Colorectal cancer is the second leading cause of death from cancer in the United States, after lung cancer, yet many Americans are still loathe to be screened for the disease.

The U.S. Preventive Services Task Force strongly recommended adults ages 50 to 75 to be screened for colon cancer and suggested adults 76 to 85  make individual decisions about whether to be screened, depending on their overall health and prior screening history. The recommendation and several accompanying editorials were published Wednesay in the Journal of the American Medical Association (JAMA).

The independent body of national experts in prevention and evidence-based medicine emphasized colonoscopy is not the only valid test out there. There are multiple screening options available to the one-third of Americans over 50 who have never been screened.

We pose five key questions about the Task Force recommendations to Douglas K. Owens, the Henry J. Kaiser, Jr., Professor of Medicine at Stanford and director of the Center for Health Policy and Center for Primary Care and Outcomes Research. He is an author of the recommendation and was a member of the Task Force when the guidelines were developed.

What is the most significant finding of this final recommendation?

Colorectal cancer is the second leading cause of death from cancer in the United States. The good news is that evidence convincingly shows screening for colorectal cancer works. The Task Force strongly recommends screening adults 50 to 75 for colorectal cancer, as it reduces the risk of dying from the disease. Unfortunately, one-third of people 50 to 75 have never been screened, so we are missing an important opportunity to prevent deaths from colorectal cancer.

There are multiple screening options for colorectal cancer. What are they and how should individuals decide which is best for them?

What really matters is that people get screened. There are several options that are effective, so we recommend that people discuss the options with their clinician. There are direct visualization tests, like colonoscopy, and stool-based tests, like fecal immunochemical testing (FIT). Each test has different strengths and limitations, and people may prefer one approach over another. For example, colonoscopy can be done every 10 years, but FIT testing should be done every year. But the real message is, choose an approach in consultation with your clinician and get screened.

The Task Force found that once adults reach 76 years old, the benefits of screening become smaller and the potential for harm is greater. Why is this and how should older Americans determine which test is best for them?

We recommend individual decision making for patients 76 to 85. The benefits are smaller because a person’s chance of dying of other causes goes up as they get older. The harms are still small but increase with age, primarily because the risks of the potential complications of colonoscopy (bleeding, perforation, and infection) go up with age. Still, some people in this age group will benefit from screening. People most likely to benefit are those who have not been screened before, people who are healthy enough to undergo treatment for CRC should it be found, and people who do not have other diseases or conditions that limit their life expectancy substantially.

Owens explains the Task Force's recommendations to JAMA

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JAMA Network | JAMA | USPSTF Recommendation Statement: Screening for Colorectal Cancer

African-Americans have the highest incidence of and mortality rates from colorectal cancer among all racial and ethnic subgroups. Why are African-Americans more susceptible and does this mean that the screening recommendations differ for them?

The Task Force recognizes the burden that colorectal cancer has on African-Americans, who are at higher risk of being diagnosed with and dying from the disease than other racial/ethnic subgroups. We don’t know why this is — more research is needed in this area. The Task Force did not find enough evidence to conclusively support that making a different recommendation specific to African-Americans would result in a greater net benefit for this population. So our recommendations are intended to apply to all racial/ethnic groups. More robust efforts are needed to ensure that at-risk populations actually receive the screening tests and the follow-up treatments or interventions they need, as people are dying unnecessarily from this disease.

What data did the Task Force use to come to its conclusions?

The Task Force commissioned a comprehensive systematic review of the available evidence on the benefits and harms of colorectal cancer screening. The Task Force also commissioned a modeling study from the Cancer Intervention and Surveillance Modeling Network (CISNET) to help it better understand different screening strategies, such as the optimal age to start or stop screening, and the length of time between screenings. The evidence is convincing that screening reduces the risk of dying from colorectal cancer.

For four decades since 1976, the SPICE staff has worked with many centers of Stanford Global Studies (SGS)—including the Center for Russian, East European, and Eurasian Studies, Center for East Asian Studies, Center for Latin American Studies, and Center for African Studies—on innovative educational outreach efforts. The 2015–16 academic year was no exception.

During 2015–16, SGS’s Education Partnership for Internationalizing Curriculum (EPIC) Fellowship Program supported nine community college faculty from Foothill College and the College of San Mateo. The inaugural cohort of EPIC Fellows collaborated with SGS, Lacuna, and SPICE on projects aimed at internationalizing course curricula and producing innovative curricular materials for use in community college classrooms.

SPICE's Jonas Edman worked with two EPIC Fellows, Michele Titus and Tania Beliz from the College of San Mateo. As EPIC Fellows, Titus and Beliz received stipends and access to Stanford Library resources. In addition to producing the projects, they participated in monthly meetings, served as liaisons to their college, presented their work at their college, and shared their projects at the EPIC Fellows Symposium, which was held on May 14, 2016. In addition, the EPIC Fellows were invited to attend half-day seminars that featured talks by Francis Fukuyama (governance), Walter Falcon (food security), and Gordon Chang (U.S.–China relations) and curriculum demonstrations on all three topics by Edman.

The EPIC Fellows Symposium, which featured presentations by the nine EPIC Fellows, was attended by over 50 California community college instructors from as far north as Shasta College in Redding to Santa Ana College and Santa Monica College in southern California. The presentations by Beliz and Titus during the Symposium stimulated a robust discussion.

Beliz focused her EPIC project on integrating the latest research on biodiversity and food production into her biology classes. Her work in utilizing technology to infuse international perspectives on this research into her classes inspired community college instructors to take a close look at the syllabus of one of her courses. In reviewing her syllabus, she explained that since the College of San Mateo enrolls significant numbers of students of Filipino descent, she was prompted to integrate a lecture on research on biodiversity from a scholar from the Philippines in her curriculum. Reflecting upon her experience as an EPIC Fellow, Beliz noted, “There are different and varied ways, and different depths of internationalizing curriculum. It depends on our course objectives, our vision of the message we want to impart to our students, and our own experiences in the international community… EPIC made the internationalizing of my biology classes possible in providing a platform for the project to take shape and be implemented.”

Titus’ participation in the EPIC Fellowship Program provided her with the opportunity to internationalize and revitalize the curriculum for her cultural and physical anthropology courses. Specifically, “ethnicity of diet” was investigated cross-culturally and internationally, with a special emphasis on the Tongan and Tongan-American student population at College of San Mateo. Her work with a very diverse student body prompted questions from community college instructors on topics such as culturally sensitive curriculum and culturally relevant pedagogy. Titus noted, “The EPIC Symposium was a showcase of faculty presentations that reflected the evolution of courses to broader, more global perspectives. It was a great opportunity to share my own project and to enjoy feedback from others.”

Titus, Beliz, and other EPIC Fellows appreciated the importance placed upon active and collective participation in the EPIC Fellowship Program. This may have contributed to the steady growth since fall 2015 of a community of learners comprised of the EPIC Fellows and SGS, Lacuna, and SPICE. Beliz commented, “I found our exchange of ideas thought-provoking, and after every conversation I was able to come up with more ideas about possible paths to follow. It helped that I was teaching a summer class, so after our conversations I could implement one or two of our ideas.” Titus noted, “I worked most closely with Tania Beliz… but also interacted regularly at seminars with the other faculty from the colleges and university. The Stanford group was supportive and inspiring, helping me shape my ideas into something meaningful for students.”

Most of SPICE’s work with SGS over the past 40 years has focused on elementary and secondary schools. The 2015–16 collaboration with SGS on the EPIC Fellows Program and the 2011–14 focus on the promotion of human rights education at community colleges (Stanford Human Rights Education Initiative or SHREI) have helped SPICE to expand its reach to community colleges throughout California. The EPIC Fellowship Program and SHREI could serve as models for other research universities in the United States that are recipients of U.S. Department of Education Title VI grants. To receive news about the EPIC Fellows Program, please visit SGS’s “Community Engagement” webpage. 

On May 27, 2016, President Obama will become the first sitting president to visit Hiroshima. In light of this historic visit, SPICE hosted a webinar on May 23, 2016, which featured the talk, “Beneath the Mushroom Cloud,” by Clifton Truman Daniel, grandson of President Harry S. Truman and author of Growing Up with My Grandfather: Memories of Harry S Truman. Following a question and answer period with Mr. Daniel, SPICE staff shared classroom resources (Sadako’s Paper Cranes and Lessons of Peace and Divided Memories) that introduced diverse perspectives on the atomic bombing of Hiroshima.

RELATED CLASSROOM RESOURCES

Hiroshima: Perspectives of the Atomic Bombing
Divided Memories: Comparing History Textbooks
Examining Long-term Radiation Effects
Nuclear Tipping Point (video)
Sadako's Paper Cranes and Lessons of Peace
Reflections from an Atomic Bomb Survivor (video)

This webinar is being offered in collaboration with the National Consortium for Teaching about Asia, which is funded by the Freeman Foundation. The NCTA is a multi-year initiative to encourage and facilitate teaching and learning about East Asia in elementary and secondary schools nationwide.

Alliances serve an important purpose in international relations, but the attention given by each country to each other is rarely equal. This kind of asymmetry is apparent in the U.S.-South Korea alliance; however, South Korea as the weaker ally can work to garner greater attention from the United States by leveraging the news media, according to Stanford professor Gi-Wook Shin and Yonsei University professor Rennie Moon.

Their co-authored editorial can be viewed on the AIIA blog. More on the subject can be found in an extended journal article by Shin, Moon and Hilary Izatt in the Australian Journal of International Affairs, and the Stanford University Press book One Alliance, Two Lenses: U.S.-Korea Relations in a New Era.

Nancy Lonhart is the calm at the center of the storm for the 70 people working at Stanford Health Policy.