- Email: [email protected]
Breaking the Barriers to Colorectal Cancer Screening
Gastroenterology News Anil K. Rustgi, M.D., Section Editor
NIDDK Names IBD Expert Digestive Diseases Director he NIDDK deputy director Dr. Stephen P. James (Figure 1) has been appointed director of the institute’s division of digestive diseases and nutrition, DDN. James, the division’s deputy director since 2001, is a leader in the field of inflammatory bowel disease research. He previously headed the gastroenterology division at the University of Maryland School of Medicine. Dr. Allen M. Spiegel says James is both an outstanding clinician and researcher who has “shown himself to be a highly capable administrator well.” James first came to NIH in 1977 as a medical staff fellow in the liver diseases section of NIDDK, where he studied hepatic disease immunology. He furthered his training at the National Cancer Institute in the early 1980s and became a senior investigator in the National Institute of Allergy and Infectious Diseases laboratory of clinical investigation until 1991, where he focused on immunological features of IBD. James says NIDDK funds about one-third of all digestive disease research from the NIH and that the majority of that comes from DDN. Legislation that created NIDDK mandates that the institute sponsor broad research in alimentary, liver and pancreatic disease, the normal fundamental biology of the gastrointestinal tract, nutrition research and, increasingly, research in obesity and obesity prevention.
T
Breaking the Barriers to Colorectal Cancer Screening espite the great strides made to encourage colorectal cancer screening and successful public
D
GASTROENTEROLOGY 2004;126:1232–1233
“In terms of supporting a research program, the majority of what the division does is provide grant in aid, or grants to investigators around the country,” James notes. “We also support career development grant awards of various types and training programs for both M.D. and Ph.D. scientists.” In addition, the division supports 16 digestive disease research centers and 12 centers for obesity or obesity and nutrition research. DDN also supports conferences, including NIH consensus conferences in partnership with the director’s office. “And we also have a responsibility to provide public information of digestive diseases, which we do largely through a Web site that provides this information to the general public,” James adds. James points out that the period of NIH budget doubling enabled DDN to put in place many new research programs, including the creation of multicenter projects, including the
Stephen James, M.D.
awareness campaign credited with increasing colonoscopy rates by as much as 20%, one of the major barriers to improved patient compliance is the confusion surrounding insurance coverage for preventative tests.
HALT-C trial on the long-term consequences of hepatitis C. “We have a research network to study nonalcoholic steatohepatitis (NASH). We have a consortium of geneticists to study the genetics of IBD, and there are many more examples of special projects we were able to put in place with the doubling money.” The newest of these is a consortium to study the long-term effects of bariatric surgery “and to try to understand the mechanisms of weight loss and the amelioration of some of the morbidities of obesity that occur with this type of surgery.” According to James, the recent program of cross-cutting initiatives called the NIH Roadmap “sets the tone” for some of the endeavors NIH is interested in doing broadly. “Within the institute we are interested in doing things that will complement, take advantage of and further expand these Roadmap initiatives in terms of digestive diseases-oriented or mission-specific types of activities. And we’re also very interested in trying to enhance translation of fundamental research discoveries, to bring them to the bedside as new therapies and diagnostic tests.” Says Spiegel of James, “Given the complexity of science in the 21st century and our need to foster interdisciplinary research, I can think of no one better to lead the division.” The new DDN director says he welcomes communications from the gastroenterology community regarding research ideas. “Send me an e-mail,” James offers. Contact him at [email protected].
Unfortunately, there is no Federal legislation that requires insurance providers to cover preventative screenings for colorectal cancer. But in recent years, a handful of states have passed legisla-
Gastroenterology News continued
tion designed to encourage screenings. In response to patient and physician uncertainties of whether or not insurance will pick up the tab for colorectal cancer tests, the Entertainment Industry Foundation’s National Colorectal Cancer Research Alliance (EIF’s NCCRA) and the American Gastroenterology Association (AGA) have joined forces to create a report that clearly explains state laws governing insurance coverage for cancer screenings. “EIF’s NCCRA has teamed up with AGA to applaud those states with comprehensive healthcare protections, and reinforce our key message that preventative screening is the first step to beating colorectal cancer,” said Lisa Paulsen, president and CEO of the Entertainment Industry Foundation. “By recognizing states with exemplary legislation, our hope is that others will follow suit.” The 2004 Colorectal Cancer Legislation Report Card helps people make sense out of the varied and complex laws surrounding colorectal tests. An AGA Report Card Taskforce was assembled to determine the evaluation criteria and assign a grade (A–F) for every state in the union, including Washington D.C. Legislative research was collected from numerous public sources including: the National Cancer Institute’s (NCI) State Legislative Database, National Conference of State Legislatures, American Cancer Society (ACS), and Centers for Disease Control and Prevention. This first-of-its kind, on-line report (EIF.NCCRA.org) provides web links to actual legislation for current state laws. There is also a call-to-action for those states with failing grades. People can e-mail a prepared letter to their state’s Senate Health Commit-
tee Chair to petition for quality legislation. “We believe that colorectal cancer merits a higher priority in our nation’s public health agenda,” said J. Thomas Lamont, M.D., a member of AGA’s Report Card Taskforce. “If we can persuade more states to pass preventative screening legislation, our states have the potential to save billions of dollars spent annually to treat colorectal cancer and, most importantly, save thousands of lives.”
States That Make the Grade A total of 18 states received passing grades (A–C). In 2000, Virginia was the first state to adopt comprehensive colorectal cancer screening coverage that meets AGA and ACS guidelines, setting the standard for model legislation and receiving a grade “A” in this report. Since then, 12 states have followed its outstanding example, including: Connecticut, Georgia, Illinois, Indiana, Maryland, Missouri, Nevada, New Jersey, North Carolina, Rhode Island, Tennessee, Virginia, and Washington D.C. Another 3 states–Delaware, Texas, and West Virginia–received a “B” rating falling short because the law itself did not reference AGA or ACS. California and Wyoming squeezed by with passing grade of a “C” because legislation is vague and omits specifics on types of tests covered and age requirements for screening.
States That Fall Short Two-thirds of the country (34 states) remain without legislation. Among those states that failed, Oklahoma does have legislation but received a “D” because it only recommends
that coverage be offered, rather than required. Many of these same states have passed insurance provisions for other cancers. For instance, breast cancer advocates have made a tremendous impact overcoming a once taboo subject and have positively influenced patient behavior. As a result, 47 states now require insurers to cover breast cancer screenings. Today, NCI reports that compliance among women to receiving mammograms has increased to 70%, while compliance for colorectal cancer screening among women remains low (27%). Colorectal cancer has the second highest death rate in the United States. Although colorectal cancer is one of the most highly preventable cancers (90% curable with early detection), fewer states have passed preventative screening legislation for this disease when compared with other cancers with lower death rates. Similar legislative advancements have provided coverage for prostate screenings (26 states) and cervical cancer screenings (23 states) whose combined death rates are far below that of colorectal cancer. This year, 5 states: Alabama, Kansas, Kentucky, Mississippi, and Pennsylvania have introduced colorectal cancer screening bills within the 2004 legislative session. Hopefully, this report card will encourage more people living in those states to take action and vocalizing their support of this type of measure. To learn more about the 2004 Colorectal Cancer Legislation Report Card released by AGA and EIF’s NCCRA, please visit www.eif.nccra. org. Stories by Les Lang
1233
NIDDK Names IBD Expert Digestive Diseases Director he NIDDK deputy director Dr. Stephen P. James (Figure 1) has been appointed director of the institute’s division of digestive diseases and nutrition, DDN. James, the division’s deputy director since 2001, is a leader in the field of inflammatory bowel disease research. He previously headed the gastroenterology division at the University of Maryland School of Medicine. Dr. Allen M. Spiegel says James is both an outstanding clinician and researcher who has “shown himself to be a highly capable administrator well.” James first came to NIH in 1977 as a medical staff fellow in the liver diseases section of NIDDK, where he studied hepatic disease immunology. He furthered his training at the National Cancer Institute in the early 1980s and became a senior investigator in the National Institute of Allergy and Infectious Diseases laboratory of clinical investigation until 1991, where he focused on immunological features of IBD. James says NIDDK funds about one-third of all digestive disease research from the NIH and that the majority of that comes from DDN. Legislation that created NIDDK mandates that the institute sponsor broad research in alimentary, liver and pancreatic disease, the normal fundamental biology of the gastrointestinal tract, nutrition research and, increasingly, research in obesity and obesity prevention.
T
Breaking the Barriers to Colorectal Cancer Screening espite the great strides made to encourage colorectal cancer screening and successful public
D
GASTROENTEROLOGY 2004;126:1232–1233
“In terms of supporting a research program, the majority of what the division does is provide grant in aid, or grants to investigators around the country,” James notes. “We also support career development grant awards of various types and training programs for both M.D. and Ph.D. scientists.” In addition, the division supports 16 digestive disease research centers and 12 centers for obesity or obesity and nutrition research. DDN also supports conferences, including NIH consensus conferences in partnership with the director’s office. “And we also have a responsibility to provide public information of digestive diseases, which we do largely through a Web site that provides this information to the general public,” James adds. James points out that the period of NIH budget doubling enabled DDN to put in place many new research programs, including the creation of multicenter projects, including the
Stephen James, M.D.
awareness campaign credited with increasing colonoscopy rates by as much as 20%, one of the major barriers to improved patient compliance is the confusion surrounding insurance coverage for preventative tests.
HALT-C trial on the long-term consequences of hepatitis C. “We have a research network to study nonalcoholic steatohepatitis (NASH). We have a consortium of geneticists to study the genetics of IBD, and there are many more examples of special projects we were able to put in place with the doubling money.” The newest of these is a consortium to study the long-term effects of bariatric surgery “and to try to understand the mechanisms of weight loss and the amelioration of some of the morbidities of obesity that occur with this type of surgery.” According to James, the recent program of cross-cutting initiatives called the NIH Roadmap “sets the tone” for some of the endeavors NIH is interested in doing broadly. “Within the institute we are interested in doing things that will complement, take advantage of and further expand these Roadmap initiatives in terms of digestive diseases-oriented or mission-specific types of activities. And we’re also very interested in trying to enhance translation of fundamental research discoveries, to bring them to the bedside as new therapies and diagnostic tests.” Says Spiegel of James, “Given the complexity of science in the 21st century and our need to foster interdisciplinary research, I can think of no one better to lead the division.” The new DDN director says he welcomes communications from the gastroenterology community regarding research ideas. “Send me an e-mail,” James offers. Contact him at [email protected].
Unfortunately, there is no Federal legislation that requires insurance providers to cover preventative screenings for colorectal cancer. But in recent years, a handful of states have passed legisla-
Gastroenterology News continued
tion designed to encourage screenings. In response to patient and physician uncertainties of whether or not insurance will pick up the tab for colorectal cancer tests, the Entertainment Industry Foundation’s National Colorectal Cancer Research Alliance (EIF’s NCCRA) and the American Gastroenterology Association (AGA) have joined forces to create a report that clearly explains state laws governing insurance coverage for cancer screenings. “EIF’s NCCRA has teamed up with AGA to applaud those states with comprehensive healthcare protections, and reinforce our key message that preventative screening is the first step to beating colorectal cancer,” said Lisa Paulsen, president and CEO of the Entertainment Industry Foundation. “By recognizing states with exemplary legislation, our hope is that others will follow suit.” The 2004 Colorectal Cancer Legislation Report Card helps people make sense out of the varied and complex laws surrounding colorectal tests. An AGA Report Card Taskforce was assembled to determine the evaluation criteria and assign a grade (A–F) for every state in the union, including Washington D.C. Legislative research was collected from numerous public sources including: the National Cancer Institute’s (NCI) State Legislative Database, National Conference of State Legislatures, American Cancer Society (ACS), and Centers for Disease Control and Prevention. This first-of-its kind, on-line report (EIF.NCCRA.org) provides web links to actual legislation for current state laws. There is also a call-to-action for those states with failing grades. People can e-mail a prepared letter to their state’s Senate Health Commit-
tee Chair to petition for quality legislation. “We believe that colorectal cancer merits a higher priority in our nation’s public health agenda,” said J. Thomas Lamont, M.D., a member of AGA’s Report Card Taskforce. “If we can persuade more states to pass preventative screening legislation, our states have the potential to save billions of dollars spent annually to treat colorectal cancer and, most importantly, save thousands of lives.”
States That Make the Grade A total of 18 states received passing grades (A–C). In 2000, Virginia was the first state to adopt comprehensive colorectal cancer screening coverage that meets AGA and ACS guidelines, setting the standard for model legislation and receiving a grade “A” in this report. Since then, 12 states have followed its outstanding example, including: Connecticut, Georgia, Illinois, Indiana, Maryland, Missouri, Nevada, New Jersey, North Carolina, Rhode Island, Tennessee, Virginia, and Washington D.C. Another 3 states–Delaware, Texas, and West Virginia–received a “B” rating falling short because the law itself did not reference AGA or ACS. California and Wyoming squeezed by with passing grade of a “C” because legislation is vague and omits specifics on types of tests covered and age requirements for screening.
States That Fall Short Two-thirds of the country (34 states) remain without legislation. Among those states that failed, Oklahoma does have legislation but received a “D” because it only recommends
that coverage be offered, rather than required. Many of these same states have passed insurance provisions for other cancers. For instance, breast cancer advocates have made a tremendous impact overcoming a once taboo subject and have positively influenced patient behavior. As a result, 47 states now require insurers to cover breast cancer screenings. Today, NCI reports that compliance among women to receiving mammograms has increased to 70%, while compliance for colorectal cancer screening among women remains low (27%). Colorectal cancer has the second highest death rate in the United States. Although colorectal cancer is one of the most highly preventable cancers (90% curable with early detection), fewer states have passed preventative screening legislation for this disease when compared with other cancers with lower death rates. Similar legislative advancements have provided coverage for prostate screenings (26 states) and cervical cancer screenings (23 states) whose combined death rates are far below that of colorectal cancer. This year, 5 states: Alabama, Kansas, Kentucky, Mississippi, and Pennsylvania have introduced colorectal cancer screening bills within the 2004 legislative session. Hopefully, this report card will encourage more people living in those states to take action and vocalizing their support of this type of measure. To learn more about the 2004 Colorectal Cancer Legislation Report Card released by AGA and EIF’s NCCRA, please visit www.eif.nccra. org. Stories by Les Lang
1233