March is Colorectal Cancer Awareness Month; Kentucky has the nation's fourth highest rate of death from colon cancer

Photo illustration by OnTheRunPhoto, iStock/Getty Images Plus

By Natalie Pitman
University of Kentucky

In March, we wear blue to recognize Colorectal Cancer Awareness Month, first observed in March 2000. Since then, it has become an opportunity to spread awareness about the importance of screening and honor those diagnosed with colorectal cancer.

Excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in both men and women. It’s estimated that 106,590 new cases of colon cancer and 46,220 new cases of rectal cancer will be diagnosed in 2024. Kentucky has the fourth highest rate of death from colon cancer in the nation.

“The good news is colorectal cancer is easier to prevent than most other cancers and is highly treatable. It is often curable when caught early, and we could dramatically reduce complications from this disease by getting more people screened,” says Darwin Conwell, M.D., UK HealthCare medical pancreatologist and Jack M. Gill Endowed Chair in Internal Medicine at the UK College of Medicine.

Let's talk about the importance of colorectal cancer screenings and why they should be a priority for everyone.

What is colon cancer? The colon and rectum are parts of the digestive system. Colorectal cancer begins when cells that are not normal grow inside the colon or rectum. Early symptoms may be subtle, making regular screenings crucial for early detection.

Who should get screened? Most people should begin getting screened at age 45. You may need to begin screening earlier. Talk with your provider if you or a close relative has had colon polyps or colon cancer, or if you have an inflammatory bowel disease.

What are the different screenings? Screenings play a pivotal role in catching abnormalities before they turn cancerous. Detecting and removing polyps during screenings significantly reduces the risk of colorectal cancer.

There are different tests to detect colorectal cancer. For most people, the best test is the one they can complete. Talk with your primary-care provider about which test is right for you. More information is provided below or click on this link for a flyer.

UK HealthCare offers three types of colorectal cancer screening tests:

• Colonoscopy: The provider performing the screening can see and remove growths (polyps) in the colon and rectum during this test to prevent or detect colorectal cancer. You will need to take off work the day of the procedure. Some patients who take off the day before the procedure as well to complete bowel preparation. If a polyp is detected, it can be removed during the procedure. Screening is conducted every 10 years if results are normal.
• Cologuard: Your healthcare provider will order the Cologuard test to screen for colorectal cancer. Cologuard can be completed at home and is designed to detect abnormal cells in your stool. After you collect the sample, follow the Cologuard instructions to mail the sample to a lab. Results are sent to you and your provider. Screening is conducted every three years if results are normal.
• FIT Tests: The provider will test your stool sample for blood, by ordering a FIT test. You can complete the FIT test at home. Screening should be completed every year if results are normal.

A positive Cologuard or FIT test result is not the same as a cancer diagnosis, so please talk to your health care or telehealth provider for next steps.

“Colonoscopies are considered the gold standard for colorectal cancer screening, but stool-based tests like Cologuard or FIT tests can be a more accessible option if work, transportation, or family obligations are preventing you from getting a colonoscopy,” said Dr. Avinash Bhakta, a UK Markey Cancer Center colorectal surgeon. “Regardless of the test you choose, the most important thing you can do is get screened regularly.”

If you have a primary-care provider, or if you are in for a checkup or treatment, ask them if you’re due for your routine colorectal cancer screening. Based on your health history, they will be able to tell you which screening option is best for you.

Screening can help detect early signs and help monitor situations that can increase your risk of developing colorectal cancer. Getting screened for colorectal cancer is one of the most important ways you can take charge of your health.

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.”

Colorectal cancer screening should begin at age 45, says federal panel, following American Cancer Society's advice of 2 years ago

By Melissa Patrick

Kentucky Health News

A federal task force now recommends that adults with a normal risk for colorectal cancer get their first screening at age 45, instead of 50, as the American Cancer Society has recommended since 2018. 

Kentucky already requires health insurance plans to start screening for colorectal cancer at 45, and pay for it without any patient cost sharing, under legislation passed by the 2019 General Assembly.

But many other states still follow the U.S. Preventive Services Task Force guidelines, making this new guidance a welcome change in policy, Dr. Whitney F. Jones, founder of the Colon Cancer Prevention Project, said in a news release. 

“This long-anticipated and overdue course correction proposed by USPSTF is welcome in our state and nationally by patients and advocates,” said Jones. “In Kentucky, the potential to prevent colorectal cancers and reduce colorectal deaths for the 225,000 people between age 45 and 49 will further advance our nation-leading improvements in colorectal cancer screening rates.”

Kentucky leads the nation in colon cancer, but is nationally recognized for getting its citizens screened for it, with about 70% of Kentuckians who are 50 and older reporting  they have been screened for it. In the last 10 years, Kentucky colon cancer screenings have resulted in a 25% reduction in incidence and a 28% reduction in death, according to the prevention project website.

The state law on screening, sponsored by Sen. Ralph Alvarado, R-Winchester, also requires health plans to cover genetic tests for cancer, including those for colon cancer.  It took effect Jan. 1.  

The federal task force's proposal is still a draft open for public comment until Nov. 23. The task force is an independent group of experts appointed by the Department of Health and Human Services.

Once finalized,  private insurance plans that are subject to the Patient Protection and Affordable Care Act and Medicare plans would be required to cover colorectal-cancer screening with no co-pay or out-of-pocket cost, according to a group of colorectal-cancer organizations.

Like the Cancer Society's advice two years ago, the task force's decision is largely driven by increases in colorectal cancer in younger adults. The society says 12% of colorectal cancers will be diagnosed in people under 50. 

"Rates have been increasing since the mid-1980s in adults ages 20-39 years and since the mid-1990s in adults ages 40-54 years, with younger age groups experiencing the steepest increase," the society says. It also reports that in African Americans, colorectal-cancer rates are about 20% higher than whites, and death rates are almost 40% higher. 

Timely screening is important because colorectal cancer usually starts from polyps in the colon or rectum that can only be found during a screening so that they can be removed before they ever turn into cancer. Further, there are no symptoms for polyps or early colon cancer. 

"It is estimated that six out of 10 deaths from colon cancer could be prevented if everyone were screened at 45," says the prevention project.

The draft recommendations cover two types of screenings for colorectal cancer, including a direct visualization tests, such as a colonoscopy, or tests that can detect signs of cancer from a stool sample. 

Stool-based tests are noninvasive and can be done at home, but must be done more frequently. Colonoscopies are generally recommended every 10 years after the first one is done, as long as the patient is considered low risk. 

For people aged 76 to 85, the task force continues to recommend that the decision to be screened be made on an individual basis. 

Black Kentuckians need more information about colon cancer screening, especially the availability of in-home tests, study finds

Most focus-group participants in Louisville said they had not
been offered stool-based testing as an option for colorectal
cancer screening, stressing the need for more community-
based outreach. (Photo by fizkes, iStock/Getty Images Plus)

By Elizabeth Chapin

University of Kentucky

A recent study at the University of Kentucky's Markey Cancer Center highlights the need for increased outreach and education to reduce colorectal cancer screening disparities in Black communities.

According to the study, published in the Journal of Cancer Education, people in Kentucky’s Black communities may not be aware of all of the colorectal-cancer screening options available to them, particularly stool-based tests.

Black communities are disproportionately affected by colorectal cancer. In Kentucky, Blacks who have colorectal cancer are more likely to die from the disease than whites.

Since about half of the racial gap can be explained by differences in screening rates, educating Black communities about screening options can save lives, says Markey Cancer Center researcher Aaron Kruse-Diehr, the study’s principal investigator.

“In the colorectal-cancer screening world, we like to say ‘the best test is the one a patient completes’ — and giving people multiple options has been shown in previous studies to increase their likelihood of completing screening,” said Kruse-Diehr, who is an associate professor in the UK College of Medicine. “To reduce the Black-white colorectal cancer mortality rate, we need to make sure Black people of screening age are being provided all available options.”

Regular screening, beginning at age 45 is the key to preventing colorectal cancer and finding it early. Two types of tests are recommended by the U.S. Preventive Services Task Force: visual exams (primarily colonoscopies) and tests that check a stool sample for signs of cancer. Stool-based tests are less invasive and, for many, more accessible since they can be done at home.

Kruse-Diehr said, “Home tests can reduce a number of both individual-level and structural barriers that often exist for many people with respect to completing colonoscopy, such as needing to take time off work, finding an individual to drive the person to/from the procedure, and travel distance to a provider who can perform colonoscopy.”

The research team partnered with five Black churches in Louisville, which has bihg racial differences in screening, to conduct focus groups exploring screening barriers and facilitators for cancer education and outreach.

While focus-group participants overwhelmingly recognized the importance of being up to date with screening, nearly all reported that they had never heard about stool-based tests or heard health-care providers offer them as an option.

To address this knowledge gap, participants stressed community-based outreach and communication from trusted individuals, such as local Black medical providers and colorectal cancer survivors.

Kruse-Diehr led the study with Elizabeth Holtsclaw, cancer support strategic partnerships manager at the American Cancer Society. Two of the study’s co-authors, College of Public Health undergraduates Carlee Combs and Rose Wood, helped analyze the data and write the results as part of an independent-study course.

The research team is now planning to pilot a church-based screening program with one of the partner churches, with hopes of eventually expanding the program across Kentucky.

“These study results are informing outreach efforts that we hope will make a huge dent in the death rates from colorectal cancer among Black Kentuckians,” said Kruse-Diehr.

Kentuckians rank high in colorectal cancer deaths; study will use emergency rooms to promote screening to save lives

University of Kentucky College of Nursing Associate Professor Jennifer Hatcher has received a two-year $359,528 grant for her project, “Promoting Colorectal Cancer Screenings in Rural Emergency Departments.”

The grant, given by the National Cancer Institute, will be used to study how effective motivational interventions are in helping non-emergency patients in rural Appalachian emergency departments to get screened for colorectal cancer, Hatcher said in an interview. Patients' companions in the emergency rooms can also participate in the interviews.

Of cancers that affect both men an women, colorectal cancer is the second leading cause of cancer-related deaths in the United States and the third most common cancer in men and in women, according to the Centers for Disease Control and Prevention.

Kentucky leads the way in these national health statistics.  It has the highest rate of colorectal cancer in the nation at 55.1 per 100,000 and is the fourth highest in the nation for deaths caused by colorectal cancer at 19.8 per 100,000. And those in Kentucky's Appalachian counties have a higher incidence rate than the rest of the state and nation overall at 57.2 percent, according to a Kentucky Colon Cancer Screening Program annual report.

“Residents of rural Appalachia have a higher incidence and mortality rate from colorectal cancer than residents of any other region of the country," Hatcher said in the release. "In light of the fact that colorectal cancer is one of the few cancers that can actually be prevented by screening, this grant presents a tremendous opportunity for us to address one of the key factors affecting this disparity for rural Appalachians—limited access to the health care system."

The interventions for the study will be conducted by lay health workers, trained local people who are interested in the health of the community and helping their neighbors get screened. They will talk to the patients or their companions about their perceived barriers related to colorectal screening and help them work toward resolving those barriers. All interactions are voluntary, Hatcher said in an inteview.

The lay health workers act as connections between the patients and whatever resources they may need to get screened, or helps alleviate fears they may have about colorectal screening. They are also trained to provide education on what types of screenings are available and discuss what is best for each individual.

Patients who agree to the intervention will get a follow-up call one week after the emergency room intervention to see if they need further assistance in setting up a screening and will receive yet another call in three month.

The project will be the first to address the disproportionate incidence and mortality from colorectal cancer in rural Appalachia utilizing the emergency department as an access point, says the release.

"We believe that using an emergency department as an access point for this project will allow us to reach more individuals who are at risk for developing colorectal cancer, thereby reducing the disparate mortality rates that rural Appalachians suffer from this disease,” Hatcher said in the release.

Kentucky will get money to increase colon cancer screenings in Louisville and Appalachia, which lag behind recent success

By Melissa Patrick
Kentucky Health News

Kentucky will receive about $2.6 million in federal money over five years to help fight colon cancer by encouraging people to be screened for it, with a focus on populations in Louisville and Appalachia.

"Those regions have large numbers of underserved, underscreened residents," Gov. Steve Beshear said at a press conference. Screening rates are lower among African Americans, men, the poor and the less educated.

Lt. Gov. Crit Luallen, a colon-cancer survivor, said "Colon cancer is the one cancer we can prevent through early screening and detection. And if it is caught early, it can be treated effectively."

According to the federal Centers for Disease Control and Prevention, the five-year survival rate for colon cancer is 90 percent when it is found and treated early. In 2013, the last year for which data are available, Kentucky ranked first in colon cancer and fourth in colon-cancer deaths, according to the Colon Cancer Prevention Project.

This Kentucky Cancer Consortium graph shows the
deaths from cancers with evidence-based prevention
or early detection methods in Kentucky in 2005-09.

Kentucky has both the highest rate of new cancers and deaths from cancer in the nation, many of them preventable through early screening and detection. But preventive screening among those who have recently gotten insurance for the first time and those without insurance is not the norm, partly because people who have been accustomed to getting health care only when something seems wrong often don't understand the importance of preventive screening or that these services are provided free of charge if they have Medicaid or private insurance.

A recently reported CDC study found that Americans with insurance or with higher incomes were up to three times more likely than those without coverage or with lower incomes to receive preventive screenings and services, which has certainly been the case with Kentucky's expanded Medicaid population.

A Department for Medicaid Services report found that preventive screenings rose sharply in 2014 among Medicaid recipients in Kentucky: colorectal cancer screenings rose 108 percent to 35,633; breast cancer screenings rose 111 percent to 51,292; cervical cancer screenings rose 88 percent to 78,281;cholesterol screenings rose 111 percent to 170,514; preventive dental services rose 116 percent to 159,508, to name a few. This increase in preventive care is expected to improve the future health outcomes of Kentuckians and to help decrease future cost by catching problems earlier.

Kentucky has made great strides in fighting colon cancer.

In 2002, the Kentucky Cancer Consortium began an initiative that brought more than 60 different agencies and organizations together to fight colon cancer. At the time, Kentucky's colorectal-cancer screening rate was next to lowest in the nation, said Dr. Tom Tucker, senior director for cancer surveillance at the University of Kentucky's Markey Cancer Center and director of the Kentucky Cancer Registry.

Seven years later, the screening rate rose from one-third of the eligible population (those are 50 or older) having ever been screened to nearly two-thirds. This caused a 24 percent decrease in the incidence of colorectal cancer and a 28 percent drop in deaths from the disease, Tucker said.

"A 24 percent decrease in incidence means that each year 230 Kentucky residents who would have been diagnosed with colorectal cancer no longer get the disease," he said.

"This is a remarkable public-health accomplishment," Tucker said. "But we are clearly not done," since the state still ranks first in colon cancer. "The new grant just announced by the governor will be an essential resource in helping us reach this last one-third of the eligible Kentucky population with lifesaving colorectal screening."

Since 2012, Kentucky has also provided colorectal screenings to the uninsured through a partnership with the nonprofit Kentucky Cancer Foundation, which matched $1 million in state funds in both 2012 and 2014 to pay for the program.

This year, the legislature passed a law to make sure doctors are coding colonoscopies as screening and not diagnostic, to make sure patients are not charged for the procedure.

Another effort to combat cancer in Kentucky is through the Horses and Hope Program, led by First Lady Jane Beshear, who, along with the Kentucky Cancer Program, Kentucky One Health and the University of Louisville's James Graham Brown Cancer Center, is working to raise $1 million for a mobile cancer screening unit which will provide free or reduced-cost cancer screenings across Kentucky.

“Kentucky has transformed into the state with the broadest number of colon-cancer screening options and the lowest barriers for colon-cancer screening,” said Dr. Whitney Jones, founder of the Colon Cancer Prevention Project and co-founder of the Kentucky Cancer Foundation. "Hopefully, we will be one of the first Southern states, if not the first state, to screen 80 percent of our population by 2018."

People in the most rural areas are more likely to die from colon cancer even though they are less likely to get it in the first place

Patients who live in remote or very small rural communities are a bit more likely to show up at their doctor's office with late-stage colon cancer than other Americans, which could help explain why patients who live in these areas have such poor colorectal cancer outcomes, a new study says.

Johns Hopkins Medicine image

The study, published in The Journal of Rural Health, looked at the relationship between late-stage colorectal cancer at diagnosis and county-level characteristics, including the level of rurality (how rural a place is), patient characteristics, and factors such as persistent poverty, low education, and low employment.

The study notes that cancer outcomes are often worse for rural patients, with various studies finding they have an 8 to 15 percent greater chance of dying from colon cancer.

"While rural communities overall have lower incidence of cancers compared to urban populations, they have higher cancer-related mortality rates," says the report. In other words, people in the most rural areas are more likely to die from colon cancer even though they are less likely to get it in the first place.

The researchers identified 132,777 patients in Kentucky and nine other states who had colorectal cancer in 2010-14. After placing patients in five rural-to-urban categories, the study found that the adjusted percentages of stage 4 colon-cancer patients by county geography were: metropolitan areas, 19.3 percent; micropolitan areas (with a city of 10,000 to 50,000) adjacent to a metro area, 20.4%; non-adjacent micropolitan areas, 19.2%; small rural places, 20.2%; and remote rural places, 22.7%.

"Patients living in remote, small counties were significantly more likely to present with stage 4 colorectal cancer than patients living in other counties," the study report says.

The data came from cancer registries in California, Connecticut, Georgia, Hawaii, Iowa, Kentucky, Louisiana, New Mexico, Utah and Washington. The registries included 352 rural and 235 urban counties, representing 18% and 20% of all rural and urban U.S. counties, respectively.

Among the 10 states studied, "Patients in Kentucky had the lowest adjusted rate (18.2%) of stage 4 diagnosis," the report says.

Kentucky's rate of colon cancer is the nation's highest, but the state has been nationally recognized for getting its citizens screened for it. A University of Kentucky news release in March said the Kentucky Cancer Consortium received an award for its efforts to increase screening. The release said that between 1999 and 2016 screening rates in Kentucky rose from 35% to 70%, improving more than any other state in the country and moving the state from a ranking of 49th to 17th.

Breakdown of study; click on image for a larger version

The study found that younger patients, black patients and single or widowed patients were more likely to present with late-stage colorectal cancer. The researchers note that these findings are consistent with decades of data and suggest that little or no improvement has been made in addressing these disparities.

It also found that a lack of insurance was the most significant predictor of late-stage diagnosis, which was also consistent with other research.

"Patient medical insurance categories had the greatest effects on the rate of stage 4 colorectal cancer at diagnosis. The rate was highest among uninsured patients (28.6%) compared to patients with any type of Medicaid insurance (24.4%) and other insured patients (18.4%)."

In addition to a known lack of screening services in rural areas, "the high cost of colonoscopy, access to specialty referral networks, lack of transportation, and lower health literacy may all play a role in these findings," says the report.

The American Cancer Society recommends colorectal screening for average risk individuals to begin at the age of 45, instead of 50. Those with a family history of colon or rectal cancer should check with their doctor about getting screened earlier. Colon cancer is 90 percent curable when detected early.

Colorectal cancer has declined, except in people under 30; overall, it's more common in Kentucky than in any other state

By Melissa Patrick
Kentucky Health News

Colorectal cancer has become less common since the mid-1980s, but has been increasing steadily in people younger than 50, according to a recent American Cancer Society study.

Infographic : The ColonCancer Prevention Project

Darla Carter of the Courier-Journal tells the story of Keisha Dalton, who was 30 when she noticed blood in her stool after eating spicy food and thought it was from hemorrhoids, but learned through a colonoscopy that it was cancer.

“I never thought in a million years that I would have colon cancer,” the Louisville mom told Carter. But she did.

The research, published in the Journal of the National Cancer Institute, found that while colorectal cancer rates have declined in adults age 55 and older since the mid-1980s, they increased in adults ages 20 to 39 by 1 to 2.4 percent in that period; and by 0.5 to 1.3 percent a year in adults aged 40-54 since the mid-1990s.

Rectal cancer rates increased by about 3 percent per year among people in their 20s from 1974 to 2013 and among people in their 30s from 1980 to 2013; and by 2 percent in adults ages 40 to 54 from the 1990s to 2013.

Put another way, people born in 1990 have double the risk of colon cancer and quadruple the risk of rectal cancer compared to someone born around 1950, when the risk was lowest.

The New York Times gives these numbers some perspective: "The risk of colon cancer for individuals in 1990 was 5 per million in that birth group, up from 3 per million at the same stage of life for those born in 1950. And the risk of rectal cancer for those born in 1990 was four per million, up from 0.9 million for those born in 1950."

The upward trend deserves attention, say the researchers and the Colon Cancer Prevention Project, which says one in seven colon cancer diagnoses are among people under 50.

The CCPP stresses on its website that everyone needs to be aware of the signs and symptoms of colon cancer and that providers must get an accurate family history "long before the age of 50" to make sure that people with a family history of colon cancer get screened earlier.

The study examined about 500,000 cases of colorectal cancer from 1974 to 2013. breaking down the cases by five-year age groups and by year of birth. The research does not explain the reasons for this increase in young people, but the report says increased obesity rates, poor diets, and lack of exercise are likely contributors.

And because many young people like Dalton attribute rectal bleeding to hemorrhoids and routine screening is generally not recommended for most people under 50, these cancers are often in more advanced states when they are discovered. The ACS says people under 55 are nearly 60 percent more likely than older adults to be diagnosed at a more advanced stage than those 55 and over.

The good news is that colorectal cancer rates for those older than 50 have fallen by 32 percent since 2000, while deaths from the disease fell 34 percent, likely due to increased screening, which detects and removes precancerous polyps, according to a separate study by the ACS.

This separate report notes that while every state saw a drop in colorectal cancers rates among people aged 50 and older, the slowest declines were seen in states with the highest rates, like Kentucky, which leads the nation in the incidence of colon cancer and ranks No. 4 for deaths from it.

The study authors recommend that because of this study, screening should be considered before age 50. The ACS said it is considering this suggestion.

Meanwhile, Dalton told Carter that she now educates others about colon cancer and encourages people to have open discussions with the provider, even if they are embarrassed by their symptoms or think they are too young to get cancer.

It's important to "make sure they do a colonoscopy, do any type of testing they can do, because you cannot take no for an answer," Dalton said. "This is your life. You're only getting one life."

Early colon cancer often has no symptoms, but if there are symptoms, they may include: change in bowel habits, rectal bleeding, cramping or abdominal pain, weakness and fatigue and unintended weight loss, according to the ACS. The CCPP says you can reduce your risk of colon cancer by staying active, reducing or eliminating red and processed meat, maintaining a healthy weight and stopping smoking.

UK receives $3.75 million from CDC to use for colorectal cancer screening in Kentucky River's headwater counties

The University of Kentucky Rural Cancer Prevention Center has received a $3.75 million, five-year grant renewal from the Centers for Disease Control and Prevention to use toward the prevention of colorectal cancer in Central Appalachia and other rural areas.

The UK Center is one of 26 CDC-funded Prevention Research Centers in the country, Mallory Powell reports for UKNow. It works with a team of community members, public health professionals and researchers to conduct and support community-based, participatory prevention research toward rural cancer prevention in the Kentucky River Area Development District.

Over the next five years, this $3.75 million grant will allow Dr. Richard Crosby, director of the RCPC and his team to develop, implement, and disseminate an at-home colorectal screening test that has the potential to drastically increase annual colorectal cancer screenings in rural areas, Powell reports.

Kentucky has the nation's highest rates of cancer incidence and death, with more people from Appalachian Kentucky dying from colorectal cancer than those diagnosed with the same cancer in other regions of the state.

"This is about serving Kentuckians, and we are targeting an area of rural Appalachia that has extremely high rates of colorectal cancer morbidity," Crosby told Powell. "We're focusing on a project that engages people at a point when we can still do something to prevent their death."

The at-home colorectal screening test will allow the person to collect a small stool sample per instruction in the privacy of their home and mail it in the provided kit to the lab for testing, Powell notes. The lab will then determine if there are any potentially cancerous cells. If the test comes back positive, the RCPC staff will assist the participant with further testing and treatment as needed.

Colorectal cancer is usually a slow growing cancer and has a higher survival rate if detected and treated early. Late diagnosis because of delayed or lack of screening causes the chance of survival rate to significantly drop.

Delayed or lack of screening for colorectal cancer is often a problem for people living in rural areas like Appalachia because of healthcare access, Powell notes. The Kentucky River ADD falls into this category, since all eight counties in the district are classified as health-care professional shortage Areas by the Health Services and Resources Administration. This district is also one of the poorest in the nation.

The colorectal screening work of the RCPC will build on the successes of its previous prevention program for cervical cancer prevention and screening, which is now being used in 18 local Kentucky health departments and has also been adapted for use in 30 local health departments in North Carolina.

UK center promotes at-home test for colorectal cancer, reports on efforts to get young women vaccinated for cervical cancer

More people in Appalachian Kentucky die from colorectal cancer than in any other region of the state. A screening project of the Rural Cancer Prevention Center at the University of Kentucky is working to decrease those rates.

Cancer Registry maps show in color Kentucky counties served by the Appalachian Regional Commission,
and rates for invasive cancer and cancer mortality in Appalachian Kentucky and the balance of the state.

In July 2014, the center received a $3.75 million, five-year grant renewal from the federal Centers for Disease Control and Prevention for a colorectal cancer at-home screening prevention project in Central Appalachia and other rural areas. The UK Center is one of 26 CDC-funded Prevention Research Centers in the country.

Tom Collins, associate director of the RCPC, gave an update on its project at a Center for Clinical and Translational Science clinical research update meeting at UK Oct.18. Robin Vanderpool, associate professor in the College of Public Health, discussed the results and successes of its completed cervical-cancer screening project.

Early screening and prevention are key to surviving colorectal cancer. The CDC says that most deaths caused by colorectal cancer could be prevented if everyone over the age of 50 got screened. And if detected early, treatment for colorectal cancer is highly effective.

In 2013, the last year for which data is available, Kentucky ranked first in colon cancer and fourth in colon-cancer deaths, according to the Colon Cancer Prevention Project.

The project's title and motto is "I did FIT." FIT stands for fecal immunochemical test, an at-home test that allows a person to collect a small stool sample in the privacy of their home and mail it in a provided kit to the lab for testing. The FIT test must be done every year.

Since June 2015, the UK center has distributed more than 700 kits, with a 60 percent return rate in the eight-county Kentucky River Health District. Those with a positive test result, about one in six, have been offered a colonoscopy with follow-up; the rest have been invited to be part of the research, which is ongoing.

To help determine the best way to get people to do a yearly test, researchers divided the volunteer participants into two groups: one that gets social media and personal messages about it along with the traditional standard of care and another that gets standard of care alone. A year and a half remains in this portion of the research.

Cervical cancer and the HPV vaccine

Collins said they are trying to build on the success of the UK Center's previous prevention program for cervical cancer prevention and screening, called "1-2-3 Pap."

Prevention Research Center graphic; click on it to view a larger version

This UK center study promoted the human papillomavirus vaccination to prevent cervical cancer in Appalachia, which also has a higher incidence and mortality rate for cervical cancer than the rest of the state.

The three-dose HPV vaccine was approved by the federal government 10 years ago and is recommended for all adolescent girls and boys 11 and 12 years old. It is approved for females between 9 and 26 and is nearly 100 percent effective in preventing pre-cancers and noninvasive cervical cancers caused by two strains of the virus.

Kentucky falls in the bottom 10 states for HPV vaccinations, with 37.5 percent of its girls and 13.3 percent of boys aged 13-17 vaccinated as of 2014.

An earlier study of adult Appalachian women aged 18-26 that were offered the first HPV vaccination free found that 45.1 percent got the first dose, 13.8 percent got the second dose and only 4.5 percent got all three doses. This and other formative research prompted the UK Center to start a two-stage HPV vaccine promotion program for women aged 19-26 in the Kentucky River Health District.

First, researchers launched a marketing campaign to recruit the women in for the first dose. Then, participants were asked to participate in the study, which was designed to promote adherence to doses two and three. The volunteer participants were randomly separated into two groups; one participated in an informational video-based intervention that was made using local people along with the traditional standard of care; the other was offered standard of care alone.

The study found that 43.3 percent of the young women who watched the DVD completed the three-dose HPV vaccine series, while 31.9 percent of the women in the comparison group completed the series.

Vanderpool said the "take-home message" was that women were two and one-half times more likely to complete the series if they watched the DVD.

Since the completion of the study, 18 Kentucky health departments now use the DVD to promote completion of the three-dose HPV series, and it has also been adapted for use in North Carolina and West Virginia.

Kentucky and Ohio researchers get $5.7 million grant to improve Appalachian colorectal cancer screening and follow-up care rates

Researchers in Kentucky and Ohio have received a $5.7 million grant from the National Cancer Institute to increase colororectal cancer screenings and follow-up care among under-served people in Appalachia.

The research will be led by the cancer centers at the University of Kentucky and The Ohio State University. "We are excited to have the opportunity to take on the challenge of promoting colorectal cancer screening and follow-up in rural communities that have an elevated burden of this disease," said Mark Dignan, co-leader of the Cancer Prevention and Control Research Program at UK'.

The five-year study is designed to help community health centers and communities implement multi-level evidence-based strategies to increase their rates of colorectal cancer screenings, as well as follow-up and referral-to-care for patients between the ages of 50 and 74.

Kentucky has doubled its colorectal screening rates in the past 20 years, "but more work is needed to increase access to screening and follow-up care in the Appalachian region," says the news release.

"Rates of colorectal cancer incidence and related mortality in Appalachia are among the highest in the United States, and far too many people in this region do not receive potentially life-saving colorectal cancer screening," said Electra Paskett, co-leader of the cancer research program at OSU.

In Appalachian Kentucky, for every 100,000 people, 50.6 colon and rectum cancer cases were reported in 2012-16; the non-Appalachian counties everaged 57.9 cases per 100,000, according to the Kentucky Cancer Registry.

In that same period, 4,275 Kentuckians died from colon and rectal cancer, according to the Centers for Disease Control and Prevention. For every 100,000 people in Kentucky who died from these cancers, 19.8 of them lived in Appalachian counties and 15.4 of them lived outside the region.

The study was piloted in Lewis County, Kentucky and Guernsey County, Ohio, with activities rolling out to 10 other counties over the next three years, including Breathitt, Carter, Lawrence, Morgan and Powell counties in Kentucky and Adams, Belmont, Hocking, Lawrence and Morgan counties in Ohio.

Deaths from colorectal cancer in Appalachian Kentucky have declined, but far less than in the rest of the nation, UK study says

County rates per 100,000 are seen in five ranges or quintiles.(Map adapted by Kentucky Health News)

Kentucky Health News

Deaths from colorectal cancer in Appalachian Kentucky declined from 1999 to 2020, but far less than the rate of decline in the rest of the nation.

That's the upshot of a University of Kentucky study analyzing death data.

It found that in the 54 Kentucky counties served by the Appalachian Regional Commission, the mortality rate fell from 31.24 deaths per 100,000 residents in 1999 to 24.46 per 100,000 in 2020. But the national rate dropped by almost half, from 27 deaths per 100,000 Americans in 1999 to 14.81 in 2020. In non-Appalachian Kentucky, the rate dropped from 27.6 to 17.1.

During the entire 21 years covered by the study, the colorectal-cancer death rate in Appalachian Kentucky was 25.8 per 100,000 residents. In the 66 non-Appalachian counties, the rate was about 22 per 100,000. The national rate was 19.43 deaths per 100,000. Kentucky has the fourth highest death rate. 

The Kentucky county with the highest age-adjusted rate from 1999 through 2020 was Fleming, at 39.6 deaths per 100,000 residents. The next highest were Harlan, 34.4; Bath, 33.2; Pike, 32.1; Breckinridge, 31.6; Henry, 31.5; Todd, 31.1; Carter, 30.7; Lewis, 30.7; Cumberland, 30.6; Mason, 30.5; Lawrence, 30.4; Morgan, 30.4; Clay, 30.2; Letcher, 29.7; Washington, 29.4; Nicholas, 28.6; Breathitt, 28.5; Perry, 28.5; Floyd, 28.3; Monroe, 28.3; Powell, 28.2; and Nelson, 27.9 (all in dark blue on the map).

The counties with the 10 lowesr rates were Lyon, 14.9 per 100,000; Trimble, 16.97; McCracken, 17.7; Jessamine, 18.2; Shelby, 18.3; Madison, 18.4; Bullitt, 18.7; Trigg, 18.8; and Owen, 18.8.  Rates for Hickman and Robertson counties were not reported due to small case numbers.

The study, in the journal Gastroenterology, used data from the Centers for Disease Control and Prevention on the causes of death for Americans 15 or older. Its lead author is Dr. Syed Hassan, a research coordinator and clinical research scientist in UK's Department of Internal Medicine.

Hassan "said efforts to enhance screening rates should be improved and more education on colorectal cancer is needed," according to a UK news release.

He noted that In Appalachian Kentucky, nearly 41% of the colorectal cancer deaths occurred at home, suggesting that many victims might not have been seen by a doctor until the cancer had significantly advanced.

“That’s concerning, in my opinion,” Hassan said. “Access to health care, lifestyle related modifiable risk factors and education are important factors we should further work upon.”

Hassan also said anxiety about colonoscopies and other cancer screenings, and lack of education about the disease, may also play a role: “Many of these patients might’ve believed that they probably wouldn’t be able to afford as much care due to their socioeconomic status.”

Screening for colon cancer is recomended to start at age 45, because cancers of the colon and rectum tend to occur after age 40, but recent studies have shown increases in younger people, especially those with risk factors.

These cancers tend to run in families; studies show that if a close relative has had colorectal cancer, you can be predisposed to polyps — pre-cancerous lesions that can lead to the development of the cancer,

Other risk factors include age and lifestyle factors such as smoking, sedentary living, obesity, a diet rich in red meat, salt and saturated fats or a low-fiber diet.

Officials hope reduction in Ky. colon cancer deaths via screening can be replicated with lung cancer, in which state is No. 1

Health officials in Kentucky, especially in the eastern part of the state, hope to increase lung-cancer screenings by following a successful colon-cancer screening initiative, Jackie Judd reports for PBS NewsHour. (Centers for Disease Control and Prevention graphic: Colon-cancer screenings are up)

In rural Eastern Kentucky, smoking and lung cancer rates are double the national average, while the state is second in adult smoking rates and leads the nation in lung cancer and rates of death from it. That is "fueled by a toxic combination of poverty, medical illiteracy, limited access to care, lifestyle choices like smoking, and a fatalism that says knowing you have cancer won’t save you."

Another challenge is that local bans of smoking in public places have left two-thirds of residents living in areas with no such bans, and a statewide ban seems unlikely because it failed to pass the state House this year after narrowly passing last year. New Republican Gov. Matt Bevin opposes a statewide ban.

Fifteen years ago Kentucky led the nation in "both the highest incidence and mortality rates for colorectal cancer," Allison Perry reports for University of Kentucky News. Rural residents didn't seek care, partly because of a lack of facilities and partly because of a refusal to schedule an appointment. If local residents wouldn't seek care, health officials decided to bring care to local residents.

"In the seven years following this new focus on colorectal cancer, the screenings rates nearly doubled, from 34.7 percent of the age-eligible population receiving screenings to 63.7 percent," Perry writes. "This raised Kentucky’s rank from 49th in the country to 23rd compared to other states. No other state has had such a dramatic increase in colorectal screenings in such a short period of time. As a result, the lives of many Kentuckians have been saved: the incidence rate for colorectal cancer is down nearly 25 percent, and the mortality rate has dropped 30 percent. Through colorectal screenings, doctors can find precancerous lesions and remove them before they become cancer. Screenings also allow physicians to find these cancers at an earlier stages, when they are more likely to respond to treatment."

The number of cancer screenings jumped in 2014 and 2015, as the state expanded eligibility for the Medicaid program under federal health reform, making many more people eligible for free screenings. Bevin is seeking change the state's program in ways that could require co-payments, premiums and deductibles.

In Kentucky "the challenge is to not only encourage certain lifelong smokers to get screened, but to get them to quit, and for others to never start," especially because of the addictive nature of smoking, Judd reports. "It will be even more difficult than changing the profile of colon cancer, because smoking involves addiction. The hope of public health officials is that the model used to bring down colon cancer deaths can be used to the same effect, not only for lung cancer, but for other diseases plaguing this depressed swath of America."

Wear blue on Friday, March 7 to mark Colorectal Cancer Awareness Month and encourage screening and colonoscopies

Friday, March 7 will be "Dress in Blue Day" to mark National Colorectal Cancer Awareness Month and to help raise awareness about colon cancer in Kentucky, according to Madeline Abramson, wife of Lt. Gov. Jerry Abramson.

“Kentucky has one the highest mortality rates of colorectal cancer in the nation,” she said in a news release.  “The good news is that through preventative screenings, this deadly disease can be detected early and treated successfully. I ask Kentuckians to join me in wearing blue on March 7 to help spread the word about the risks of colon cancer and the importance of getting screened.”

The American Cancer Society estimates that about 2,200 Kentuckians will be newly diagnosed with colon cancer this year and nearly 900 of them will die from it.  Those over 50, or who have a family history of colon cancer, are at the greatest risk and should get regular colonoscopies, doctors say.

To help raise awareness in Frankfort, the State Capitol dome will be lit blue until March 7. Hospitals, businesses, churches, schools, banks, health departments and other organizations are planning and hosting special activities to commemorate the month and promote screening.  

For more information on Colorectal Cancer Month and Dress in Blue Day, visit Madeline Abramson’s website at http://1.usa.gov/NrsMri and the Colon Cancer Prevention Project site at http://bit.ly/1i3q98G. The Kentucky Cancer Program website at www.kycancerprogram.org has information about cancer prevention, awareness and treatment.

Whitesburg clinic shows rural lag in colon-cancer screening can be erased by overcoming the reluctance to talk about it

Screening for colorectal cancer isn't as common in rural areas as it is in metropolitan areas, partly because rural people seem to have trouble talking about it. Whatever the reason, the rural death rate from it is higher, and the disease is more common in Kentucky than any other state.

Dr. Van Breeding talks with a patient. (WEKU-FM photo)

When Dr. Van Breeding of Whitesburg found that only 19 percent of patients at Mountain Comprehensive Health Corp. had been screened, he said, "That's horrible! We've got to do better than that!" reports Dr. Kay Miller Temple for The Rural Monitor's Rural Health Information Hub: "He said their effort started with everyone in their clinic talking about it, from check-in personnel to lab team members to providers — everyone started talking about colorectal cancer screening." Breeding told her, "We got everyone who had contact with the patient to talk about it, starting with a simple question: ‘Have you ever been screened for colon cancer?’" Breeding says the rate is now 73 percent, in "an area where its incidence and death rates are the highest in the country," Temple notes.

Temple reports that a similar approach was used at Clearwater Valley Hospital and Clinics and St. Mary’s Hospital and Clinics in Idaho. "Using an electronic record indicator, providers were reminded to talk to unscreened patients during any appointment scheduled for any reason," Temple reports. "In addition to talk, they mailed reminders to patients" and did community outreach.

The screening rate at the Idaho facilities was much better, 52 percent, but their quality-improvement director, Heather Hodges, said their goal was 70 percent. They are now at 69 percent and have set a new goal of 75 percent. The national rate is 60 percent; the rural rate is 58 percent and the metro rate is 63 percent. Kentucky's statewide rate is 68 percent. The National Colorectal Cancer Roundtable’s 2018 goal is 80 percent, which acknowledges that some patients will always choose not to be screened.

"Hodges said the subject of CRC screening is a bit distasteful, but this can’t prevent healthcare organizations from doing community outreach," Temple reports. Such outreach includes a much-latger-than-life-size colon, through which people can walk. Here's a video:

“Screening rates are lower in rural areas, where geography causes barriers like lack of access to providers and lack of specialists or access to those specialists,” Dr. Djenaba Joseph, medical director for the federal Centers for Disease Control and Prevention’s Colorectal Cancer Control Program, told Temple. “In some states, there are hundreds of miles between the patient and the nearest endoscopist. But, regardless of location, I tell everyone, rural and urban, you can improve rates by knowing your population. Know the number of endoscopists in your area, know the population you are trying to reach, know the income limits, and know insurance status.”

Temple writes, “A recent American Cancer Society survey showed that 'nearly all unscreened people knew they should be screened.' Many who hadn’t completed screening assumed if they had no family history, they were at no risk for the disease. Others perceived the test was expensive, complicated, painful, embarrassing, and only needed for worrisome symptoms. With information like this, many providers feel that talking about CRC screening seems not only delicate, but time-intensive in order to dispel myths about screening, especially when discussions around other cancer screenings are often as simple as 'It’s time for you to make an appointment for a pap smear, mammogram or prostate check.'”

In Whitesburg, "as the CDC’s Joseph suggested, success came from knowing the population," Temple reports. "Breeding said they talked to their area insurance carriers about ensuring colonoscopy coverage. They also discovered that patients without insurance could get assistance from the health department due to the area’s high risk. Next, the local hospital decided to improve the endoscopy area, and the area’s surgeons, who performed the colonoscopies, immediately accommodated a structured approach to direct screening. Mondays and Fridays became designated testing days to accommodate prep and recovery times."

Breeding told Temple that one of the most powerful factors in his clinic's huge increase in screening "was a new dynamic that emerged in their tight-knit community: when community members looked into the face of a family member, a friend, a neighbor, and realized that person was living in an area of high colorectal cancer incidence and death rates, they encouraged one another to get screened. With this effort, Breeding shared that more than 30 lives have been saved. Their new screening goal — their community’s goal? It’s now 100%. Among the many lessons learned in this effort was patients’ understanding that the clinic was not just a place to come when sick, but a place to come to get, and stay healthy."

Lifestyle changes and screening will decrease risk of cancer, which is especially deadly in Kentucky

This Kentucky Cancer Consortium graph shows the
deaths from cancers with evidence-based prevention
or early detection methods in Kentucky in 2005-09.

By Melissa Patrick
Kentucky Health News

Kentucky has the nation's highest rates of newly diagnosed cancers and death rate for all cancers combined, but Kentuckians could easily reduce those rates through proper screening and lifestyle changes, says a report from the Kentucky Cancer Consortium. Kentucky has a high death rate from lung, colon and cervical cancer, and leads in lung cancer deaths, with a rate almost 50 percent higher than the national rate.

The Nos. 1, 2 and 3 causes of cancer deaths in Kentucky, are lung, colon and breast cancer, and all three can be easily prevented or detected, according to the report.

Many risks associated with cancer are outside a person's control, but lifestyle changes and screening tools have been proven to reduce cancer risk and to catch cancer early, said Mark Varvares, M.D., director of the Saint Louis University Cancer Center.

“Healthy choices and preventive screenings won’t totally erase cancer, but they can reduce our risk in a really meaningful way," Varvares said in a news release. "They offer us the chance to change the course of the future, if we take advantage of them.”

According to the American Cancer Society, “More than half of all cancer deaths could be prevented by making healthy choices like not smoking, staying at a healthy weight, eating right, keeping active, and getting recommended screening tests.”

Specific suggestions made by the Saint Louis University Medical Center to reduce the risk of cancer are:

#1: Quit smoking. Smoking causes most lung cancer deaths in the U.S.

#2: Eat a healthy diet. Obesity is a risk factor for many cancers, including those of the esophagus, pancreas, colon, and breast. A healthy diet includes foods like fruits, vegetables and whole grains, which  also linked reduce cancer risk. Limiting red meats and processed meats can lower your risk of colorectal cancer. Many specific foods, like leafy green vegetables or blueberries, have been shown to have specific anti-cancer properties.

 #3: Exercise. Studies show exercise lowers risk of colon and breast cancer. There also appear to be links between exercise and reduced prostate, lung and endometrial cancer risks.

 #4 Limit alcohol. Excessive alcohol is bad for your health, and can raise the risk of certain types of cancer. For women, even a few drinks a week may increase breast cancer risk. The overuse of mouthwash, which contains alcohol, been linked to mouth cancer, Varvares said in the report. The recommended maximum amount of alcohol is two 4-ounce drinks per day for men and one for women.

#5: Wear sunscreen and avoid tanning beds altogether. Sunscreen, which blocks dangerous rays from the sun, is your best bet to avoid skin cancer.  Tanning-bed users have a high incidence of skin cancer.

#6: Get screened. Colonoscopy, pap smears and mammography can be life-saving tools.

 #7 Get vaccinated. The human papilloma virus (HPV) vaccine lowers cervical-cancer rates in women, and is now being recommended for boys as well as girls partly because it shows promise in preventing head and neck cancer, too.

 #8: Consider genetic counseling. This is a possible option for those with a family history of certain cancers, but should be a decision made with your doctor and with careful consideration of what you will do with the results.   In deciding whether or not to have the screening, Suzanne Mahon, genetic counselor at Saint Lois University Cancer Center says, "Patients should ask ‘Is this something I really want to know about myself. If I know I am at high genetic risk of developing cancer, am I going to do something with this information?’"

UK doctor debunks myths about lung-cancer screening, which can find cancer before it spreads or causes symptoms, and save lives

Photo illustration by dragana991, iStock/Getty Images Plus

By Dr. Timothy Mullett

University of Kentucky

Lung cancer is the leading cause of cancer deaths in the U.S., claiming more lives than prostate cancer, breast cancer, and colorectal cancer combined. However, it can be a curable disease if detected early through screening, which can often identify cancer before it spreads or causes symptoms.

The U.S. Preventive Services Task Force recommends annual low-dose CT scans for lung-cancer screening for individuals who meet the following criteria:

• Are 50 to 80 years old
• Currently smoke or have quit smoking within the past 15 years
• Have at least a 20 pack-year smoking history, which is determined by multiplying the number of packs a person smoked per day by the number of years the person has smoked

Despite the benefits of screening, only a fraction of eligible people get screened due to public unawareness, stigma, and prevalent myths and misconceptions about the procedure. Here I address some of the most common myths:

Myth: “Lung cancer screening is not covered by my insurance or is too expensive.”
Fact: If you meet the eligibility criteria, lung cancer screening is covered by Medicare, Medicaid and most private insurance plans without cost-sharing. In rare instances where insurance coverage is unavailable, many programs including UK’s Lung Cancer Screening Program, offer screenings at a relatively low cost.

Myth: “I quit smoking years ago, so I don't need to be screened.”
Fact: Even individuals who have quit are at high risk for lung cancer and should get screened. While screening is primarily recommended for those who quit within the past 15 years, the American Cancer Society recently expanded its guidelines to encourage screening for people with a smoking history outlined above regardless of the number of years since quitting.

Myth: “I currently smoke, so I will get screened after I quit.”
Fact: If you currently smoke, you are at the highest risk. Everyone deserves empathetic health care, and you should not feel judged or ashamed for smoking. In addition to screening, your doctor can help connect you to smoking cessation resources. Quitting smoking at any time, even after a lung cancer diagnosis, reduces the risk of dying from other diseases besides cancer, including heart and lung disease.

Myth: “Lung cancer diagnosis is a death sentence. I’d rather not know.”
Fact: A lung cancer diagnosis today is not the same as it was even 10 years ago. Surgery for lung cancer is becoming much less invasive, and improved treatment options include targeted therapy and immunotherapy. Getting screened is your best defense against lung cancer — if it’s caught early, outcomes are greatly improved, and in some cases, the cancer can be cured.

Myth: “Lung cancer screening is time-consuming and invasive.”
Fact: Lung cancer screening is less invasive than procedures like mammograms or colonoscopies. It is a painless, quick process that involves a low-dose CT scan of the chest, taking only a few minutes to complete. Minimal preparation is required, and no needles or contrast dye are used.

Myth: “Lung cancer screening has a high rate of false positives.”
Fact: While cancer screenings provide valuable tools for early detection, they also carry a potential for false positives. These results may appear as abnormalities on imaging tests but don't necessarily translate to a need for invasive procedures.

Timothy Mullett, M.D., is a UK Markey Cancer Center surgeon and the medical director of the UK Markey Cancer Center Affiliate and Research Networks.

Testing for colon cancer may detect it without colonoscopy

Dr. Morris Beebe III
(Photo from Baptist Health)

Colorectal cancer is the second leading cause of cancer deaths (after lung cancer) even though effective, inexpensive, non-invasive screening options have been developed, says a Corbin gastroenterologist.

When it comes to colorectal cancer screening, patients are often embarrassed or worried about potentially painful procedures, Dr. Morris Beebe III writes in a Lexington Herald-Leader column.

Two simple screening options can be done in the privacy of a patient's own home: fecal occult blood testing (FOBT) and fecal immunochemical testing (FIT). Each test requires only an "at home" kit, collecting samples from several bowel movements.

"It’s all very private," Beebe notes.

FOBT requires minor changes to a patient's diet, such as avoiding red meat right before the test; FIT does not.

"The idea behind these tests is to see if there are small amounts of blood hidden in the stool, suggesting pre-cancerous polyps or cancerous growths," he says.

If results show hidden blood, a follow-up colonoscopy can be used for diagnosis and treatment. Colonoscopy is widely recommended as one of the most effective screening tests, Beebe says, reducing the odds of colorectal cancer deaths by as much as 60 to 70 percent. Doctors can also remove any abnormalities that are found during the same procedure.

Doctors perform a colonoscopy by inserting a scope, a flexible tube with a camera, into the rectum and threading it through the length of the colon. Air is pumped into the colon to make viewing easier. The patient is given either general anesthesia or sedation, so the procedure is much less unpleasant than the description suggests, Beebe notes.

The federal Centers for Disease Control and Prevention recommend regular colorectal cancer screenings at age 50.

"These screenings can save lives by detecting cancer at a treatable stage or even preventing it in some cases," Beebe adds.

Cancer Society says screening for colon cancer should start at 45, not 50; Ky. leads the nation in colon cancer and deaths from it

By Melissa Patrick
Kentucky Health News

In response to rising rates of colorectal cancer among younger people, the American Cancer Society now recommends that adults with a normal risk for colon cancer get their first screening at age 45, instead of 50.

The change was prompted by an ACS study published last year in the Journal of the National Cancer Institute, which found that since the mid-1990s colon-cancer rates among Americans between the ages of 20 and 54 have been steadily increasing, between 0.5 percent and 2 percent per year. Rectal cancer has risen more rapidly, 2 to 3 percent a year.

"Millennials have double the risk of developing colon cancer and quadruple the risk of rectal cancer for reasons that are not yet 100 percent clear," Amanda Smart, executive director of the Colon Cancer Prevention Project, said in a news release about the new recommendations.

Graphic: Colon Cancer Prevention Project

Nationally, colon cancer is the second leading cause of death from cancers that affect both men and women with 43 percent of "young onset patients" diagnosed between the ages of 45 and 49, according to the release.

Kentucky leads the nation in colon cancer, but is nationally recognized for getting its citizens screened for it, moving from 49th to 19th in the past 15 years. However, only 65 percent of Kentuckians 50 and older have been screened. So, there's more work to do -- especially in a state that ranks fourth for colon cancer deaths.

Smart added, "No matter your age, if you are experiencing symptoms such as rectal bleeding, unexplained anemia, changes in bowel habits, unexplained weight loss or gain, or unexplained abdominal pain, please don’t wait to be screened!”

Dr. Whitney Jones, a Louisville gastroenterologist and founder of CCPP, emphasized that, while this policy change is a huge step forward, it only applies to individuals with average risk who do not have symptoms.

“Those with a family history of colon or rectal cancer, or advanced adenomatous colon polyps, should check with the doctor about on-time screening, which begins at 40 but could be necessary even earlier," he said in the release.

Options for screening include a colonoscopy, which is recommended every 10 years for people at average risk of the disease, a yearly stool test that looks for hidden blood, a DNA-based stool test done every three years, virtual colonoscopy and a flexible sigmoidoscopy, according to the National Cancer Institute.

Colon cancer usually starts from precancerous polyps in the colon or rectum, which can be removed before they turn into cancer. Screening also allows for early detection of the cancer, which is 90 percent curable when detected early.

In Kentucky, those with commercial insurance will be immediately eligible to receive "on-time" screening at 45, says the release.

Kentucky Medicaid has no age restrictions on colonoscopies for its fee-for-service members. The co-payment requirement is cancelled if it is billed as a preventive service for people 50 and older, but the state Department for Medicaid Servicessays it is working to have this changed to 45. The department said managed-care organizations will develop their own policies for their members.

Smart added that the new guideline may cause some confusion for doctors and patients, and stressed that it will be important for providers to enter the appropriate insurance code to make sure younger patients don't get charged for the exam.

The Patient Protection and Affordable Care Act requires colon cancer screenings be entirely covered by insurance. Kentucky has also passed a law to clarify that a fecal test to screen for colon cancer, and any follow-up colonoscopy, are also covered by insurance.

Smart said her Colon Cancer Prevention Project can help patients who have been wrongly charged.

The U.S. Preventive Services Task Force guidelines still recommend initial screening for colon cancer at age 50 for those with average risk.

Laurie McGinley of The Washington Post reports that the task force decided several years ago to not lower its recommended age because it concluded that the data was mixed and that a younger starting age would only proved a "modest" benefit. She adds that the cancer society, by extending the analysis used by the task force and incorporating recent data on the rising incidence of the disease among younger people, came to a different conclusion that shows the life-saving potential of earlier screening.