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Young-Onset Colorectal Cancer Information Guide

Endangered Butts Come in All Shapes, Sizes and Ages!

Endangered Butts Come in All Shapes, Sizes and Ages!

About Colorectal Cancer

Colorectal cancer is a malignant tumour that starts in cells of the colon or rectum.

1 in 14 men and 1 in 16 women are diagnosed with colorectal cancer each year in Canada. Approximately 25,100 Canadians were diagnosed with CRC in 2015. It is the 2nd deadliest cancer, although the disease is more than 90% curable if detected early. Colorectal cancer is Preventable, Treatable and Beatable!

Colorectal cancer most often touches individuals over the age of 50 and over ninety percent (90%) of patients are over 55 years of age. Ten percent (10%) of new colon cancer patients however are under the age of 50. Individuals with certain risk factors such as a family history of polyps, colon cancer or genetic alterations, have an increased risk of developing colon cancer at a younger age. Sixteen percent (16%) of patients under the age of 40 have been reported to have predisposing factors and twenty-three percent (23%) had a family history of the disease.

Table 1: Number of new cases of colorectal cancer diagnoses in 2015 by age group in Canada

chart 1 EN

About the Colorectal Cancer Association of Canada (“CCAC”)

The CCAC is dedicated to colorectal cancer awareness and education, supporting patients and their families, and advocating on their behalf. The CCAC raises awareness and provides important and practical information to colorectal cancer patients, young and old. Together with the Never Too Young (“N2Y”) coalition, we provide support and information to young patients in Canada who have experienced early onset of the disease.

About N2Y

The Never Too Young Coalition is united to take action on young onset of colorectal cancer through action, education, and research. The Coalition includes medical professionals, patient advocacy organizations, cancer survivors and caregivers working to educate the public about this growing issue and to reduce the number of late stage young-onset colorectal cancer cases.

As the leading national colorectal cancer patient advocacy organization in Canada, we’re dedicated to bringing together the brightest minds to increase screening and to promote equal and timely access to effective treatments to improve patient outcomes.

Symptoms of CRC

• Blood in the stool
• Narrower-than-normal stools
• Prolonged diarrhea or constipation
• Feeling that the bowel does not completely feel empty
• Abdominal pain or discomfort
• Loss of appetite, unexplained weight loss
• Constant fatigue, anemia
• Nausea, vomiting

Risk Factors

Family History of Colon Cancer or polyps

About 10% of the population has a first degree relative with colon or rectal cancer.

First and second degree relatives (children, siblings, grandchildren, nieces, nephews) of a person with a history of colon cancer are more likely to develop CRC themselves, especially if their relative had the cancer at a young age. If several close relatives have a history of colon cancer, there is an increased risk. In view of this increased risk, both the U.S. Preventative Services Task Force (USPSTF) and the Canadian Task Force on Preventive Health Care (CTFPHC) recommend screening as of the age 40 for these high-risk individuals or ten years earlier than the youngest age of colorectal cancer diagnosis for any affected relative.

Genetic Alterations

Changes in certain genes increase your risk of colon cancer.

Hereditary nonpolyposis colon cancer (HNPCC or Lynch Syndrome) is the most common type of inherited colon cancer, accounting for about 2% of all colon cancer cases. It is caused by changes in a HNPCC gene. If not closely monitored, most individuals with this altered gene will develop colon cancer, with the average age at diagnosis being 42-45, and 35-40% being diagnosed before the age of 40. General screening guidelines recommend colonoscopy every 1-2 years, beginning between the ages of 20-25, or five years younger than the earliest age at diagnosis in the family, whichever is sooner.

Much rarer is familial adenomatous polyposis (FAP) an inherited condition in which hundreds of polyps form in the colon and rectum. It is caused by a change in a specific gene called APC. Unless FAP is treated, it usually leads to colon cancer by age 40. FAP accounts for less than 1% of all colon cancer cases.

Family members of individuals who have HNPCC or FAP can have genetic testing to check for specific genetic changes. For those who have changes in their genes, healthcare providers may suggest ways to try to reduce the risk of colon cancer or to improve the detection of this disease. For adults with FAP, the doctor may recommend the removal of all or part of the colon and rectum.

Ulcerative Colitis or Crohn’s Disease

A person who has had a condition that causes inflammation of the colon (such as ulcerative colitis or Crohn’s disease) for many years is at an increased risk of developing colon cancer. Patients should therefore be screened regularly.

Other Factors

Other factors contributing to young-onset of colon cancer have not been definitely identified, but we do know they occur with an increased prevalence of obesity and diabetes. Factors that may increase your risk of colon cancer include:

• There is approximately two times higher risk of developing colorectal cancer later life if you are overweight or obese during adolescence.
• A diet high in red or processed meat and low in fiber, vegetables and fruits.
• Inactivity: 12-14% of colorectal cancer could be attributed to lack in physical activity
• Smoking
• Increase consumption of alcohol
• Racial and ethnic background

Statistics and Data

• Colon cancer incidence and mortality rates are increasing in the young-onset population while decreasing in those over 50.
• About 30% of young-onset colorectal cancer cases develop in those with a family history of the disease or genetic disposition.
• Young-onset rectal cancer incidence has increased at nearly twice the rate of young-onset colon cancer.
• About 72% of cases of colorectal cancer in young people arise in the colon and about 28% in the rectum.
• Younger adults were more likely than older adults to be diagnosed with late-stage cancers.
• Rates have been increasing in all younger age groups with the highest increases for the 15-29 years old, followed by the 30-39 years old and then 40-49.
• The increase is more rapid in males compared to females.
• Diabetes has been associated with up to a 38% increase in colon cancer risk and 20% increase in rectal cancer risk.

Prevention

Research shows that a high fat diet is a risk factor for colon cancer. Some studies have also suggested that a diet high in fiber and a lifestyle that includes moderate exercise are helpful in preventing the disease. Be aware of symptoms and getting recommended screenings are key factors in prevention of the disease.
After speaking to family members and gathering your family health history, speak to your primary care provider about ways to improve your diet and lifestyle to prevent colon cancer and about scheduling preventative screenings when necessary. A healthy lifestyle and healthy body weight is important for prevention of all cancers.

Screening

• Men and women at average risk, screening should be done at least every two years starting at fifty years old with either FOBT (fecal occult blood test) or FIT (fecal immunochemical test). Positive FOBT or FIT tests should be followed up with a colonoscopy.
• Screening has the potential to prevent colorectal cancer because polyps found in the colon (precursors to cancer) can be removed during a colonoscopy screening. Furthermore, being screened at the recommended frequency increases the likelihood that when colorectal cancer is present, it will be detected at an earlier stage and is more likely to be treatable and curable.

Table 2: Canadian Colon Screening Guidelines

chart 2 EN

Genetics

Tests have been developed that look at the activity of many different genes in colon cancer tumors. These tests can be used to help predict which patients have a higher risk that the cancer will spread.

Lynch Syndrome (see also previous section of genetic alterations)

Lynch syndrome is a mutation of a gene that is responsible for fixing errors in your DNA. Lynch Syndrome, also known as hereditary nonpolyposis colon cancer (HNPCC), is an hereditary disorder caused by a genetic mutation in which affected individuals have a higher than normal chance of developing colorectal cancer, endometrial cancer, and various other types of aggressive cancers, often at a young age. To prevent colorectal cancer, people with Lynch Syndrome should undergo a colonoscopy every 1-2 years, starting in their twenties. Doing this will reduce the risk of colorectal cancer by 77%.

People with Lynch syndrome have a mutation of the MMR gene, which means their bodies are less able to fix errors in the DNA. Consequently, a person with Lynch syndrome is more likely to get certain types of cancer. Lynch syndrome increases the risk of getting colorectal cancer by 80 percent and endometrial cancer by 60 percent. Lynch syndrome may also lead to other cancers, such as small bowel and stomach cancer. Lynch syndrome accounts for 2- 4% of all colorectal cancer cases.

Treatments and Effects

1. Newer surgery techniques:

Surgeons are continuing to improve their techniques for operating on colorectal cancers. They now have a better understanding of what makes colorectal surgery more likely to be successful.
Laparoscopic surgery is done through several small incisions in the abdomen instead of one large one, and it’s becoming more widely used for some colon cancers. This approach usually allows patients to recover faster, with less pain after the operation. Laparoscopic surgery is also being studied for treating some rectal cancers, but more research is needed to see if it as effective as standard surgery.

With robotic surgery, a surgeon sits at a control panel and operates very precise robotic arms to perform the surgery. This type of surgery is also being studied.

2. Chemotherapy:

Different approaches are being tested in clinical trials, including:

• Five most common chemotherapy drugs: 5-fluorouracil (Adrucil, 5-fu), capecitabine (Xeloda), oxaliplatin (Eloxatin), and irinotecan (Camptosar).
• Combination of drugs known to be active against colorectal cancer, such as irinotecan and oxaliplatin, improve their effectiveness.
• Combination of chemotherapy with radiation therapy, targeted therapies, and/or immunotherapy.

3. Targeted therapy:

Several targeted therapies are already used to treat colorectal cancer, including bevacizumab (Avastin), cetuximab (Erbitux), and panitumumab (Vectibix). Doctors continue to study the best way to give these drugs to make them more effective.

Targeted therapies are currently used to treat advanced cancers, but newer studies are trying to determine if using them with chemotherapy in earlier stage cancers as part of adjuvant therapy may further reduce the risk of recurrence.

4. Immunotherapy:

Researchers are studying several vaccines to try to treat colorectal cancer or prevent it from coming back after treatment. Unlike vaccines that prevent infectious diseases, these vaccines are meant to boost the patient’s immune reaction to fight colorectal cancer more effectively.

Because cancer treatments may damage healthy cells and tissues, side effects are common. Side effects depend mainly on the type and extent of the treatment. While many effects may be the same, there are some unique challenges those diagnosed and going through treatment under age 50 may encounter, including:

• Relationships with family and friends
• Impact on young children
• Dating issues
• Infertility issues
• Intimacy issues
• Career/workplace issues
• Financial issues
• Psychological issues

References

1. Ahnen et al. (2014). The Increasing Incidence of Young-Onset Colorectal Cancer: A Call to Action. Mayo Clinic.
2. McKay et al. (2014). Does young age influence the prognosis of colorectal cancer: a population-based analysis. World of Surgical Oncology.
3. Patel, P. & De, P. (2016). Trends in colorectal cancer incidence and related lifestyle risk factors in 15-49-year-olds in Canada, 1969-2010. Cancer Epidemiology.
4. Stigliano et al. (2014). Early-Onset Colorectal Cancer: A Sporadic or Inherited Disease? World Journal of Gastroenterology.
5. Alive And Kickn. (2015). http://aliveandkickn.org/
6. Canadian Cancer Society. (2016). http://www.cancer.ca/en/?region=on
7. Colon Cancer Alliance. (2016). http://www.ccalliance.org/
8. Colon Cancer Coalition. (2016). http://coloncancercoalition.org/
9. Colorectal Cancer Association of Canada. (2016). http://www.colorectal-cancer.ca/en/
10. Fight Colorectal Cancer. (2016). http://fightcolorectalcancer.org/
11. Present and Future Directions in Research. (2013). Michael’s Mission. http://www.michaelsmission.org/
12. Stop Colon Cancer Now. (2014). http://stopcoloncancernow.com/
13. What you need to know about your colon. (2013). Colon Cancer Challenge Foundation. http://www.coloncancerchallenge.org/

Werner Muehlemann – Survivor and Advocate for Change!

Werner Muehlemann

“At 28 years-old, I went to see my doctor about a problem I was having. He told me that I had nothing to worry about because I was young and in good shape. Following a few tests, I was diagnosed with colorectal cancer. In that moment, I saw my life flash before my eyes – my career and dreams of getting married and starting a family vanishing.

The CCAC helped me acquire all the information that I needed to understand my treatments to follow in the months ahead and ultimately beat colorectal cancer. The CCAC also helped my family get the information they needed to support me in my long journey. Today, nine years later, I have three children with the same woman and I survived this cancer. And for the first a few years ago, I was able to complete my marathon.

Werner now serves on the Board of Directors at the CCAC and advocates on behalf of   all the work that we do in order to beat this terrible disease.

Werner now serves on the Board of Directors at the CCAC and advocates on behalf of all the work that we do in order to beat this terrible disease.

My dream for the future is that colorectal cancer screening becomes as routine as going to the dentist.”

In the spirit of Young Survivors Week, the CCAC has compiled a series of survivor stories to offer hope, instill courage and inspire change. We continue to share new stories every day. If you would like to share yours, please send it to isabellan@colorectal-cancer.ca.

RECENT STUDIES SHOW COLORECTAL CANCER DOES NOT AGE DISCRIMINATE. YOU’RE NEVER TOO YOUNG TO BE AWARE & PREPARED

RECENT STUDIES SHOW COLORECTAL CANCER DOES NOT AGE DISCRIMINATE. YOU’RE NEVER TOO YOUNG TO BE AWARE & PREPARED

butt pic Reports from across Canada show doctors are observing a new trend in colorectal cancer that cannot be ignored nor explained – a “rapid increase” in the number of patients being diagnosed under age 50.
A new study, led by doctors from the University of Toronto, looked at Canadian Cancer Registry data from 1997 to 2010 and found that incidences of colorectal cancer rose by:

• 0.8 per cent per year for people in their 40s,
• 2.4 per cent per year for people in their 30s, and
• 6.7 per cent per year for those between ages 15 and 29.

Thankfully awareness campaigns and advocacy to increase the accessibility of colorectal cancer screening has been responsible for declining rates in people over 50 in the last few years. However, these new reports are a reminder that there is still so much more work to be done.

This year, the CCAC was proud to join forces with the Never Too Young Coalition (N2Y), a branch of Colon Cancer Alliance. Their mandate, like ours, is to raise awareness about the disease, preventative screening and to provide much needed information to the younger Canadian population about the signs and symptoms of the disease, particularly how to avoid a misdiagnosis, which according to studies is occurring more frequently due to the age shift.

Although it is evident that more research is needed to determine the cause of this age shift, we are encouraging doctors and patients to become more vigilant and conscience as the signs and symptoms of colon cancer can often be mistaken for other, less serious issues. The longer it takes for a diagnosis the harder it is treat, which is key in survival.

Risk factors for colon cancer

The fact that incidence is rising only among younger people suggests “lifestyle” factors are at play, but the evidence of this is not concrete. Pay attention to your body and if you have any of these risk factors, talk to your doctor – take charge of your health!

• Family history of colon cancer or polyps: First and second degree relatives of a person with a history of colon cancer and polyps are more likely to develop this disease, especially if the relative had the cancer at a young age
• Genetic Alterations: Changes in certain genes increase your risk of colon cancer. Those with syndromes like hereditary nonployposis colon cancer (HNPCC or Lynch Syndrome) or Familial Adenomatous Polyposis (FAP) should be screened earlier than 50
• Ulcerative Colitis and Crohn’s disease
• African Americans should be screened starting at age 45, or sooner if you have other risk factors or symptoms
• Lifestyle factors, like eating processed and red meats, a lack of dietary fibre, a lack of physical exercise, obesity, alcohol, smoking, diabetes and genetics

June 5-11 will mark the second annual “Young Survivors Week,” connecting with patients, survivors, and caregivers to create buzz around young onset colon cancer. Join us and N2Y as we spread the word via social media by sharing stories and information to help others understand that IT can happen to anyone.

Get Into The Active Groove: The Colorectal Cancer Association Hosts It’s Third Annual Sortez! Bougez! This June

Physical activity provides many health benefits, such as getting or maintaining a healthy body weight and reducing the risk of colon cancer and many other diseases.

That’s why on Saturday, June 20th, The Colorectal Cancer Association (CCAC), The Dairy Farmers of Canada and U.N.I.Training, have joined forces to host the third Annual Sortez! Bougez!/ Get Out There and Move fitness event to promote the importance of physical activity.

Whether you’re a fitness guru or a beginner looking for a place to kick start your new past time, this event on the Lachine Canal is the place to be. Rain or shine, participants will partake in the CCAC’s endurance, adaptable to all fitness levels.

The challenge, should you choose to accept it, is to take part in four 45 minutes classes showcasing different forms of group training; Zumba, Kickboxing, Boot Camp and Yoga.

This taster pack of physical activity costs participants $30 to register and includes snacks, lunch and beverages throughout the day, which runs from 9:00 AM – 2:00 PM. Any additional sponsorship or doantions will receive a tax receipt. Proceeds will be donated to the CCAC.

“The importance of physical activity cannot be emphasized enough. In today’s society that is moving towards a more sedentary lifestyle, there is a greater need than ever to increase one’s daily activity level to maintain optimal health and prevent future illness. This event is designed to remind people of that and to introduce them to a new way of thinking. We hope to see you there!” Said Barry Stein, CCAC president.

For more information or to join the fitness revolution, visit www.sortezbougez.ca.

FDA fast-tracks Taiho Oncology’s TAS-102 for Colorectal Cancer

Otsuka

The US Food and Drug Administration has granted Fast Track designation for TAS-102 (trifluridine and tipiracil hydrochloride), an oral combination anticancer drug under investigation by Taiho Oncology, a unit of Japanese drugmaker Otsuka (TYO: 4768).

The New Drug Application is for the treatment of refractory metastatic colorectal cancer (mCRC), and the company has initiated a rolling NDA submission to the FDA. According to the American Cancer Society, an estimated 136,830 people will be diagnosed with, and 50,310 people will die from, cancer of the colon or rectum during 2014 in the USA.

“We are pleased that TAS-102 has been granted Fast Track designation,” said Fabio Benedetti, senior vice president and chief medical officer at Taiho Oncology, adding: “Patients with metastatic colorectal cancer, whose disease has progressed after treatment with standard therapies, have limited treatment options to manage their disease. We have initiated our rolling NDA submission to the FDA, and are committed to submitting the rest of the filing as efficiently as possible.”

The results from the Phase III RECOURSE trial of TAS-102 in 800 patients affected with mCRC, whose disease had progressed after or who were intolerant to standard therapies, are the foundation for Taiho Oncology’s NDA submission to the FDA.

Taiho Oncology, Otsuka, TAS-102, Fast-track designation, USA, FDA, Colorectal cancer, NDA

 

Calcium, Vitamin D, Dairy Products, and Mortality Among Colorectal Cancer Survivors

Calcium, Vitamin D, Dairy Products, and Mortality Among Colorectal Cancer Survivors: The Cancer Prevention Study-II Nutrition Cohort

Yang B, McCullough ML, Gapstur SM, et al

J Clin Oncol. 2014;32:2335-2343

Study Summary

Diet and lifestyle changes may play an important role in cancer pathogenesis. Yang and fellow American Cancer Society investigators analyzed the role of calcium, vitamin D, and dairy product intake before and after diagnosis of nonmetastatic colorectal cancer. The study population comprised 2284 participants in a prospective cohort study.

In multivariate analysis, post-diagnosis total calcium intake was inversely associated with all-cause mortality (relative risk [RR] for those in the highest relative to the lowest quartiles, 0.72; 95% confidence interval [CI], 0.53-0.98; Ptrend = .02). An inverse association with all-cause mortality was also observed for postdiagnosis milk intake (RR, 0.72; 95% CI, 0.55-0.94; Ptrend = .02), but not for vitamin D intake. Prediagnosis intakes were not associated with mortality.

Viewpoint

Diet and modifiable lifestyle factors are important issues for survivors of localized colorectal cancer. Unfortunately, randomized trials in this setting are difficult to conduct, require prolonged follow-up, and may not be able to control for all lifestyle factors. Therefore, data from well-conducted prospective cohort studies may be good enough to make recommendations to patients.

This study suggests that increased milk and calcium intake is associated with improved outcomes. Limitations include the primarily white study population with known higher rates of lactase persistence; in addition, the lack of association with vitamin D intake is inconsistent with prior reports.[1] Increased milk and calcium intake, along with reduced red meat intake and regular exercise, can be discussion points for survivors of colorectal cancer interested in modifiable lifestyle risk factors.

Abstract

Avec de la viande rouge, mangez des pommes de terre froides

 

Avec de la viande rouge, mangez des pommes de terre froides 

La consommation (excessive) de viande rouge est associée à un risque accru de cancer du côlon. Il s’avère qu’une série d’aliments peuvent atténuer cet effet.

Le premier message, c’est qu’il est important de limiter ses apports en viande rouge : 300 g par semaine, et en tout cas pas plus de 500 g, si possible en choisissant des coupes maigres et en retirant le gras avant la cuisson. Et donc, expliquent ces chercheurs de l’université Flinders (Australie), il est utile d’accompagner sa viande d’aliments riches en fibres (cela on le savait) et en amidon résistant.

Cet amidon présente la particularité de ne pas être (pré)digéré par l’estomac et par l’intestin grêle et dès lors d’arriver intact dans le gros intestin, où il va produire des substances bénéfiques appelées acides gras à chaîne courte. L’équipe australienne a conduit une expérience sur des volontaires adultes et a pu démontrer que l’amidon résistant contrait l’apparition de molécules néfastes liées à la viande rouge.

Comme sources alimentaires, on mentionnera les légumineuses (en particulier les haricots, les pois chiches et les lentilles), les grains entiers (blé, maïs, riz…), les bananes assez vertes, ainsi encore que les pommes de terre cuites et refroidies. Cela ne signifie évidemment pas que la viande rouge peut alors être consommée à volonté, mais que des apports réguliers d’aliments riches en amidon résistant – et en fibres, encore trop négligées ! – peuvent avoir un effet protecteur très intéressant contre le cancer colorectal.

publié le : 21-10-2014

Source: Cancer Prevention Research (http://cancerpreventionresearch.aacrjournals.org)

Boehringer Ingelheim Global Phase III study in patients with Metastatic Colorectal Cancer (mCRC).

Tue, 10/21/2014 – 8:30am

Colorectal cancer is the third most common cancer in the world, with nearly 1.4 million new cases diagnosed each year. Prognosis is very poor for patients with mCRC with fewer than 10% surviving for more than five years after diagnosis.

LUME-COLON 1 [ClinicalTrials.gov identifier: NCT02149108] is a double-blind, randomized, placebo-controlled study designed to evaluate the safety and efficacy of nintedanib plus best supportive care (BSC), versus placebo plus BSC, after previous treatment with standard chemotherapy and biological agents. This new study will build on previous Phase I/II studies evaluating nintedanib in mCRC.
Nintedanib is an investigational compound in mCRC; its safety and efficacy have not been established.

“Based on previous clinical studies with nintedanib, BI will initiate the LUME-COLON 1 study to evaluate this compound as a potential treatment option for patients with refractory colorectal cancer,” said Berthold Greifenberg, M.D., vice president, Clinical Development and Medical Affairs, Oncology, Boehringer Ingelheim Pharmaceuticals, Inc.

“Patient needs are the driving force behind BI’s innovation in cancer research, and the initiation of this global Phase III study represents our commitment to addressing a critical need in the colorectal cancer community.”

L’analyse de sang, piste d’avenir pour le soin

SOPHIE GUIRAUD

Cancer : l’analyse de sang, piste d’avenir pour le soin 
Marc Ychou et Alain Thierry, partenaires de la start-up DiaDx.

CHRISTOPHE FORTIN

Alain Thierry a mis au point une “biopsie liquide” présentée jeudi au congrès international d’oncologie digestive à Montpellier.

Il y a six mois, il a eu les honneurs de la revue scientifique Nature Medicine : pour la première fois, un chercheur montrait l’intérêt d’une “biopsie liquide”, qui consiste, depuis un échantillon sanguin, à rechercher des mutations génétiques dans l’ADN pour traiter les cancers colorectaux. Depuis, l’idée a fait du chemin. Ce jeudi, Alain Thierry, chercheur Inserm à l’institut de recherche en cancérologie de Montpellier (IRCM), a présenté ses travaux à la conférence internationale d’oncologie digestive organisée jusqu’à samedi au Corum. Le concept est aujourd’hui expérimenté dans une quinzaine de centres en France. Une start-up a été créée. Un développement est envisageable à l’horizon 2016.

Une prise de sang plutôt qu’une biopsie

Explications : “Toutes les cellules relarguent de l’ADN dans le sang, l’ADN circulant”, indique le chercheur. Que se passe-t-il chez un malade ? “Quand une personne a un cancer, l’ADN circulant est relargué en plus grande quantité. C’est un biomarqueur intéressant pour analyser la tumeur. Le test sanguin que nous avons mis au point évite de faire une biopsie pour accéder à des informations capitales dans les choix thérapeutiques à venir. On recherche des mutations génétiques qui, si elles sont présentes, rendent inefficaces un traitement par anticorps”, décrypte Alain Thierry.

Pionnier allemand

L’Allemand Klaus Pantel (CHU de Hambourg), pionnier et expert de l’étude des cellules tumorales circulantes, sera à Montpellier du 14 au 16 octobre 2014 pour une formation de la communauté scientifique et médicale. Il donnera un cours du master international “Cancer Biology” coordonné par le docteur Catherine Panabières, du CHU de Montpellier. Les deux établissements (CHU de Montpellier et de Hambourg) sont associés sur un projet européen de détection des cellules tumorales circulantes dans le cancer de la prostate.

18 000 décès du cancer colorectal par an en France

La méthode a plusieurs avantages : “On gagne du temps, avec un résultat obtenu en 48 h plutôt qu’en un mois. Le test est moins invasif, plus précis, moins coûteux.” L’histoire est loin d’être terminée : “On est dans un programme de recherche clinique”, précise le professeur Marc Ychou, de l’ICM (Institut régional du cancer de Montpellier), associé à Alain Thierry au sein de la start-up DiaDx. Le potentiel est conséquent. Le cancer colorectal touche 40 000 nouveaux patients par an en France, pour 18 000 décès. Enfin, précisent le chercheur et le médecin, “le test est adaptable aux cancers solides comme le sein et le poumon”.

Training Dogs to Sniff Out Cancer

 

Training Dogs to Sniff Out Cancer

By 

 September 11, 2014 2:50 pmoto

McBaine, a cancer detection dog.Credit Penn Vet Working Dog Center

PHILADELPHIA — McBaine, a bouncy black and white springer spaniel, perks up and begins his hunt at the Penn Vet Working Dog Center. His nose skims 12 tiny arms that protrude from the edges of a table-size wheel, each holding samples of blood plasma, only one of which is spiked with a drop of cancerous tissue.

The dog makes one focused revolution around the wheel before halting, steely-eyed and confident, in front of sample No. 11. A trainer tosses him his reward, a tennis ball, which he giddily chases around the room, sliding across the floor and bumping into walls like a clumsy puppy.

McBaine is one of four highly trained cancer detection dogs at the center, which trains purebreds to put their superior sense of smell to work in search of the early signs of ovarian cancer. Now, Penn Vet, part of the University of Pennsylvania’s School of Veterinary Medicine, is teaming with chemists and physicists to isolate cancer chemicals that only dogs can smell. They hope this will lead to the manufacture of nanotechnology sensors that are capable of detecting bits of cancerous tissue 1/100,000th the thickness of a sheet of paper.

“We don’t ever anticipate our dogs walking through a clinic,” said the veterinarian Dr. Cindy Otto, the founder and executive director of the Working Dog Center. “But we do hope that they will help refine chemical and nanosensing techniques for cancer detection.”

Since 2004, research has begun to accumulate suggesting that dogs may be able to smell the subtle chemical differences between healthy and cancerous tissue, including bladder cancer, melanomaand cancers of the lung, breast and prostate. But scientists debate whether the research will result in useful medical applications.

Photo

Trainers tend to notice early on that certain dogs have natural talents that make them better suited for specific kinds of work.Credit Penn Vet Working Dog Center.

Dogs have already been trained to respond to diabetic emergencies, or alert passers-by if an owner is about to have a seizure. And on the cancer front, nonprofit organizations like the In Situ Foundation, based in California, and the Medical Detection Dogs charity in Britain are among a growing number of independent groups sponsoring research into the area.

A study presented at the American Urological Association’s annual meeting in May reported that two German shepherds trained at the Italian Ministry of Defense’s Military Veterinary Center in Grosseto were able to detect prostate cancer in urine with about 98 percent accuracy, far better than the prostate-specific antigen (PSA) test. But in another recent study of prostate-cancer-sniffing dogs, British researchers reported that promising initial results did not hold up in rigorous double-blind follow-up trials.

Dr. Otto first conceived of a center to train and study working dogs when, as a member of the Federal Emergency Management Agency’s Urban Search and Rescue Team, she was deployed to ground zero in the hours after the Sept. 11 attacks.

“I remember walking past three firemen sitting on an I-beam, stone-faced, dejected,” she says. “But when a handler walked by with one of the rescue dogs, they lit up. There was hope.”

Today, the Working Dog Center trains dogs for police work, search and rescue and bomb detection. Their newest canine curriculum, started last summer after the center received a grant from the Kaleidoscope of Hope Foundation, focuses on sniffing out a different kind of threat: ovarian cancer.

“Ovarian cancer is a silent killer,” Dr. Otto said. “But if we can help detect it early, that would save lives like nothing else.”

Dr. Otto’s dogs are descended from illustrious lines of hunting hounds and police dogs, with noses and instincts that have been refined by generations of selective breeding. Labradors and German shepherds dominate the center, but the occasional golden retriever or springer spaniel — like McBaine — manages to make the cut.

The dogs, raised in the homes of volunteer foster families, start with basic obedience classes when they are eight weeks old. They then begin their training in earnest, with the goal of teaching them that sniffing everything — from ticking bombs to malignant tumors — is rewarding.

“Everything we do is about positive reinforcement,” Dr. Otto said. “Sniff the right odor, earn a toy or treat. It’s all one big game.”

Trainers from the center typically notice early on that certain dogs have natural talents that make them better suited for specific kinds of work. Search and rescue dogs must be tireless hunters, unperturbed by distracting environments and unwilling to give up on a scent – the equivalent of high-energy athletes. The best cancer-detection dogs, on the other hand, tend to be precise, methodical, quiet and even a bit aloof — more the introverted scientists.

“Some dogs declare early, but our late bloomers frequently switch majors,” Dr. Otto said.

Handlers begin training dogs selected for cancer detection by holding two vials of fluid in front of each dog, one cancerous and one benign. The dogs initially sniff both but are rewarded only when they sniff the one containing cancer tissue. In time, the dogs learn to recognize a unique “cancer smell” before moving on to more complex tests.

What exactly are the dogs sensing? George Preti, a chemist at the Monell Chemical Senses Center in Philadelphia, has spent much of his career trying to isolate the volatile chemicals behind cancer’s unique odor. “We have known for a long time that dogs are very sensitive detectors,” Dr. Preti says. “When the opportunity arose to collaborate with Dr. Otto at the Working Dog Center, I jumped on it.”

Dr. Preti is working to isolate unique chemical biomarkers responsible for ovarian cancer’s subtle smell using high-tech spectrometers and chromatographs. Once he identifies a promising compound, he tests whether the dogs respond to that chemical in the same way that they respond to actual ovarian cancer tissue.

“I’m not embarrassed to say that a dog is better than my instruments,” Dr. Preti says.

Photo

The dogs, raised in the homes of volunteer foster families, begin their training at 8 weeks of age, starting with basic obedience classes.Credit Penn Vet Working Dog Center.

The next step will be to build a mechanical, hand-held sensor that can detect that cancer chemical in the clinic. That’s where Charlie Johnson a professor at Penn who specializes in experimental nanophysics, the study of molecular interactions between microscopic materials, comes in.

He is developing what he calls Cyborg sensors, which include biological and mechanical components – a combination of carbon nanotubes and single-stranded DNA that preferentially bond with one specific chemical compound. These precise sensors, in theory, could be programmed to bind to, and detect, the isolated compounds that Dr. Otto’s dogs are singling out.

“We are effectively building an electronic nose,” said Dr. Johnson, who added that a prototype for his ovarian cancer sensor will probably be ready in the next five years.

Some experts remain skeptical.

“While I applaud any effort to detect ovarian cancer, I’m uncertain that this research will have any value,” said Dr. David Fishman, a gynecologic oncologist at Mount Sinai Hospital in New York City. One challenge, he notes, is that any cancer sensor would need to be able to detect volatile chemicals that are specific to one particular type of cancer.

“Nonspecificity is where a lot of these sort of tests fail,” Dr. Fishman said. “If there is an overlap in volatile chemicals — between colon, breast, pancreatic, ovarian cancer — we’ll have to ask, ‘What does this mean?’ ”

And even if sensors could be developed that detect ovarian cancer in the clinic, Dr. Fishman says, he doubts that they would be able to catch ovarian cancer in its earliest, potentially more treatable, stages.

“The lesions that we are discussing are only millimeters in size, and almost imperceptible on imaging studies,” Dr. Fishman says. “I don’t believe that the resolution of the canine ability will translate into value for these lesions.”

McBaine remains unaware of the debate. After correctly identifying yet another cancerous plasma sample, he pranced around the Working Dog Center with regal flair, showing off his tennis ball to anyone who would pay attention. In an industry saturated with hundreds of corporations and thousands of scientists all hunting for the earliest clues to cancer, working dogs are just another set of (slightly furrier) researchers.