March 26, 2008 - March is National Colorectal Cancer Awareness Month, and the American Cancer Society has just released the "Cancer Facts and Figures 2008." Colorectal cancer is still the second leading cause of cancer death, but the good news is the death rate from this cancer continues to decline.
What is even more impressive is despite the aging population, the actual number of people dying from this disease is also declining (49,960 in the U.S. and 730 in S.C.). The major reason for this progress is that more people are being screened for colorectal cancer with a colonoscopy. One discouraging bit of information is that the racial disparity for this disease in South Carolina is unacceptably large. The goal for colorectal cancer is not early detection or even a cure. The goal for colorectal cancer is prevention.
Colorectal cancer develops from small growths called polyps that form on the inside lining of the colon (or large intestine). We do not know exactly why individuals form polyps, but age is the most important risk factor. Men and women are equally affected, but blacks appear to die of this disease earlier. The recommendations are that everyone should be screened at age 50, and some organizations recommend that blacks should be screened at 45. If someone in your family has colorectal cancer or even polyps, you are at increased risk and should be screened at an earlier age. Like many other diseases, a healthy lifestyle -- including a low-fat diet, exercise and weight control -- may reduce your risk of developing colorectal cancer.
(Note: A "screening" test is performed on someone who has no symptoms. A "diagnostic" test is performed on someone who is complaining of problems, such as unexplained blood in the stool, change in bowel behavior, weight loss or abdominal pain.)
The best test to detect and remove polyps is a colonoscopy. This examination is generally performed by a gastroenterologist. There are about 145 gastroenterologists in South Carolina, and many of them perform over 1,000 colonoscopies each year. Most people will report that the worst part of the entire process is getting "cleaned out" the night before. You are sedated for this procedure, and the majority of the patients remember nothing about the actual colonoscopy. If the quality of the preparation and the examination are excellent and there are no polyps and no family history, an individual may be able to wait up to 10 years before repeating the colonoscopy. This is in stark contrast to the annual breast, cervical and prostate cancer screening recommendations. About 25 to 30 percent of individuals will have precancerous (adenomatous) polyps. The size, type and number of polyps will determine when a colonoscopy should be repeated.
Though colonoscopy is the "test of choice" when it comes to colorectal cancer screening, there are barriers to colonoscopy. These barriers are especially severe to the uninsured and the underinsured. In South Carolina, our health disparities related to colorectal cancer are dramatic. Black men in South Carolina have a 46 percent higher death rate than their white counterparts. Another concerning statistic is that Medicare, Medicaid and the State health plan cover colonoscopy as a screening procedure; however, less than 50 percent of those individuals who are covered take advantage
of this benefit.
On a positive note, there is an exciting collaboration between public and private organizations in South Carolina regarding colorectal cancer. The South Carolina Gastroenterology Association, the American Cancer Society, the Center for Colon Cancer Research at USC, the Midlands Partnership Parish Nurse Program and the South Carolina Cancer Alliance are developing a statewide media campaign to raise awareness about colorectal cancer and develop colorectal cancer prevention programs. These partnerships hold the key to providing adequate screening for the uninsured and underinsured.
The South Carolina Department of Health and Environmental Control has ide.jpgied colorectal cancer screening as one of its priorities and requested state funding to develop these screening programs. I would like to applaud the chairman of the House Ways and Means Committee, Rep. Dan Cooper, and the members of the Human Services and Medicaid Subcommittee: Reps. Edge, Clyburn, Davenport and Rice, for their support of this important program that addresses colorectal cancer and especially the disparity issue.
Rep. Gilda Cobb-Hunter and Sen. David Thomas have also been champions for colorectal cancer prevention. They have participated in our statewide activities and have worked closely with our partners to encourage the health care industry in South Carolina to provide colorectal cancer screening services. Blue Cross Blue Shield of South Carolina has recently announced the decision to remove one barrier by providing colorectal cancer screening services to all of their age-eligible, insured customers.
Overall, the news is encouraging regarding colorectal cancer, but hopefully through continued research and outreach, we will narrow the current disparities that exist and realize the ultimate goal of preventing this disease.
Dr. March Seabrook is governor to the American College of Gastroenterology from South Carolina and past president of the South Carolina Gastroenterology Association.