Prof. Hans-Joachim Schmoll, MD: What a Colorectal Cancer Patient in Europe Needs to Know
Prof. Hans-Joachim Schmoll, MD, PhD discusses things a patient needs to know when diagnosed with colorectal cancer, specifically in Europe. Questions for your doctor, age, risk factors, family history, diet and when to start screening are all covered.
The Group Room at the 2011 European Multidisciplinary Cancer Conference was made possible, in part, by:
VIDEO TRANSCRIPT
Selma Schimmel, Founder & CEO, Vital Options International:
This is Selma Schimmel at the Multidisciplinary Cancer Congress 2011 in Stockholm. Professor Doctor Hans-Joachim Schmoll, thank you for taking time to join us during this multidisciplinary meeting here in Stockholm. And you are certainly one of Europe’s leading physicians in the area of GI oncology. So do me a favor and talk to the patient that’s listening, who’s just been diagnosed. Doesn’t know anything yet of his or her biologic characteristics of the tumor. Talk us through what that patient needs to know and the discussion they can expect to have with their doctor.
Prof. Hans-Joachim Schmoll, MD, PhD, Head Dept. Oncology/Hematology, Martin Luther Univ. Halle-Witttenberg, Germany:
First of all I would recommend that all the patients look at this publication because even they can understand if they are affiliated with the disease and they should go with this to the doctor and show this, explain to me what is the best for me based on this. And you should ask the doctor what is this disease, what is the biology and so on. But then they should go to an expert, and not all doctors are experts in this depending where a patient is and which doctor is there treating him. But in research and treatment centers for cancers or more experienced clinics they will be informed about what is the best selection of treatment for the patient.
Selma Schimmel:
And what about age? More and more… I seem to be meeting younger people being diagnosed with colon cancer – younger meaning under 40.
Prof. Hans-Joachim Schmoll:
That’s true. We have two problems in our discussion of meta oncology, and in particular colon cancer – what to do in elderly patients, which is 70 and older. However with the metastatic disease there are no difference, in Atchuman disease early stage tumors we have to consider carefully what is good for a patient over 70, and should they get the full treatment or less treatment. But on the other side you are completely right. The young people… young patients emerge and we still do not know whether the biology of this disease in young patients is different – it’s probably worse because we see many patients with this disease. Still we have no different treatment for those patients.
Selma Schimmel:
Do we understand yet if there is a family relation? In other words, hereditary predisposition, if one’s parent has had colon cancer, does that raise the risk for the kids?
Prof. Hans-Joachim Schmoll:
Oh yes, there’s a minority fraction which have clearly inherited disease but there is a relatively large fraction of patients with familial risk is higher because of relatives having colon cancer without having genetic predisposition. And this is a very important since screening is done based on this. For example in United States and in Germany, these are the first countries where endoscopy of the colon rectum is free every ten years once age of 50. However if the patient had… if a person has in his family history colon cancer, colon cancer in one or two or three of his relatives then he’s at higher risk and he can start screening earlier.
Selma Schimmel:
And what about more frequently? Ten years seems like a very long span.
Prof. Hans-Joachim Schmoll:
And a little bit more frequently, depending on the findings. But in general it’s extremely important to find early the tumor or at least the precursor – the benign precursors – of the tumor and eliminate these precursors or treat these tumors early to give it a high chance of cure.
Selma Schimmel:
And if a patient presents with polyps they will…?
Prof. Hans-Joachim Schmoll:
Precursor legion, which will be pulled out or cut out, and then the patient has no risk anymore as long as he does not have other polyps.
Selma Schimmel:
But that patient needs to screen more frequently.
Prof. Hans-Joachim Schmoll:
Right. So it is a positive family history should have high risk and should have more screenings but in general all persons in United States and in Germany above the age of 50 allowed to make a screening by endoscopy free of charge, which is a major step for it. And this will use the mobility and mortality automatically in the future.
Selma Schimmel:
Risk factors. Aside from the genetic predisposition or familial related cancers, what about diet? We hear in the United States that one of the culprits is heavy red meat consumption, and that’s being more and more discouraged. What’s the philosophy in Europe about diet and prevention?
Prof. Hans-Joachim Schmoll:
It’s the same. It’s fat and red meat, which is a problem… increases the risk, and lot of smoked food, which is typical for example in Germany and some parts of Germany – less typical here in the north of Europe, and is much less typical in Italy and Mediterranean countries. So the risk is higher in those countries where this type of food is taken very much. But the education on food, eating behavior is trying to change this.
Selma Schimmel:
And what about gender? Do we understand anything more about these GI cancers in women versus men?
Prof. Hans-Joachim Schmoll:
There’s now major difference in colorectal cancer and gastric cancer for the gender however there might be differences in response to chemotherapy. So this indicates there are some minor – or probably major – biological differences in the disease in the different genders, which we do not understand in the moment. For example it’s now clear for gastric cancer that Asian patients with gastric cancer have a different benefit from let’s say Bevacizumab in addition to chemotherapy than American or European patients. It’s a clear difference with no affect with this drug in Asian patients including China and Japan and Korea but has clear affect which is significant in western population. So we don’t know why it is. We just know that this is the case. So many things has been important to be investigated which I suspect to regional and genetical background differences.
Selma Schimmel, Founder & EO, Vital Options International
Professor Schmoll, what about the economics? The impact of economics on the treatments and the diagnosis of colorectal cancer?
Prof. Hans-Joachim Schmoll:
It is very good under economic reasons to make screening and identify those people on risk or patients very early because it is cheaper than treat patients, and probably without cure. And the patients live longer and longer because of the good treatments but they need more and more treatments which increases the cost for treatment. And then the new drugs in particular, more and more letting the exploding the economic part of the treatment. And this is a major concern in all the European countries – how we can pay the future of these drugs. And even now it’s a problem, and in particular Germany or UK are cutting down, and trying to select the patients who should get the drug, who deserves the drug really or do not? So the answer to this is biology – look on biological markers, molecular markers to identify these patients clearly.
Selma Schimmel:
And you probably have one other important obstacle to overcome, and that is getting people to go in and do their screening, and to go in and do their… in the US it would be a colonoscopy; you mentioned endoscopy here. But whatever modality you’re using how do you get people to overcome – especially men – who do not like it all going to the doctor?
Prof. Hans-Joachim Schmoll:
That is a very good question. The endosopy, colonoscopy is same, means the same. Germany, there’s a foundation which is done by a major media family based on a son of them who died early, it was 30 years from colon cancer. And they can involve all the stars and film and TV and trying to motivate people. So that’s very important part in this… everybody knows in this country about the possibility but again, the participation of this program is far too low, and should be increased. So it’s like United States and it needs a lot of education and continuous efforts to do this.
Selma Schimmel:
So I gather that there is truly a paradigm shift in the way we understand colon cancer, and the way colon cancer is being treated?
Prof. Hans-Joachim Schmoll:
And prevented by multiple screening of risk patients with people.
Selma Schimmel:
Thank you Professor Hans-Joachim Schmoll, who comes to us from Germany.
Prof. Hans-Joachim Schmoll:
Thank you.
END OF VIDEO