Unhealthy substance use a risk factor for not receiving some preventive health services, study finds

ScienceDaily (May 13, 2011) — Researchers from Boston Medical Center (BMC) and Boston University School of Medicine (BUSM) have identified unhealthy substance use as a risk factor for not receiving all appropriate preventive health services. The findings, which currently appear in BMJ Open, identify unhealthy substance use as a barrier to completion of mammography screening and influenza vaccination.

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Cancer and influenza are among the leading causes of mortality in the United States. Influenza is preventable, in part, through vaccination, and mortality from cervical, breast and colorectal cancer can be reduced through routine screening. Nevertheless, many eligible U.S. adults do not receive these recommended preventive services, in particular, low-income persons, racial and ethnic minorities, the uninsured and the foreign-born.

Despite this knowledge, and the implementation of interventions targeting these groups, preventive services are still underused, which has led some to believe that high-risk "pockets" of the population may account for gaps in service receipt.

"Persons with unhealthy substance use (for alcohol, the spectrum that ranges from risky use to dependence; for drugs, the spectrum from any illicit drug use, including prescription drugs to dependence), represent one such "pocket," said lead author Karen Lasser, MD, MPH, a primary care physician at BMC as well as an associate professor of medicine at BUSM.

The researchers analyzed data from 4,804 women eligible for mammograms, 4,414 eligible for Papanicolou (Pap) smears, 7,008 persons eligible for colorectal cancer (CRC) screenings, and 7,017 persons eligible for influenza vaccination. All patients were screened for unhealthy substance use.

Among the nearly 10,000 patients eligible for one or more of the preventive services of interest, 10 percent screened positive for unhealthy substance use. Compared to women without unhealthy substance use, women with unhealthy substance use received mammograms less frequently (75.4 percent vs. 83.8 percent), but Pap smears no less frequently (77.9 percent vs. 78.1 percent). Persons with unhealthy substance use received CRC screenings no less frequently (61.7 percent vs. 63.4 percent), yet received influenza vaccination less frequently (44.7 percent vs. 50.4 percent). "We speculate that persons with unhealthy substance use who are not engaged in primary care at the high thresholds used in these analyses may have substantially lower receipt of preventive services," said Lasser.

According to the researchers future interventions to promote mammography screening might target women with unhealthy substance use, and those to promote influenza vaccination might target both men and women with unhealthy substance use. "Clinical interventions could embed mammography screening and influenza vaccination in other services delivered to individuals with substance use problems. In addition, training interventions could enhance skills and systems for health care personnel who screen for substance use disorders to include referrals for preventive health services," she added.

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New test targets Lynch syndrome, a risk factor for colon cancer

ScienceDaily (May 18, 2011) — Mayo Clinic has developed a screening procedure that could dramatically increase testing for Lynch syndrome, a hereditary genetic disorder that raises cancer risk, particularly for colorectal cancer. An estimated 3 percent of colon cancers can be attributed to Lynch syndrome. At least 80 percent of people with Lynch syndrome develop colorectal cancer, many of them before age 50.

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In the past, as few as 50 percent of patients who fit the profile for possible Lynch syndrome were tested before or after surgery. Now, a group of Mayo Clinic researchers has developed and tested a protocol that could raise the level of testing to nearly 90 percent, helping doctors make important decisions on the timing and delivery of care for patients with the disease. Their findings were presented at The American Society of Colon and Rectal Surgeons Annual Scientific Meeting, May 14-18, 2011 in Vancouver, British Columbia, Canada.

Mayo Clinic researchers in 2003 started testing all newly diagnosed colorectal cancers in patients under 50. Biopsies of the cancers were sent to pathologists, who conducted Microsatellite Instability (MSI) testing on them. MSI testing looks for certain mutations in genes that repair DNA by testing 10 different DNA markers for irregularities. Patients categorized in the "high" group for microsatellite instability were offered additional testing for Lynch syndrome and genetic counseling.

Over the five-year study, 210 of 258 newly diagnosed patients under age 50 who underwent colorectal cancer surgery at MCR had the MSI testing. Of those, 13 percent had MSI-H tumors. Overall, 88 percent of the high-risk group had tests, and the protocol caught 11 percent of MSI-H tumors that would have otherwise been missed.

"Probably the most significant result of this research is that it has stimulated our multidisciplinary team of geneticists, pathologists, gastroenterologists and surgeons to develop new clinical pathways that will direct patients at risk to providers experienced with management of Lynch Syndrome," says Eric Dozois, M.D. who has organized the multidisciplinary Young Onset Working Group and is the lead researcher on this project. This ensures appropriate evaluation and genetic and surgical counseling before critical treatment decisions are made, thus allowing patients and referring physicians to be fully informed regarding options for treatment, especially risks and benefits.

"The benefit of this testing to the patient and their family is huge," says research fellow Rajesh Pendlimari, M.B.B.S. "If they have Lynch syndrome and will, therefore, be more prone to getting cancer, they can get screened more regularly. Plus, with it being a hereditary condition, family members can also get tested." As a result of this testing, cancer may be caught earlier and physicians may be more proactive in treatment. The testing should be done before surgery, because a diagnosis may change the course of treatment. Testing after surgery also is beneficial; the knowledge gleaned can affect future care for patients and their families.

The study's other researchers are Noralane Lindor, M.D.; Stephen Thibodeau, Ph.D.; Thomas Smyrk, M.D.; David Larson, M.D.; Robert Cima, M.D.; Lisa Boardman, M.D.; Nancy You, M.D.; and Jennifer Wang, M.D.

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