When Diane Kesterson of Virginia Beach read about a recent study on the notable uptick of colon cancer among young people, it hit home in two ways. The retired teacher was 45 years old when she was diagnosed with colon cancer — which is considered young for a disease that isn’t usually screened for until age 50.
And, some of the young people now getting cancer had once been her students.
“I taught a lot of those kids, so I have a special heart for them,” Kesterson said. “I even know people in that age group who have passed on.
“Screening is important, and a lot of these kids don’t have doctors,” she continued. And cancer is the last thing on their minds — as it was for Kesterson.
She attributed her own bowel difficulties to stress, and her abdominal cramps possibly to appendicitis — especially when they kept her up at night.
That’s when Kesterson decided it was time to go to the doctor. Her diagnosis, however shocking, was also sobering. At stage 3, the cancer was in her intestinal wall and lymph nodes. But it hadn’t traveled to any organs — at which point cancer becomes incurable.
“My severe pain was a lifesaver,” Kesterson said. She had a foot of her colon removed, and six months of aggressive therapy. Seventeen years later, she’s cancer-free.
“One of the great things is that all my friends have gotten colonoscopies,” she said.
Late-stage diagnoses drive death rates
For people who are not as lucky as Kesterson, however, intense pain often means that it’s too late to cure a disease that’s sometimes called a “silent killer.” But if caught early, colon cancer is one of the most treatable cancers, said Rebecca Siegel, the director of surveillance information in the Surveillance and Health Services Research Program at the American Cancer Society.
“Screening can prevent cancers as well as detect them early so that survival is much more likely,” said Siegel, who conducted a nationwide study to identify colon cancer hotspots, or clusters where death rates from the disease were highest. The 2015 study was published in the journal Cancer Epidemiology, Biomarkers & Prevention.
Hampton Roads was in one of the three clusters. So was the Lower Mississippi Delta — which between 2009 and 2011, had a colon cancer death rate that was 40 percent higher than the country’s average. West Central Appalachia was the other hotspot, where the death rate was 18 percent higher. In the Virginia (and North Carolina) hotspot, it was nine percent higher.
“Colorectal cancer death rates have dropped by half in these four decades,” Siegel said. “The problem is these hotspots have been left behind.”
She added that most of the same issues are driving the death rates in all three areas.
“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.
“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,” Siegel added.
In Virginia, women’s death rates were 15 percent higher than the U.S. average for women; whereas men 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 she added that men generally have higher colorectal cancer death rates than women, even though the incidence of the disease is roughly the same in both genders.
Data spurs local action
If there’s a silver lining to the sobering study, it’s that health professionals are taking notice, Siegel said.
“We were contacted by several public health organizations that were within one of the hotpots.”
She added that Virginia in particular is “not used to being called out.” She suspects that’s because it’s a state of socioeconomic extremes, with wealthy pockets like Alexandria as well as poor rural parts of the state.
It might not be just the poor areas that are responsible for elevated death rates, said Dr. Bruce Waldholtz, a gastroenterologist in Chesapeake who also chairs the board of directors of the South Atlantic Division of the American Cancer Society.
“Most people who are not screened have insurance,” Waldholtz said, adding that more than 50 percent of colon cancer cases at Inova Alexandria Hospital are stages three and four.
There’s a tendency for people generally to not only avoid colonoscopies, but any discussion of their bowels, said Dr. John Sayles, a colorectal surgeon with Sentara Surgery Specialists in Norfolk.
“Bowel issues aren’t given the same importance as other symptoms and are hidden or suppressed too often,” Sayles said. “I would like to change society’s perception of bowel function from something “funny”–as discussed by 13-year-old boys–to something serious and very important to one’s health.”
But the hotspots study focused not on people who don’t can and don’t get colonoscopies, but rather, on those people living in parts of the state where they don’t have access to healthcare. Waldholtz cites Otis Brawley, the chief medical officer of the ACS, who has a saying: “Your zip code is more important than your genetic code.”
For the purposes of this study, Waldholtz translates that as: “Your risk of dying in Portsmouth is three or four times that of other areas.”
Waldholtz said the ACS and other local groups have been spurred to action by the study’s results. They formed a coalition and have already had several roundtable discussions. They also introduced the fecal immunochemical test (FIT) test as a baseline test for colon cancer at the Sentara Ambulatory Care Center. A medical student acts as a patient navigator to help patients.
“We’ve screened something like 80 patients with FIT tests. We’re starting to make some headway,” Waldholtz said. “In the upcoming year, we have intentions to work with barbers in those communities, and churches.”
The FIT test is about 73 percent accurate, and can be done annually as an alternative to colonoscopies, Waldholtz said. But the colonoscopy is still the gold standard test for preventing colon cancer and catching it early, especially for people at high risk of the disease, he added.
“There’s no disagreement [over colonoscopies],” he said. “We know it works.”
Sayles added, “In theory, if patients have regular colonoscopies and avoid risk factors like obesity, we can keep the incidence of [colon] cancer at its lowest.”
Meanwhile, Waldholtz suggests, “Know your family history and talk to your doctor about [your risk].”
A risk assessment test is also available at the National Cancer Institute web site: https://www.cancer.gov/colorectalcancerrisk/