support some extreme forms of life. 

Credit: Credit: JAXA/J. J. Petkowski

If there is life in the solar system beyond Earth, it might be found in the clouds of Venus. In contrast to the planet’s blisteringly inhospitable surface, Venus’ cloud layer, which extends from 30 to 40 miles above the surface, hosts milder temperatures that could support some extreme forms of life. 

If it’s out there, scientists have assumed that any Venusian cloud inhabitant would look very different from life forms on Earth. That’s because the clouds themselves are made from highly toxic droplets of sulfuric acid — an intensely corrosive chemical that is known to dissolve metals and destroy most biological molecules on Earth. 

But a new study by MIT researchers may challenge that assumption. Appearing today in the journal Astrobiology, the study reports that, in fact, some key building blocks of life can persist in solutions of concentrated sulfuric acid. 

The study’s authors have found that 19 amino acids that are essential to life on Earth are stable for up to four weeks when placed in vials of sulfuric acid at concentrations similar to those in Venus’ clouds. In particular, they found that the molecular “backbone” of all 19 amino acids remained intact in sulfuric acid solutions ranging in concentration from 81 to 98 percent.  

“What is absolutely surprising is that concentrated sulfuric acid is not a solvent that is universally hostile to organic chemistry,” says study co-author Janusz Petkowski, a research affiliate in MIT’s Department of Earth, Atmospheric and Planetary Sciences (EAPS).

“We are finding that building blocks of life on Earth are stable in sulfuric acid, and this is very intriguing for the idea of the possibility of life on Venus,” adds study author Sara Seager, MIT’s Class of 1941 Professor of Planetary Sciences in EAPS and a professor in the departments of Physics and of Aeronautics and Astronautics. “It doesn’t mean that life there will be the same as here. In fact, we know it can’t be. But this work advances the notion that Venus’ clouds could support complex chemicals needed for life.”

The study’s co-authors include first author Maxwell Seager, an undergraduate in the Department of Chemistry at Worcester Polytechnic Institute and Seager’s son, and William Bains, a research affiliate at MIT and a scientist at Cardiff University.

Building blocks in acid

The search for life in Venus’ clouds has gained momentum in recent years, spurred in part by a controversial detection of phosphine — a molecule that is considered to be one signature of life — in the planet’s atmosphere. While that detection remains under debate, the news has reinvigorated an old question: Could Earth’s sister planet actually host life? 

In search of an answer, scientists are planning several missions to Venus, including the first largely privately funded mission to the planet, backed by California-based launch company Rocket Lab. That mission, on which Seager is the science principal investigator, aims to send a spacecraft through the planet’s clouds to analyze their chemistry for signs of organic molecules. 

Ahead of the mission’s January 2025 launch, Seager and her colleagues have been testing various molecules in concentrated sulfuric acid to see what fragments of life on Earth might also be stable in Venus’ clouds, which are estimated to be orders of magnitude more acidic than the most acidic places on Earth.

“People have this perception that concentrated sulfuric acid is an extremely aggressive solvent that will chop everything to pieces,” Petkowski says. “But we are finding this is not necessarily true.”

In fact, the team has previously shown that complex organic molecules such as some fatty acids and nucleic acids remain surprisingly stable in sulfuric acid. The scientists are careful to emphasize, as they do in their current paper, that “complex organic chemistry is of course not life, but there is no life without it.” 

In other words, if certain molecules can persist in sulfuric acid, then perhaps the highly acidic clouds of Venus are habitable, if not necessarily inhabited. 

In their new study, the team turned their focus on amino acids — molecules that combine  to make essential proteins, each with their own specific function. Every living thing on Earth requires amino acids to make proteins that in turn carry out life-sustaining functions, from breaking down food to generating energy, building muscle, and repairing tissue. 

“If you consider the four major building blocks of life as nucleic acid bases, amino acids, fatty acids, and carbohydrates, we have demonstrated that some fatty acids can form micelles and vesicles in sulfuric acid, and the nucleic acid bases are stable in sulfuric acid. Carbohydrates have been shown to be highly reactive in sulfuric acid,” Maxwell
Seager explains. “That only left us with amino acids as the last major building block to
study.”

A stable backbone

The scientists began their studies of sulfuric acid during the pandemic, carrying out their experiments in a home laboratory. Since that time, Seager and her son continued work on chemistry in concentrated sulfuric acid. In early 2023, they ordered powder samples of 20 “biogenic” amino acids — those amino acids that are essential to all life on Earth. They dissolved each type of amino acid in vials of sulfuric acid mixed with water, at concentrations of 81 and 98 percent, which represent the range that exists in Venus’ clouds. 

The team then let the vials incubate for a day before transporting them to MIT’s Department of Chemistry Instrumentation Facility (DCIF), a shared, 24/7 laboratory that offers a number of automated and manual instruments for MIT scientists to use. For their part, Seager and her team used the lab’s nuclear magnetic resonance (NMR) spectrometer to analyze the structure of amino acids in sulfuric acid. 

After analyzing each vial several times over four weeks, the scientists found, to their surprise, that the basic molecular structure, or “backbone” in 19 of the 20 amino acids remained stable and unchanged, even in highly acidic conditions.

“Just showing that this backbone is stable in sulfuric acid doesn’t mean there is life on Venus,” notes Maxwell Seager. “But if we had shown that this backbone was compromised, then there would be no chance of life as we know it.” 

The team acknowledges that Venus’ cloud chemistry is likely messier than the study’s “test tube” conditions. For instance, scientists have measured various trace gases, in addition to sulfuric acid, in the planet’s clouds. As such, the team plans to incorporate certain trace gases in future experiments. 

“There are only a few groups in the world now that are working on chemistry in sulfuric acid, and they will all agree that no one has intuition,” adds Sara Seager. “I think we are just more happy than anything that this latest result adds one more ‘yes’ for the possibility of life on Venus.”

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Written by Jennifer Chu, MIT News

Paper: “Stability of 20 Biogenic Amino Acids in Concentrated Sulfuric Acid: Implications for the Habitability of Venus’ Clouds”

https://www.liebertpub.com/doi/10.1089/ast.2023.0082


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Bacteria subtype linked to growth in up to 50% of human colorectal cancers, Fred Hutch researchers report

Researchers at Fred Hutchinson Cancer Center have found that a specific subtype of a microbe commonly found in the mouth is able to travel to the gut and…

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Researchers at Fred Hutchinson Cancer Center have found that a specific subtype of a microbe commonly found in the mouth is able to travel to the gut and grow within colorectal cancer tumors. This microbe is also a culprit for driving cancer progression and leads to poorer patient outcomes after cancer treatment.

Credit: Fred Hutchinson Cancer Center

Researchers at Fred Hutchinson Cancer Center have found that a specific subtype of a microbe commonly found in the mouth is able to travel to the gut and grow within colorectal cancer tumors. This microbe is also a culprit for driving cancer progression and leads to poorer patient outcomes after cancer treatment.

The findings, published March 20 in the journal Nature, could help improve therapeutic approaches and early screening methods for colorectal cancer, which is the second most common cause of cancer deaths in adults in the U.S. according to the American Cancer Society.

Examining colorectal cancer tumors removed from 200 patients, the Fred Hutch team measured levels of Fusobacterium nucleatum, a bacterium known to infect tumors. In about 50% of the cases, they found that only a specific subtype of the bacterium was elevated in the tumor tissue compared to healthy tissue.

The researchers also found this microbe in higher numbers within stool samples of colorectal cancer patients compared with stool samples from healthy people.

“We’ve consistently seen that patients with colorectal tumors containing Fusobacterium nucleatum have poor survival and poorer prognosis compared with patients without the microbe,” explained Susan Bullman, Ph.D., Fred Hutch cancer microbiome researcher and co-corresponding study author. “Now we’re finding that a specific subtype of this microbe is responsible for tumor growth. It suggests therapeutics and screening that target this subgroup within the microbiota would help people who are at a higher risk for more aggressive colorectal cancer.”

In the study, Bullman and co-corresponding author Christopher D. Johnston, Ph.D., Fred Hutch molecular microbiologist, along with the study’s first author Martha Zepeda-Rivera, Ph.D., a Washington Research Foundation Fellow and Staff Scientist in the Johnston Lab, wanted to discover how the microbe moves from its typical environment of the mouth to a distant site in the lower gut and how it contributes to cancer growth.

First they found a surprise that could be important for future treatments. The predominant group of Fusobacterium nucleatum in colorectal cancer tumors, thought to be a single subspecies, is actually composed of two distinct lineages known as “clades.”

“This discovery was similar to stumbling upon the Rosetta Stone in terms of genetics,” Johnston explained. “We have bacterial strains that are so phylogenetically close that we thought of them as the same thing, but now we see an enormous difference between their relative abundance in tumors versus the oral cavity.”

By separating out the genetic differences between these clades, the researchers found that the tumor-infiltrating Fna C2 type had acquired distinct genetic traits suggesting it could travel from the mouth through the stomach, withstand stomach acid and then grow in the lower gastrointestinal tract. The analysis revealed 195 genetic differences between the clades.

Then, comparing tumor tissue with healthy tissue from patients with colorectal cancer, the researchers found that only the subtype Fna C2 is significantly enriched in colorectal tumor tissue and is responsible for colorectal cancer growth.

Further molecular analyses of two patient cohorts, including over 200 colorectal tumors, revealed the presence of this Fna C2 lineage in approximately 50% of cases.

The researchers also found in hundreds of stool samples from people with and without colorectal cancer that Fna C2 levels were consistently higher in colorectal cancer.

“We  have pinpointed the exact bacterial lineage that is associated with colorectal cancer, and that knowledge is critical for developing effective preventive and treatment methods,” Johnston said.

He and Bullman believe their study presents significant opportunities for developing microbial cellular therapies, which use modified versions of bacterial strains to deliver treatments directly into tumors.

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Fred Hutchinson Cancer Center unites individualized care and advanced research to provide the latest cancer treatment options while accelerating discoveries that prevent, treat and cure cancer and infectious diseases worldwide.

Based in Seattle, Fred Hutch is an independent, nonprofit organization and the only National Cancer Institute-designated cancer center in Washington. We have earned a global reputation for our track record of discoveries in cancer, infectious disease and basic research, including important advances in bone marrow transplantation, immunotherapy, HIV/AIDS prevention and COVID-19 vaccines. Fred Hutch operates eight clinical care sites that provide medical oncology, infusion, radiation, proton therapy and related services. Fred Hutch also serves as UW Medicine’s cancer program.


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