Colorectal Cancer Screening Uptake Tripled in 45-49 Age Group

 Mean rates of colorectal cancer (CRC) screening tripled among average-risk individuals 45-49 years old after the U.S. Preventive Services Task Force (USPSTF) issued a recommendation encouraging screening in this group, according to a retrospective cohort study.

The mean screening rate increased from 0.50% every 2 months before the recommendation to 1.51% every 2 months afterward (P<0.001), a 3-fold increase that represented an absolute change of 1.01 percentage points, reported Sunny Siddique, MPH, of the Yale School of Public Health in New Haven, Connecticut, and colleagues.

Those in the highest socioeconomic category experienced the largest absolute increase in screening (1.25 percentage points) compared with the lowest category (0.75 percentage points), but relative changes were not significant, they said in JAMA Network Openopens in a new tab or window.

By Dec. 31, 2022, screening uptake among individuals 45 to 49 years reached a level comparable to that among individuals 50 to 75 years (2.37% and 2.40%, respectively).

"The 3-fold increase in screening uptake among average-risk individuals aged 45 to 49 years reflects an accomplishment, yet evidence of widening disparities based on SDI [social deprivation index] and locality indicate that population subgroups may not be benefiting equally from this change in CRC screening recommendation," the researchers wrote.

"Furthermore, given that only 11.5% of average-risk individuals aged 45 to 49 years during the post-recommendation period received CRC screening before the age of 50 years, targeted initiatives to improve screening in this age group are warranted to reach the national goal of screening 80% of the population in every community," the study authors said.

In an editorial accompanying the studyopens in a new tab or window, Sarmad Sadeghi, MD, PhD, of the University of Southern California in Los Angeles, and Afsaneh Barzi, MD, PhD, of the City of Hope Comprehensive Cancer Center in Duarte, California, said the higher screening rates reported by Siddique and colleagues might not be entirely related to the new national recommendation.

"The increase in screening rates among individuals aged 45 to 49 for CRC reported by Siddique et al is encouraging," they wrote. "However, it is unclear whether this increase is entirely attributable to the USPSTF recommendation -- other factors, such as deferred and postponed screenings that were carried out after the height of COVID-19 restrictions, may have contributed to this significant increase."

Sadeghi and Barzi agreed that more must be done to further increase screening rates. "To achieve a significant improvement in CRC outcomes among younger adults, widespread adoption of screening is essential," they said. "This largely depends on interactions between patients and their primary care physicians. Understanding physicians' practice patterns, such as their referral tendencies and test-ordering habits, can shed light on their approach to screening."

Siddique and colleagues analyzed deidentified claims data from more than 10 million Blue Cross Blue Shield (BCBS) beneficiaries age 45-49 from 2017 through 2022. They compared absolute and relative changes in screening uptake between a 20-month period before and a 20-month period after the USPSTF recommendation was issued. They categorized May 1, 2018 to December 31, 2019 as the period before the recommendation and May 1, 2021 to December 31, 2022 as the period after.

The researchers used interrupted time-series analysis and autoregressive integrated moving average models to evaluate changes in screening rates, adjusting for temporal autocorrelation and seasonality.

The mean age of beneficiaries was 47, and 51% were female. Both males and females with average risk had significantly higher uptake of overall screening in the post-recommendation period compared with before the recommendation, but post-recommendation screening uptake did not differ significantly between them.

A key limitation of the study was it included only BCBS beneficiaries, the authors noted. Although BCBS is the largest provider of commercial health insurance, the study cohort may not be fully representative of the general U.S. population because beneficiaries tend to be younger and more socioeconomically advantaged with employer-based insurance, they explained.

Furthermore, data on ethnicity and race were available for only a subset of the BCBS beneficiaries. "Although we analyzed SDI and locality as factors that represent multiple domains of the social and physical environment, prior studies showed that [socioeconomic status] alone does not capture the pervasive association of race with health outcomes," Siddique and colleagues said.

Disclosures

The study was supported by the National Cancer Institute.

Siddique reported no relevant conflicts of interest. Co-authors reported relationships with Johnson & Johnson, Genentech, the National Comprehensive Cancer Network (NCCN) Foundation (with funding to the NCCN provided by AstraZeneca), and Bristol Myers Squibb.

Sadeghi and Barzi reported no conflicts of interest.

Primary Source

JAMA Network Open

Source Reference: opens in a new tab or windowSiddique S, et al "USPSTF colorectal cancer screening recommendation and uptake for individuals aged 45 to 49 years" JAMA Netw Open 2024; DOI: 10.1001/jamanetworkopen.2024.36358.

Secondary Source

JAMA Network Open

Source Reference: opens in a new tab or windowSadeghi S, Barzi A "USPSTF recommendations and colorectal cancer in younger adults -- current challenges and future opportunities" JAMA Netw Open 2024; DOI: 10.1001/jamanetworkopen.2024.36305.

https://www.medpagetoday.com/gastroenterology/coloncancer/112250

Timeline of Irregular Heartbeats Emerges From Close Watch of Young Binge Drinkers

 Continuous rhythm monitoring showed the timeline in which heart rate and atrial tachycardias typically arise after binge drinking by young adults, researchers reported.

In people with no known history of cardiac arrhythmias, premature ventricular complexes (PVCs) were more frequent during the hours of alcohol consumption, after which premature atrial complexes occurred significantly more frequently about a day later, according to a group led by Stefan Brunner, MD, of LMU Klinikum University Hospital of the Ludwig-Maximilians-Universität in Munich, Germany.

Also, during the hours of recovery after binge drinking, some of the roughly 200 participants experienced notable arrhythmic episodes, including atrial fibrillation (Afib; n=1), non-sustained ventricular tachycardias (n=2), and various degrees of atrioventricular block (n=4), the MunichBREW II study group reported in the European Heart Journalopens in a new tab or window.

"Taken together, the 'Holiday Heart Syndrome' remains rare in otherwise healthy individuals, but should be recognized as a relevant health problem," Brunner's group concluded.

They noted that a heart rate variability analysis indicated autonomic modulation, with sympathetic activation during and soon after alcohol consumption, followed by parasympathetic predominance thereafter.

Prior research has shown that beyond the excessive drinking linked to "Holiday Heart," even small amounts of alcoholopens in a new tab or window can be linked with incident Afib. Alcohol is among the substances associated with early-onset atherosclerotic cardiovascular diseaseopens in a new tab or window, especially in women.

"Whereas the 'Holiday Heart Syndrome' is typically linked with atrial fibrillation, also cases of malignant ventricular arrhythmias and sudden cardiac death have been reported. Given the alcohol-related increase in PVCs and as ventricular ectopy may eventually deteriorate to ventricular tachycardia, the relation of excessive alcohol intake and ventricular arrhythmias may have been underestimated," Brunner and colleagues suggested of the prior literature.

They cited their original MunichBREW cross-sectional studyopens in a new tab or window that showed a significant association between breath alcohol concentration (BAC) and cardiac arrhythmias, and a 0.59% incidence of new-onset Afib among Munich Octoberfest participants in 2015. That study had lacked continuous rhythm monitoring that could capture delayed arrhythmias, however.

MunichBREW II was a single-arm study that enrolled people from 2016 to 2017.

Participants were 202 adult volunteers planning acute alcohol consumption with expected peak BACs of ≥1.2 g/kg. Investigators excluded individuals with a known history of Afib, a cardiac implantable electronic device, or contraindications to the study procedure.

As part of the study, people agreed to 48-hour electrocardiographic monitoring with a patch Holter recorder. They subsequently drank in public or private locations accompanied by study personnel. A handheld breathalyzer provided BAC measurements to assess acute alcohol intake.

According to Brunner's group, the final study cohort included 193 people (mean age 29.9 years, 36% women) who had sufficient ECG recordings. Their chronic alcohol use came out to an average 6.8 drinks per week, and there was a median 22.9 g of daily consumed alcohol.

During the recorded drinking sessions, the average maximum BAC reached was 1.4 g/kg in both men and women.

Long-term follow-up conducted in 2024 revealed a very high burden of symptomatic events (e.g., palpitations) self-reported by over 20% of participants. There were two additional cases of clinically diagnosed Afib from that long-term follow-up, averaging 7.2 years.

The authors nevertheless acknowledged the study's limited generalizability to older individuals, those with preexisting heart disease, and the general population. The investigators also did not look for relevant arrhythmias that may have arisen beyond the initial 48-hour observation period.

"Given the still low numbers and the long observation period of >7 years, any conclusion needs to be made with caution. Yet, considering a total of three atrial fibrillation diagnoses among our relatively young participants one might infer an association with alcohol consumption," Brunner and colleagues surmised.

Disclosures

Study authors did not report any study funding or conflicts of interest.

Primary Source

European Heart Journal

Source Reference: opens in a new tab or windowBrunner S, et al "Acute alcohol consumption and arrhythmias in young adults: the MunichBREW II study" Eur Heart J 2024; DOI: 10.1093/eurheartj/ehae695/7809582.

https://www.medpagetoday.com/cardiology/arrhythmias/112275

Doctors Cut Back on Seeing Medicare Patients as Another Pay Cut Looms

 Will his independent practice be able to survive another Medicare payment cut? That's what Terre Haute, Indiana internist Pardeep Kumar, MD, wonders each day as the next round of cuts looms.

"We have to see," Kumar said in a phone interview. "We have around 40% of the population of patients that are on Medicare ... Our overall ability to sustain as a private practitioner is significantly under distress because of these cuts."

Can We Stay in Business?

Kumar and his wife, who is also an internist, are in private practice togetheropens in a new tab or window, and each has taken on outside work at various points in order to keep the practice viable, he said. "I used to be the director of a hospice company outside the practice, and I also [work at] another hospital for geriatric psychiatric patients. I go and see them so that we have additional revenue to sustain our practice."

CMS is proposing a 2.8% cutopens in a new tab or window in the Medicare fee schedule for the 2025 fiscal year, which would, if approved by Congress, come on top of a 1.69% cut in 2024. Often, Congress reverses the cuts, although this year they did so only partially. The cut is currently in limbo -- along with the rest of the federal budget -- now that Congress has passed a short-term budget dealopens in a new tab or window keeping the government funded at current levels through mid-December, after the election.

Doctors' groups such as the American Medical Association, to which Kumar belongs, argue that instead of cutting doctor pay, CMS should adopt an inflation-adjusted reimbursement model. "When the cost of living goes up, there should be some [similar] adjustment in the physician reimbursement model," Kumar said. "That will provide sustainability, especially for the private practice."

Helping private practices stay in business, rather than forcing doctors to close their private practices and work for hospital systems, "will actually eventually lower the cost of care ... because reimbursement in private practice is relatively lower than hospital-based [reimbursement] so there's a cost saving for health insurers," including Medicare, said Kumar.

Although there is some movement in Congress toward site-neutral payment, in which hospitals would get the same pay as private practices for providing the same outpatient services, "hospitals are fighting that, because they are saying that they are employing more and more physicians now ... They're getting site benefit from that, and they're able to pay the physicians to keep them employed," he said. "I also sit on the hospital board here, and they are saying their margins are very shrunken and they will not be able to sustain or at least employ as many physicians if they [institute site-neutral payment]."

Primary Care Shortage Persists

Donaldo Hernandez, MD, a hospitalist in Santa Cruz, California, has seen first-hand how continued Medicare payment cuts are keeping patients from getting care. "Central and northern California can be somewhat expensive places to conduct healthcare business for a number of reasons," Hernandez said during a telephone interview at which a press person was present. "Even prior to the pandemic ... it was really the commercial marketplace that allowed medical practices that have enough money to invest in staff and all the other things that they do to maintain themselves."

"As we emerged from the pandemic, with the inflationary pressures exerted by the pandemic and the ongoing issues with hiring staff and sundry other things that occurred -- such as increases in the cost of electricity, for example, from Pacific Gas & Electric -- those pressures really were exerted on medical practices to a much greater extent," said Hernandez, who is immediate past president of the California Medical Association.

Doctors "really want to see this Medicare population, and yet the economics really forces physicians into sort of a Sophie's Choice between, 'Do I see these patients because I want to, and I know they have a need, or do I save my practice from financial uncertainty and the challenges that exist in me being able to hire MAs [medical assistants], back office people and [deal with] all the administrative burdens that are inserted on all medical practices?'" he said.

Hernandez recalled a recent patient he had seen at his hospital for a severe hypoglycemic episode; the patient -- who had recently moved to California from Oklahoma to care for her ailing father-in-law -- had been in 2 weeks before for a myocardial infarction. "That was treated, managed, and she was placed on some new medications in order to manage that particular medical problem, and was told to follow up with her doctor," he said. "Well, it turns out she really didn't have a community doctor that was managing her problems. There was nobody managing those [medication] alterations in an effective way in the outpatient setting ... As a consequence, she took her diabetes medications erroneously, and ended up having low blood sugar."

"The challenge for me was that day and the following day was to try to find her someplace that she could get follow-up," said Hernandez. "I had two social workers working on it for 48 hours to try to find her a medical home, including within our safety net system, who at this time isn't taking you Medicare patients because they're at capacity." He finally called in a favor with a doctor he knew personally, and was able to get the patient into that practice.

"That's what we're seeing throughout the state, is physician practices are just not able to take these new patients on," he added. "With every subsequent cut or pullback ... It continues to be, in my opinion, an ongoing risk factor for these patients moving forward."

A Personal Effect of the Shortage

For Rene Bravo, MD, a 65-year-old pediatrician in San Luis Obispo, CA, the cumulative effect of the previous Medicare cuts hit him very personally. He had had private health insurance for himself and had gotten care without a problem, "and I finally went on Medicare and tried to find a physician," Bravo said in a phone interview. "I couldn't find one -- they were all either full up or not available ... I finally found an internist who took Medicare, but I had to pull some strings."

"If I have trouble finding a physician, what's going on for other folks in the population?" he said. "The fact that these reimbursement cuts are coming -- everybody is aware of these things, and it just creates a profound amount of insecurity in the system."

"This has got to be fixed once and for all," Bravo said. "The Medicare payment system needs to be significantly revamped because this is creating a lot of stress on healthcare provision for seniors. There's nothing about this that is right."

https://www.medpagetoday.com/practicemanagement/reimbursement/112273

Yardeni sees Fed pausing rate cuts after 50 bp move

 

The Federal Reserve’s monetary-easing campaign for 2024 may already be over as the strong labor report Friday underscores the stubborn resilience of the world’s largest economy, according to Wall Street veteran Ed Yardeni.

Further policy easing would risk sparking inflation just as oil prices rebound and China seeks to jump start its economy, according to the founder of Yardeni Research Inc., who famously coined the “Fed Model” and the “bond vigilante.”

https://www.bloomberg.com/news/articles/2024-10-04/ed-yardeni-sees-fed-pausing-rate-cuts-for-2024-after-jobs-report

Harris 'meets briefly' with Arab American and Muslim leaders in Michigan

 Vice President Harris met with leaders from the Muslim and Arab American community while in Flint, Mich., on Friday amid the ongoing war in the Middle East and shrinking support for Democrats from the community.

Harris traveled to Michigan this week for campaign events and ahead of her Flint rally, she “met briefly” with the leaders and “heard directly their perspectives on the election and the conflicts in Gaza and Lebanon,” according to a Harris campaign official.

The official added that Harris “discussed her efforts to end the war in Gaza, such that: Israel is secure, hostages are released, the suffering in Gaza ends, and the Palestinian people can realize their right to dignity, freedom, self-determination.”

She also, the official noted, expressed concern about civilian casualties and displacement in Lebanon and reiterated the Biden administration’s stance that a diplomatic solution is the best path to achieve stability, protect civilians, and prevent regional war.

The vice president’s meeting comes after Minnesota Gov. Tim Walz (D) participated in a virtual event with Emgage Action on Thursday to talk about concerns from the community. Phil Gordon, national security adviser to Harris, met virtually on Wednesday with Arab, Muslim and Palestinian Americans.

The group Emgage Action met with Harris and underscored the “deep pain our communities feel over the intensifying crisis in Gaza and Lebanon,” said Wa’el Alzayat, CEO of Emgage Action, in a statement. 

“Emgage Action also reiterated the organization and the Muslim community’s disappointment in the handling of the crisis that has endangered the wellbeing of our communities at home and is now widening to a broader regional war,” he said. 

Alzayat added that the meeting with Harris is the “latest step in assuring the Muslim community that the organization is committed to leveraging its endorsement of Vice President Harris to advocate on behalf of our community.” 

In an effort to gain back support, a new coalition called Arab Americans for Harris-Walz launched this week. The group said it represents a “broad” group of Arab American voters, including some voters who were formerly in the uncommitted movement that opposed Biden during the Democratic primary over his handling of the Israel-Hamas war in Gaza.

Biden, who has received criticism for not engaging enough with pro-Palestinian Americans, felt the anger about his handling of the war in the primary, when tens of thousands of voters in Michigan voted uncommitted.

The war in the Middle East has since escalated, and Iran launched a missile attack on Israel this week. Harris has voiced her support for ensuring Israel has the ability to defend itself.

https://thehill.com/homenews/campaign/4916848-harris-meets-arab-muslim-leaders-michigan/

White House bashes GOP ‘lies’ about FEMA funds

 The White House bashed Republicans on Friday for what it argues are lies about the Hurricane Helene federal response effort.

The White House focused on the claim that the Federal Emergency Management Agency (FEMA) is out of funding.

Senior deputy press secretary Andrew Bates sent a memo arguing Republicans are “peddling bald faced lies” about the cleanup after Hurricane Helene, and noted that GOP leaders in some of the affected states, including Georgia Gov. Brian Kemp and South Carolina Gov. Henry McMaster, have thanked the Biden administration for its speedy response.

“But some Republican leaders – and their partners in rightwing media – are using Hurricane Helene to lie and divide us,” Bates said. “Their latest missive: baselessly claiming that FEMA is out of money to respond to Hurricane Helene – because of an existing program that supports cities and towns that are sheltering migrants.”

Former President Trump said at a rally in Michigan on Thursday that disaster relief funding was all spent on migrants while criticizing the administration’s response effort.

“There’s nobody that’s handled a hurricane or storm worse than what they’re doing right now,” Trump said. “Kamala spent all her FEMA money, billions of dollars, on housing for illegal migrants. Many of whom should not be in our country.”

In Bates’s memo, he shared a headline about the former president’s accusation against the Biden administration.

“No disaster relief funding at all was used to support migrants housing and services. None. At. All,” Bates said. “In fact, the funding for communities to support migrants is directly appropriated by Congress to [Customs & Border Protection], and is merely administered by FEMA. The funding is in no way related to FEMA’s response and recovery efforts.”

He outlined that FEMA has already provided more than $45 million in direct financial assistance to individuals and families affected by the storm, including more than $17 million to North Carolina.

He also warned about the consequences of spreading falsehoods when people are in need.

“Unfortunately, our country has seen the dangerous consequences of peddling falsehoods. In fact, disinformation of this kind can discourage people from seeking critical assistance when they need it most. It is paramount that every leader, whatever their political beliefs, stops spreading this poison,” Bates said.

FEMA released a fact-check page Friday, outlining that “no money has been diverted” and that “FEMA has enough money right now for immediate response and recovery needs.”

President Biden has called on Congress to return from recess to pass additional funding to assist with the recovery efforts, while both chambers aren’t slated to return until Nov. 12.

The Biden administration has deployed more than 4,800 federal officials to support response efforts, and the president directed the deployment of up to 1,000 troops to assist in North Carolina’s recovery. Biden visited the Tar Heel State on Wednesday and Florida and Georgia on Thursday to survey the damage and meet with local officials.

Vice President Harris, Trump’s opponent, traveled to Georgia on Wednesday and is scheduled to travel to North Carolina on Saturday. Trump also visited Georgia on Monday.

https://thehill.com/homenews/administration/4916014-federal-response-criticized/

'Democrats irked over ‘pro-choice’ GOP candidates'

A handful of Republican candidates running for competitive Democrat-leaning congressional seats have adopted “pro-choice” stances, as they try to separate themselves from the GOP’s hardline anti-abortion history.

Democrats are accusing the Republicans of deceiving voters and redefining what the term means.    The GOP candidates who say they’re pro-choice:  In California, Republican Matt Gunderson who’s challenging Rep. Mike Levin (D-Calif.) announced last month, “I am pro-choice. I believe abortion should be safe, legal, and rare.”  Rep. John Duarte (R-Calif.) also said last month that he was pro-choice and went as far as to say he believed former President Trump is “functionally pro-choice.”  Former Maryland Gov. Larry Hogan, the Republican nominee for Senate in the state, also called himself pro-choice shortly after he won the primary. Their Democratic opponents, however, are less than convinced.    Levin told The Hill that his opponent is “trying to deceive people” by labeling himself “pro-choice.”    “I don’t really think you can be pro-choice if you believe states should have the right to ban all abortions. Those two things are just not consistent,” said Levin.    Democrat Angela Alsobrooks, running against Hogan in Maryland, has argued the former governor’s party affiliation works against him, telling the The Associated Press, “There will never be a vote as to whether or not we should codify Roe in federal law if the Republicans are in the majority.”  https://thehill.com/newsletters/health-care/4916992-democrats-irked-over-pro-choice-gop-candidates/