Colorectal cancer screening quality, cost and practice in an era of healthcare transformation.

Colonoscopy for colorectal cancer screening is the largest single source of income for gastroenterologists in the USA. Despite its proven value in preventing colon cancer, it is being scrutinized by payers and regulators as a high-volume procedure with variable quality, cost and documentation. In a rapidly evolving era of reimbursement for added value (high quality, affordable cost) rather than for individual transactions/volume, gastroenterologists are under pressure to change our practices to respond to the demands of the marketplace. Excellent guidance is available through our professional societies.

Alteration of gene expression in normal-appearing colon mucosa of APC(min) mice and human cancer patients.

The expression of many genes is altered in colon cancer, but the roles of these genes in carcinogenesis are unclear. Using real-time quantitative PCR, we demonstrated that several genes previously implicated in human colon cancer undergo altered expression in the APC(min) mouse adenomatous polyp, a precursor of cancer, as well as in normal-appearing surrounding mucosa. The five genes that were most highly up-regulated in mouse polyp were also significantly up-regulated in polyp-free colon mucosa. Similar changes occurred in morphologically normal mucosa of surgical sections taken from human cancer patients, frequently extending to the margins. Thus, morphologically normal colon mucosa in APC(min) mice and in human cancer patients is not metabolically normal. Altered gene expression in this tissue does not appear to result from a field effect because there was no correlation between extent of altered regulation and distance from polyp or tumor. Our data suggest that alterations of expression levels of these genes may be an early event in carcinogenesis and a marker of risk for the development of colon cancer.