Lab Soft News

Health Systems Invest in "Innovation" Startups; Non-Profit Status in Jeopardy?

At a time when many rural hospitals are going out of business due to revenue shortfalls (see: The rural hospital closure crisis: 15 key findings and trends), larger health systems are seeking other ways to protect their bottom line such as investing in healthcare startups and innovation (see: Health Systems Accelerate Investments in Innovation; Financial Challenges for Non-Profit Hospitals; Lab Budget Reductions Anticipated). Here is a quote from this article listing the major health system players in this space:

* Kaiser Permanente Ventures: More than 15 years of innovation investment experience, high-profile limited partner investors such as Tufts Health Plan, and about $400 million in committed capital

* Partners Innovation Fund (PIF): Established in 2007 with a commitment of $35 million from two of Partners HealthCare's hospitals, Brigham and Women's Hospital and Massachusetts General Hospital; focused on innovations in therapy, diagnostics, information technology, and medical devices....

* Cleveland Clinic Innovations: CCI has helped launch more than 75 companies; the investment house has more than 2,700 patent applications, with about 700 issued patents; and companies associated with CCI have drawn more than $910 million in equity investment

Mayo Clinic has recently been the recipient of some undesired publicity relating to a stated preference for private healthcare insurance companies (see: Cherry-picking patients may be business as usual for not-for-profits like Mayo). Below is an excerpt from this article:

When the CEO of Mayo Clinic said the world-renowned, not-for-profit health system would prioritize caring for privately insured patients over publicly insured ones, it triggered an inquiry from the Minnesota Health Department and dismay and criticism from researchers and ethicists.“We're asking ... if the patient has commercial insurance, or they're Medicaid or Medicare patients and they're equal, that we prioritize the commercial insured patients enough so ... we can be financially strong at the end of the year to continue to advance, advance our mission,” CEO Dr. John Noseworthy told staff.....It's unclear whether Noseworthy's statements represent an explicit change in policy for the health system or if Mayo, acting up that statement, would violate any laws, including federal civil rights statutes....Even if Mayo is picking and choosing its patients based on insurance, it may not be significantly different from the policies and practices of many other hospitals....In a subsequent statement, Noseworthy said that medical need would always be the "primary factor" in making patient appointments....

Not-for-profit hospitals are exempt from federal, state and local taxes that, by one estimate, added up to $24.6 billion in 2011. In theory, they receive these exemptions in return for providing benefits to the community, at the core of which is caring for the publicly insured, uninsured or indigent. But the extent to which hospitals actually offer community benefits varies substantially, and their status as tax-exempt has come under scrutiny in recent years. The IRS does not set a minimum of community benefits that hospitals must provide to gain tax exemptions. In 2013, a study published in the New England Journal of Medicine found that not-for-profit hospitals in 2009 spent on average 7.5% of their operating costs on community benefits and charity care. A 2009 IRS study of not-for-profit hospitals shed light on imbalances within the sector, showing that community benefits were concentrated in a relatively small number of hospitals. About 9% of the hospitals accounted for 60% of the aggregate community benefit expenditures.... 

I have posted a number of blog notes in the past questioning the status of tax of non-profit hospitals (see: Cities Begin to Question Non-Proft Status, Tax Breaks of Their Hospitals; Hospital Entrepreneurship and the Salaries of Non-Profit Hospital Executives). It seems to me that this situation needs to be reexamined if some large portion of their income is derived from investments in medical startups and if, as with Mayo, they show a preference for patients covered by private insurance.

Treatment of Patients with Chronic Diseases: Important for the Future of Telemedicine

I continue to be enthusiastic about the potential of telemedicine and have blogged about it frequently (see, for example: American Well Offers Remote Physical Monitoring for Telemedicine Visits; Telemedicine as a Tool for Physician Visits in Senior and Assisted Living Facilities). There is an urgent need to reduce the overall cost of healthcare delivery and it will difficult to accomplish this goal with the current care model requiring bricks-and-mortar expenditures to accommodate more patients. With telemedicine, rapidly increasing the number of physician visits is related to the capabilities of the hospital IT "engine and network" which will be less expensive and more flexible than physical expansion of the facilities.

Up to this point, telemedicine visits across the country have been generally confined to patients with less complex problems like flu or minor muscle aches. It has been considered axiomatic that the care of patients with more serious problems requires sophisticated technology that allows remote monitoring of vital signs or heart auscultation. However, a recent article reminded me instead about the feasibility of caring for patients with chronic diseases (see: Can Telemedicine Help You Cope With a Chronic Illness?). This particular article is oriented to patient readers but provides some useful information. Below is an excerpt from it:

Do you have a chronic illness, such as diabetes or high blood pressure? The back-and-forth office visits with your practitioner can get old very quickly....Is there an easier way? ....Telemedicine, which allows you to use your smartphone, tablet or desktop computer to visit your doctor for follow-ups.With video and email, you often can get care through telemedicine without disrupting your schedule, says Family Medicine practitioner, Mark Rood, MD. “If the provider knows the patient — and if the patient agrees to it — the doctor can provide disease management remotely,” he says.“If the provider knows the issues, and there’s no need for a physical exam, the patient can decide whether to use telemedicine or return to the office every three weeks. While physical exams are important at first, 90 percent of what a physician uses to provide care comes from your health history. After that conversation, your doctor often can provide care through telemedicine exactly as he or she would in at an office visit," Dr. Rood says.

Cleveland Clinic has for years offered Express Care Online which is staffed by family medicine physicians like Dr. Rood for no more than $49 a visit. Visits are scheduled and organized using a downloadable mobile app. To quote the web site: Get a diagnosis or prescription online from a healthcare provider in one 10–minute session. This site provides a list of conditions to be treated but does not seem to have caught up with the suggestion of Dr. Rood above that telemedicine is well suited for managing chronic diseases.

Most patients with chronic diseases will be older and often less mobile. Telemedicine serves them well in terms of being able to see them in their own home environments. Offering televisits to patients with chronic diseases will also be one way to bend-the-curve of the cost of healthcare. Here's a reference to the future cost of such care; it does constitute a challenge that needs to be addressed (see: THE PROJECTED TOTAL COST OF CHRONIC DISEASE FROM 2016-2030 IN AMERICA IS $42 TRILLION):

More than 190 million Americans, or about 59 percent of the population, are affected by one or more chronic diseases. Having one chronic condition can increase the risk of developing another. Without change, the number of people with three or more chronic diseases is expected to increase to 83 million by 2030, and overall costs will accumulate to more than $42 trillion.

The "Why" and "How" of Academic Tweeting

In my blog Lab Soft News, I began to discuss the advantages  of "professional blogging" almost ten years ago (see: Professional Blogs as Publication Vehicles for Physicians in Academic Clinical Tracks). By this term, I was referring to blogging by an individual in his or her area of professional expertise. In the case of Lab Soft News, my goal has always been to communicate directly with lab professionals and, to a lesser extent, healthcare consumers interested in the field. At the time that I posted this note, I was hopeful that blogging would become an important facet of academic publishing. I am not sure that even now blogging has gained much traction for academics but a google search for the term "academic blogging" did yield a number of hits. My focus today is another. and equally important, social media channel: Twitter. It offers a less time-consuming option for reaching out to a professional audience. All of the notes that I post in Lab Soft News are automatically replicated to Twitter (#labsoftnews) and to LinkedIn. My blog notes are thus shared with two broad audiencess.

Here are links to two articles that may be instructive for academics who are interested in tweeting (see:  Academic tweeting: using Twitter for research projects; Using Twitter in university research, teaching andimpact activities; PDF). However, a reasonable question at this point is what specifically can be accomplished by becoming active on Twitter? Putting the question another way, would the chairman of a department view "professional" tweeting by a faculty member as important or frivolous? I personally believe that academic tweeting yields a host of benefits. Below is a list of reasons for tweeting (the "whys"). The list is derived, in part, from the first article linked to above:

• Tweet about new research publications, either personal one or those of others. Such tweets can include a critique of the publications or speculation about future directions for the research. 
• Tweet news of interest to your followers that can affect the field such as regulatory changes.
• Tweet to organize a network of colleagues to keep up-to-date or perhaps attract attention and funding for one's own projects. This is also a way to reach out to new audiences such as potential graduate students 
• Tweet to ‘crowd source’ opinions and reactions about new ideas. Others may respond to or retweet your ideas, creating an opportunity for an ongoing dialogue.  

As to the "how" of tweeting, I would advise novices that writing tweets is not intuitive at first. The biggest challenge is generating thoughtful messages limited to a telegraphic 140 characters. In many cases, it's important to include a link to other articles on the web with a comment abut why the information is important. You may also choose to retweet an item that you find relevant. Choosing other people or organizations to follow on Twitter is also important because such choices create filters for your feed so that the information you view is timely, and newsworthy. In short, the best way to understand how Twitter works is to start using it. 

Don't Miss a Free Webinar on Digital Pathology; Tuesday, March 21 at 1:00 p.m. ET

The Association for Pathology Informatics (API) and Sunquest Information Systems will present tomorrow the next fee webinar in their joint series devoted to pathology informatics. The webinar is entitled Primary Diagnosis Using Digital Pathology: Are We There Yet? and will be delivered by Liron Pantanowitz, M.D., Director of Pathology Informatics, the University of Pittsburgh Medical Center. The time is Tuesday, March 21, 1:00 p.m. ET. Register for the event with a work email by clicking HERE.

Digital pathology has proved to be very promising so far. With maturation of whole slide imaging technology (WSI), full-scale digitization of pathology for primary diagnosis is closer than ever. However, very few labs around the world have successfully made this digital transition. This webinar will review the concept, feasibility, and reality of going “fully digital” in pathology.

Future webinars in this API/Sunquest series are listed below.  Follow the links provided below to register for each webinar separately. 

• Tuesday, April 25, 1:00 p.m. ET. An End-to-end Solution for Diagnostic Informatics presented by Manish Muzumdar, Senior Vice President, Product Development, Sunquest Information Systems. Register using a work email by clicking HERE.
• Thursday, May 11, 1:00 p.m. ET. Health Information Technology from the Regulatory Point of View presented by Walter Henricks, M.D., Medical Director, Center for Pathology Informatics, Cleveland Clinic. Register using a work email by clicking HERE.

Ronald DePinho Resigns as President of the MD Anderson Cancer Center

In a recent blog note, I discussed the abandonment of the Watson project at MD Anderson Cancer Center (see: Scandal at M.D. Anderson -- Operating Loss and Then Watson Deep-Sixed). Perhaps not too surprising now is that the president of this leading cancer hospital, Ronald DePinho, has recently resigned (see: Ronald DePinho, embattled chief of MD Anderson Cancer Center, resigns). Below is an excerpt from the article:

Dr. Ronald DePinho... resigned as president of MD Anderson Cancer Center, one of the nation’s most prestigious hospitals, after a tumultuous tenure marked by financial problems, a large layoff, and a scathing audit that raised questions about his spending practices and management. In an unusually forthcoming statement posted on MD Anderson’s website, DePinho appeared to take responsibility for the turmoil at the institution and the negative publicly it has attracted in recent months.....DePinho had been in the top job for five and a half years and had been under a particular spotlight in the past two years, as the hospital’s financial situation deteriorated.MD Anderson...posted a $267 million loss in the 2016 fiscal year and was expecting to lose as much as $450 million in 2017, though it brings in about $4 billion in annual revenue....He attracted heavy scrutiny following a recent audit by the University of Texas that raised alarms about a troubled partnership with IBM Watson to improve the precision of cancer care. The partnership, spearheaded by DePinho’s wife, Dr. Lynda Chin, was halted late last year after it failed to live up to its goals despite $62 million in spending.The audit said several contracts with IBM and a consultant, PwC, violated internal rules.  

Several of the contracts were not competitively bid and went beyond the approved scope of work, and payments were made regardless of whether the services were delivered as agreed upon. Additional questions arose regarding the project’s primary financial baker, Low Taek Jho, a flamboyant Malaysian financier who is under investigation by the US Justice Department....[Q]uestions regrading the contract, and the broader financial problems at MD Anderson, have continued to bubble up in recent weeks....University of Texas Chancellor William McRaven released a one-paragraph press release praising DePinho for his work in recruiting new talent and mobilizing “MD Anderson’s quest to speed up development for new and more effective treatments.” MD Anderson has more than 21,000 employees and treats more than 120,000 patients each year.

Obviously none of this is good news for one of the most prestigious cancer hospitals in the country. Not to put too fine a point on it but the scandal seems to involve mismanagement, misappropriation of funds, poor contract management, nepotism, and perhaps cronyism/corruption. It's hard to believe that MD Anderson and the University of Texas even considered a relationship with Jho Low who is described in the first sentence of the Wikepedia as "one of the leading figures in the misappropriation of public funds." One has to certainly ask the question: what were they thinking? It will be interesting to see if the scandal spreads to IBM and PwC although I am sure that their attorneys are working dilligently to prevent such contagion. Here's a quote from my previous note in this regard:

Also causing extreme eye-rolling on my part is the $21.2M bill from PricewaterhouseCoopers for a "business plan" for the project. Why does M.D. Anderson need a multi-million dollar business plan for a scientific, oncology/genomic initiative?

It's Time to Register for the Pathology Informatics Summit in Pittsburgh; May 22 to May 25

It's time to register for the seventh annual Pathology Informatics Summit in Pittsburgh which is sponsored by the Association for Pathology Informatics. The dates are May 22-25 at the Wyndham Grand Pittsburgh Downtown. Navigate to the conference web site which also includes useful information such as current list of exhibitors which will greatly expand by the time of the event.

The conference will include four workshops on the first day (Pathology Informatics Review, HIMA Imaging Science, Molecular Pathology Informatics, and Digital Pathology Demonstration). No special registration or fee is required for the workshops. The main conference is divided into two parallel tracks: Research Informatics and Applied Informatics. Plenary session speakers announced thus far include the following: Ulysses Balis, Michael Becich, James Crawford, Eric Glassy, Rebecca Jacobson, Veronica Klepeis, Richard Moldwin, J. Mark Tuthill, Jeroen van der Lak, and John Waugh. 

Online registration for the Pathology Informatics Summit 2017 is available here. It ends on Sunday, May 14, 2017. Here's a link for hotel reservations. The PI Summit is the only conference in the U.S. devoted exclusively to research pathology informatics and applied knowledge in both anatomic and clinical pathology. Many lectures and exhibitors at the PI Summit will also be focused on digital pathology. The lineage of the meeting stretches back to the AIMCL conference launched in Ann Arbor thirty-four years ago. Here's a link to the conference "about" page that provides many more details. Come to mingle with your pathology informatics peers and be prepared for a multi-day learning experience and a vibrant exhibitor ballroom.

Epic Developing Less Expensive Versions of Its EHR; Pursuit of Smaller Hospitals

Epic Systems is continuing to solidify its position as a leading EHR vendor against competitors like Cerner and Allscripts. The company's current initiative is to develop lower priced versions of its pricey software aimed at smaller hospitals (see: New Epic EHR systems to carry lower prices, aimed at smaller hospitals). Below is an excerpt from an article on this topic:

New, more minimalist versions of the Epic EHR system will feature lower prices, though also less functionality. And these will be aimed at smaller hospitals.... New Epic EHR systems currently in development will come with lower price tags and will target smaller healthcare providers that have not traditionally been within Epic's orbit. The moves by Epic Systems Corp. mark the first time the company -- known for its large, expensive, comprehensive and sometimes difficult-to-install systems -- has eyed down-market opportunities. The two main new Epic EHR platforms are named Utility, a moderately smaller version of the larger Epic ecosystem the company now refers to as All Terrain, and Sonnet, a more significantly slimmed-down implementation of All Terrain with many fewer modules....

Larger health systems will also be able to install Sonnet in a section of their systems while using a configuration of the larger All Terrain offering in the rest of their network....In the meantime, [an Epic executive] said the new product offerings will target critical access hospitals, physician practices and post-acute care facilities, such as rehab hospitals -- a market that will pit Epic more directly against vendors such as athenahealth Inc. and Greenway Health LLC [and Meditech]...[He] declined to talk about pricing strategy, or identify specifically which features, capabilities or modules would not be available in Sonnet and Utility....Epic EHR systems are typically found at the country's biggest and most prestigious academic medical centers and integrated delivery networks. Boston-based Partners HealthCare spent about $1.2 billion upgrading its hospital system to Epic over the past few years. Hospital officials blamed the installation and associated training and other costs for part of the healthcare system's operating loss last year. 

So, by selling less expensive systems, Epic will theoretically be more competitive in the EHR market for smaller hospitals and even post-acute-care facilities while still integrating these facilities into the "Epic ecosystem." I blogged six years ago about Epic's pursuit of the smaller hospital market (see: Epic Moving into the Meditech-Dominated, Smaller Hospital EMR Market) and also its remote hosting model where large hospitals running the Epic EHR could support the EHR needs of smaller neighboring hospitals (see: Epic Helps Convert Its Large Hospital Customers into Epic Hosting Sites/Consultants). Of course, another EHR growth strategy would be to expand into countries outside of the U.S. However, the tendency for Epic to drive some of its client hospitals into the "red ink business" is not confined to the U.S. (see: Epic EHR adds to UK hospital's financial mess).

In the past, Epic has shown little interest in cloud-based solutions, indicating that larger and more complex health systems, their major customers, preferred to own and run their own computer systems (see: Epic's Faulkner: Large customers not buying into health IT cloud). One wonders, however, whether this renewed interest in smaller hospitals on the part of Epic will ignite more of an enthusiasm for cloud-computing. Here's an article dating back to 2014 indicating that the company was investing in a large data center (see: Epic Systems Corp. plans massive cloud data center). Many corporations outside of healthcare decided long ago that cloud computing was ideal for them. Here's a link to a Forbes article dating to 2013: The Cloud Hits the Mainstream: More than Half of U.S. Businesses Now Use Cloud Computing.

The Remote Clinical Trial: New Model Emphasizing IT and Subject Convenience

I get the sense that the design of clinical trials is being reexamined with an eye toward making them more efficient and convenient for subjects (see: Why Do Some Patients Enroll in Clinical Trials and Others Don’t?). I recently discussed the topic of "siteless" trials in a blog note (see: Site-Less Clinical Trials as a Possible Means to Democratize Them). To add to this discussion, I now want to refer to  "remote clinical trials" which were discussed in a recent article (see: The Remote Clinical Trial Concept In Clinical Research), Below is an excerpt from it:

The typical patient of the 21st century expects the experience of navigating the healthcare system to be on par with other customer experiences enhanced by modern technologies. However, the pharmaceutical industry has generally remained quite behind the curve when implementing digital health technologies and interacting with patients within the context of clinical trials. Remote trials—also called digital, virtual, or mobile trials—provide an interesting spin on the use of digital health components to enhance the patient experience....At its purest definition, a remote clinical trial eliminates or significantly reduces the contribution of clinical sites, keeping one central coordinating site for the study, generally one to which the principal investigator is affiliated. Patients enroll and conduct most or all trial procedures from the comfort of their own homes....

[The following are key elements in the organization of remote clinical trials:]

* Patient recruitment using digital approaches;

* Electronic informed  consent;

* Electronic data capture at the source (eSource);

* A robust monitoring strategy, including remote risk based monitoring, remote drug adherence monitoring, and telemedicine; and

 * A strong patient engagement strategy to keep patients engaged via the remote trial conduct....

A dedicated site with the necessary technological capabilities and a motivated principal investigator are essential for success. A smooth transition should then happen from the patient being recruited and referred to your trial, to being screened and starting the educational aspect of the consent process remotely. With a proper process in place, patients schedule a remote consultation—most likely a videoconference—with the principal investigator to finalize the eConsent process. This would ensure the required patient-physician interaction takes place to provide the patient all the information he or she needs prior to enrolling in the trial.

I believe that the "siteless" clinic trial is most relevant for the less complex studies which can be managed by health professionals other than physicians such as pharmacists. In contrast, the remote clinical trial described above is designed to reduce the number of clinical sites to one, generally the home site of the principal investigator (PI), However the approach greatly increases the need for sophisticated IT, often for the subject convenience. This increases patient engagement. For example, the eConsent process is completed via videoconference but this also provides excellent documentation of the process.

One important reason to switch to one coordinating clinical site is that this centralizes support for all of the critical IT function and support. I discussed the role of institutional review boards (IRBs) in a previous note (see: For-Profit IRBs Replacing Volunteer Hospital Boards to Oversee Clinical Trials). Here I mentioned that the NIH is requiring a single IRB oversee multi-center trials to simplify the process. It thus seems that one of the distinct advantages of the remote/digital/virtual clinical trial is that it usually involves only one IRB at the home location of the PI.

Multigene Panel Testing for Patients with Early-Onset Cancer of the Colon

In a recent note, I discused some theories about why the incidence of colonic cancer is increasing in younger patients (see: Why the Increased Incidence of Colonic Cancer Among Younger Americans?). Continuing in this same vein, a recent article I came across raised the issue of multigene panel testing to reveal genetic mutations in the roughly one-third of patents with early onset colonic cancer (see: Multigene Panel Testing Reveals Mutations in One-Third of Early Onset CRC Patients). Below is an excerpt from the article:

Although the overall incidence of colorectal cancer (CRC) has been decreasing in the United States over the past 15 to 20 years, the incidence of early-onset CRC has been increasing....[A]n important new study...used multigene panel testing to closely examine genetic mutations among CRC patients younger than 50. The researchers found that 16 percent of these patients did test positive for one or more genetic mutations, which might have important ramifications regarding heightened cancer risk for both the patients and their relatives.....[T]his study is the first time in which researchers used multigene panel testing to look at potentially important mutations among patients with early-onset CRC....The study of early-onset CRC patients was part of a larger study which included all CRC patients in Ohio, which is being run by the Ohio Colorectal Cancer Prevention Initiative (OCCPI). OCCPI is a statewide program involving 51 hospitals that screens newly diagnosed CRC patients and their biological relatives for Lynch syndrome, which is caused by the presence of a mismatch repair mutation in one of four genes and which heightens risk for not only CRC, but also uterine, ovarian, stomach and other cancers. Although most young CRC patients currently have their tumors screened for Lynch syndrome using tests for known changes that accompany that syndrome, the new study’s findings strongly suggest that this limited genetic testing is insufficient....The take-home clinical translation is that 16 percent of people under 50 with CRC [who undergo multigene panel testing will be found to] have something abnormal....While the cost of multigene panel testing has come down, making far more information available affordably, our current ability to interpret the results of such tests is limited. The tests often reveal a mutation or variant of unknown significance, one that is clearly not normal, but whose clinical importance (or lack thereof) is not yet fully understood. 

Here's a definition for the Lynch Syndrome (see: Hereditary nonpolyposis colorectal cancer):

Lynch syndrome (HNPCC or hereditary nonpolyposis colorectal cancer) is an autosomal dominant genetic condition that has a high risk of colon cancer  as well as other cancers including endometrial cancer (second most common), ovary, stomach, small intestine, hepatobiliary tract, upper urinary tract, brain, and skin. The increased risk for these cancers is due to inherited mutations that impair DNA mismatch repair. It is a type of cancer syndrome.

This information about genetic testing for patients with early-onset CRC represents one view of the beginning of a broad effort to genetically define the basis for the various cancer syndromes (see: Cancer syndrome) and asses the risk for individual patients who have one of them. This is a reasonable place to start that will eventually evolve into genetic cancer screening for the whole population. However, it's important to understand, as emphasized in the last sentence of the first quote above, that genetic testing can be fraught with difficulty. "[Genetic tests for young CRC patients] often reveal a mutation or variant of unknown significance, one that is clearly not normal, but whose clinical importance (or lack thereof) is not yet fully understood." In other words, even for patients with early onset CRC, genomic testing does not always produce an actionable, clear path forward for them or their relatives. 

Why the Increased Incidence of Colonic Cancer Among Younger Americans?

A spate of stories has been published recently about the increased incidence of colonic cancer among younger Americans (see: Why Are More Young Americans Getting Colon Cancer?). I have been interested in the epidemiology of colonic cancer since I was a medical student when I was taught that cancer of the colon ws very common in Argentina and Scotland because of the high beef consumption (see: Review on meat consumption and cancer in South America). This was believed to alter the colonic bacteria flora which, in turn, produced carcinogenic chemicals in the gut. Many decades later, we continue to speculate about the epidemiology of colonic cancer. Below is an excerpt from this first article:

More than a decade ago, scientists noticed an odd quirk in the data: While overall rates of colorectal cancer have been falling dramatically since the mid-1980s, there's been a steady uptick of this disease among people younger than 50.....What's driving that is hard to say. Obesity is more common among younger than it used to be, so perhaps it's partly to blame. Or it may not be obesity itself; it could be that poor diet and lack of exercise, which contribute to obesity, are also influencing colon cancer rates....[A] professor of medicine at the Dartmouth Institute for Health Policy & Clinical Practice says what look like additional cancers in people under 50 may simply be cases that are being diagnosed earlier than they would have been....There's no question that diet and other factors can also have a profound effect on cancer rates....The increased screening for colorectal cancer has been a significant factor in reducing the burden of this illness.

Here is a short list of some of the theories used to explain why younger people may now be experiencing more colonic cancer:

• Obesity is increasing in this age group which then causes an increased cancer rate (see: Does body weight affect cancer risk?).
• Younger people are exercising les, leading to more cancer (see: Trim your cancer risk with exercise).
• The diet of younger people may be changing, which in turn alters the GI microbiome and predisposes to colonic cancer. 
• Surveillance for colonic cancer is increasing, resulting in more colonoscopies and earlier detection and treatment of cancer. This results in an increased incidence of the disease but also reduced mortality.

The correct answer to the question presented in the caption of this note is that perhaps all of the above theories may be correct. Among them, what interests me most is the new research about the GI microbiome (see: Compositional and Functional Features of the Gastrointestinal Microbiome and Their Effects on Human Health). To conclude this note, here is a key quote from this article:

Beyond microbial richness and diversity, a healthy gut microbiome can be defined by the presence of classes of microbes that enhance metabolism, resilience to infection and inflammation, resistance to cancer or autoimmunity, endocrine signaling, and brain function (brain–gut axis). The microbiome may mediate these effects via secretion of factors that modulate intestinal permeability, the mucus layer, epithelial cell function, innate and adaptive immunity, intestinal motility, and neurotransmission