All 45 and older should be screened for colon cancer, earlier if you have family history of it; Ky. has made much progress against it

Colon Cancer Prevention Project graphic

Ky. Health News

March is Colorectal Cancer Awareness Month, which serves to remind everyone who is 45 and older – or is younger than 45 with a family history of colon cancer – to get screened.

That's because colorectal cancer is one of the leading causes of cancer-related deaths in Kentucky and often doesn't cause any symptoms, especially in early stages when the only way to detect it is through screening, says Dr. Avinash Bhakta, a colorectal surgeon at the University of Kentucky Markey Cancer Center. 

The Colon Cancer Prevention Project says regular screening is recommended to begin at 45 for people who do not have a family member who has had colon cancer and/or polyps. Those who have a family history of colon cancer should get a colonoscopy at age 40 or earlier. 

For those without a family history of colon cancer, two types of tests are recommended by the U.S. Preventive Services Task Force: visual exams (primarily colonoscopies) and stool-based tests that check a stool sample for signs of cancer. 

UK's Bhakta writes that while colonoscopy is the gold standard for screening that must be done in a clinic or hospital under sedation, stool-based tests offer an alternative that is less invasive and can be more accessible. 

Stool-based tests check for blood and/or abnormal DNA in the stool, and can be done in the privacy of your own home, Bhakta notes. The test is then returned to a doctor or mailed to a laboratory for testing. All at-home tests need to be repeated every year, and any positive findings will require a follow-up colonoscopy.

Colonoscopies involve finding pre-cancerous lesions and removing them before they turn into cancer, and that means that most cases of colorectal cancer are considered preventable. Screenings also allow physicians to find cancer at an earlier stage when it is more treatable.

And as Bhakta wrote in her headline,  "The best screening test is the one you take." 

Colorectal screening in Kentucky

Kentucky has made great progress when it comes to getting Kentuckians screened for colon cancer.

"Twenty years ago, Kentucky had the highest colorectal cancer incidence and mortality rates in the U.S., as well as the second-lowest colorectal cancer screening rate," Elizabeth Chapin reports for UK. "Today, thanks to the coordinated efforts of state agencies and organizations, these dire statistics have turned around. Since 2002, colorectal cancer screenings have doubled in Kentucky, which has led to a more than 30% decrease in incidence and mortality rates."

Much of this success is due to efforts made by the Kentucky Cancer Consortium in collaboration with several major cancer groups that worked to make colorectal screenings more accessible to Kentuckians.

"What we've seen happen with colorectal cancer rates in Kentucky over the past two decades is truly a public health success story," Thomas Tucker, the Markey Cancer Center's senior director for cancer surveillance, told Chapin. "It goes to show that significant change can happen when we work together and coordinate our efforts."

Chapin reports that the KCC and its partners' efforts inspired an initiative to encourage primary care physicians to recommend and schedule colorectal cancer screenings. It also brought about two successful Kentucky bills: the first, approved in 2002, requires all health insurers in Kentucky to cover the cost of screening for age-eligible patients; the second, passed in 2008, established the Kentucky Colon Cancer Screening Program to screen uninsured age-eligible patients and educate the public about the importance of being screened.

These initiatives helped move the state's colorectal cancer screening rates from 49th in the nation to 20th.

"The results have saved thousands of lives," Tucker told Chapin. "To put it into perspective, today, 650 fewer Kentuckians are diagnosed and 270 fewer die from colorectal cancer each year than in 2001."

The Kentucky Cancer Program has also worked with KCC to increase screening rates by fostering community colon cancer screening programs, Chapin writes.

"The KCP's success in increasing colorectal cancer screening rates is attributed to working within communities at the local level," said KCP-East Director Mindy Rogers. "As residents of the areas they serve, our specialists have an understanding of their communities and the particular barriers they face when it comes to cancer screenings, treatment and care."

Despite Kentucky's progress, Chapin reports that roughly a third of eligible Kentuckians still do not seek colorectal cancer screenings due to health, socioeconomic and education disparities. 

She adds that the KCP team is collaborating with community partners to identify resources that can help overcome barriers such as transportation and family care.

Both the KCC and KCP model has led to a similar screening effort around lung cancer, including legislation to create the lung cancer screening program in the Kentucky Department for Public Health. 

"There’s more work to do because the goal is to be ranked number one in the nation for screening rates,” Tucker told Chapin.  “But Kentucky has a number of barriers not faced by many other states and together, we’ve made some remarkable change in the face of these incredible challenges.”