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Valerie Clark was 52 when she had her first colonoscopy — it came not a moment too soon.
Doctors found three polyps in Clark’s colon, not an unusual finding for someone in her fifties. Polyps are growths that form on the inside of the colon. Normally they are benign, but sometimes they signal cancer.
That was Clark’s case.
“The surgeon called and said I had cancer. That was Friday. He wanted to do surgery on Monday,” Clark said.
She was overwhelmed by the news and needed a few days to process it, but within a week, she was admitted to Mary Immaculate Hospital in her hometown of Newport News. The surgeon removed all of the cancer, and because the cancer was detected so early, Clark didn’t have to do chemotherapy or radiation.
Now at 53, Clark is a year out of surgery and “so far, so good,” she said.
“It’s a happy story,” she added. “I tell everyone who will listen to get their colonoscopy.”
According to the American Cancer Society, this year 136,830 people in the U.S. will be diagnosed with colon cancer — and 50,310 will die from it. Colon cancer is also the second leading cause of cancer death in the U.S. There are parts of the country where colon cancer is more prevalent, and the Hampton Roads is one of those places, according to a 2015 study.
The study, which was published in the journal Cancer Epidemiology, Biomarkers & Prevention, identified three colorectal hotspots in the U.S.—places with the highest rates of colorectal cancer deaths.
Highest were those in the Lower Mississippi Delta, which had a death rate 40 percent higher in the period from 2009 to 2011, compared to the rest of the U.S. The two other hotspots were in west central Appalachia, where the death rate was 18 percent higher, and eastern North Carolina and Virginia, where it was nine percent higher. In all three hotspots, the colon cancer death rate increased over time, contrary to a national trend of significant and steady declines in death rates.
“Colorectal cancer death rates have dropped by half in these four decades,” said Rebecca Siegel, the lead researcher of the study. “The problem is these hot spots have been left behind.”
Poverty is common denominator
Siegel, who is the director of surveillance information in the Surveillance and Health Services Research Program at the American Cancer Society, looked at county death rates and then used advanced geospatial modeling software to create the maps.
Siegel said that the reasons driving the high death rates were common to all three regions.
“If you look at a county-level poverty map, these three areas pop out as very high poverty. If you have lower socio-economic status, you have generally less access to healthcare: both prevention and treatment,” Siegel said. “Also, there’s a higher prevalence of risk factors associated with colon cancer, like smoking, obesity, and a less healthy diet because often the healthier foods just aren’t as affordable.”
What stuck out in the Virginia cluster, however, was that the death rates were driven by women, Siegel added. Women’s death rates there were 15 percent higher than the U.S. average for women; whereas men in the hotspot had a death rate that was only three percent higher than the U.S. average for men.
Siegel couldn’t explain why that might be the case, but added that men generally have higher colorectal cancer death rates than women, but that their incidence rates are roughly the same. Death rates are also higher in African-Americans—both men and women—a trend Siegel said is related to their disproportionately higher poverty levels.
When Dr. Lisa Coleman, a colorectal surgeon at Tidewater Physicians Multispecialty Group-Center for Colorectal Surgery in Newport News, heard about Siegel’s study last year, she was in the middle of a job search. Colonoscopy advocacy had long been a passion of hers: she’d helped start an endoscopy center at the William Beaumont Army Medical Center in El Paso, Texas—to hedge the nationwide problem of veterans not getting timely colonoscopies.
So, when Coleman noted the hotspot in Virginia, she plotted her purposeful move. “I knew this was an area that had a need, and I enjoy educating,” she said.
Last January, Coleman moved to the Hampton Roads. She’s one of three colorectal surgeons on the Peninsula, she said. “Newport News going up to Williamsburg is quite underserved.”
So far, half of Coleman’s patients are coming in for their colonoscopies. She’s also inherited, from physicians who have moved elsewhere, about 500 patients in need of colonoscopies. She’s performed six surgeries on cancer patients, and has diagnosed two people with advanced stage colon cancer.
“In this area, we are seeing a higher percentage of people with advanced disease, so the death rate’s higher,” Coleman said. “It’s a silent killer, and they come too late.”
The two main reasons for the late-stage diagnosis, she said, are lack of both education around the necessity of colonoscopies, and access to care.
“That could be because of dearth of providers in the area, or people not having health coverage that provides them with the opportunity, without enormous deductibles,” she said.
‘When they come into my office, they’re scared’
As far as medical procedures go, colonoscopies can be a hard sell—at least on the surface. For twenty-four hours beforehand, you can’t eat, and you take laxatives to clean yourself out. The procedure then involves sticking a scope inside you to check out your colon, during which you are under anesthesia.
“Some people are very fearful of the stories of the prep and having a huge gigantic snake put up their back side,” said Coleman. “No one is excited to come see me. When they come into my office, they’re scared.”
But the flip side of fear is the fact that colonoscopies save lives. If detected early, colon cancer is one of the most curable cancers. But sadly, many people wait until it’s too late—when they have symptoms like blood in their stools or stomach cramps. And then, the death rate escalates.
Other risk factors for colon cancer include a family history of the disease, the presence of inflammatory bowel disease, smoking and a poor diet with little fiber, Coleman added.
If there’s a silver lining to the study, however, it’s that local primary care providers have increased their push for patients to get colonoscopies, Coleman said. “Doctors here are really doing a great job of catching people who need those colonoscopies—and then sending them forward.”
The next barriers to overcome include providing patients in the area with access to specialized care, Coleman said, adding this could be hard since there’s a dearth of gastroenterologists and surgeons in the area.
Educating people is also key to overcoming the negative trend, she said. People in rural areas, and those who are unemployed especially risk falling through the cracks.
Coleman recommends those concerned about their colon cancer risk take an online risk assessment test by the National Cancer Institute.