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Colon cancer is one of the deadliest cancers in the United States – and also one of the most preventable, because it can be detected by early screening. This disease begins as a slow-growing precancerous polyp that, if found in time, can be removed before it turns into cancer. But across the United States, more than two-fifths of people over age 50 fail to get the recommended screenings. For rural people, screening rates are especially low.
Rural residents are more likely to be diagnosed with cancer at a late stage, and are more likely to die from the disease. In the Northeast, people living in urban areas die of cancer at a rate of 186 deaths for every 100,000 residents, but the rate for rural residents is 203. Each year, approximately 800 Mainers are diagnosed with colon cancer, and 320 die of the disease.
Maine does better than average among U.S. states in screening for cancer. But tests happen less often than they should in the state’s most rural parts – including western Maine, Aroostook County, and the Downeast areas of Hancock and Washington counties. If Maine did better at screening its rural residents, the state could reduce its currently high rates of cancer illness and death.
Colon Cancer Screening Need Not be Complicated
People often think that finding and beating cancer requires advanced technology, an arsenal of specialists, and lots of money. But there are a variety of methods to screen for colon cancer – including some that family doctors or community clinics can use inexpensively and on their own.
In recent years, the popular media have given great publicity to colonoscopy as the best method to find cancers and polyps. Colonoscopy is certainly a good screening test, and many lives have been saved due to it. However, for people at average risk – those without family history of colon cancer – the American Cancer Society and the U.S. Preventive Services Task Force recommend other screening tests that are equally acceptable, including yearly take-home tests that detect hidden blood in the stool. Hidden blood can be a clue that cancer or polyps are present.
In earlier decades, stool blood tests were less accurate than they are now. Patients used to have to adhere to strict diets before taking the test. Eating red meat could lead the test to falsely suggest cancer, while taking vitamin C supplements could mask evidence of a problem. But now there is a new test – the fecal immunochemical test for hemoglobin, or so-called FIT test – that works no matter what the person eats.
If we spread the word to the public as well as to health-care providers that there are alternatives to colonoscopy, we might reach more people living in remote, rural areas to get them more regularly screened and thus reduce colon cancer illness and deaths. Letting the public know is just as important as telling doctors, because research in rural areas has shown that one of the determinants of late-stage colon cancer or delayed colon cancer treatment is living far from a primary care provider such as a family doctor. More people might want to get screened if they knew that they could take this test at an annual doctor’s visit, at a clinic, or perhaps even by mail.
The Added Medical Benefits of the Simple Test
Not only can the current stool-blood test be completed by a family doctor or clinic without an added visit to a specialist trained to conduct a colonoscopy, it has other benefits as well:
- Colonoscopy procedures can go wrong – for example, if a patient’s colon is accidentally punctured. Approximately two out of every 1000 patients experience a bowel perforation in the course of the procedure. Other pitfalls include problems with sedation or sudden blood loss.
- Because anyone who gets a colonoscopy has to be given some sedation, people have to travel with a companion to and from the testing facility. That can be a nuisance in a city, but in a rural area it can be an outright barrier. Two people have to drive a long distance. Family members may miss work, or an older person living alone may have no way to get back and forth.
- People have to get ready for a colonoscopy by taking strong laxatives to “clean” the colon so abnormalities can be seen. Dreading the preparations, many people put the test off.
Colonoscopies may be the advanced “state of the art,” but for the 80% of people who face no more than an average risk of colon cancer, the simpler test may be preferable. A person can do it regularly. If the test is negative, there is little chance that a cancer or large polyp has been missed. If human blood is detected, a follow-up colonoscopy can be planned.
Cost-Effective for Rural America, Like Much of the World
Worldwide, most people are screened for colon cancer primarily with home-based stool blood tests. This saves trouble and money for both individuals and entire health care systems. The cost of a colonoscopy varies by region, but it can go up into thousands of dollars, while the stool blood test costs an average of $22.00 each time it is used.
Since rural Americans are less likely to have health insurance than their urban counterparts – both nationally and in Maine – stool blood tests offer an affordable way to get screened. The costs are also lower for the health system as a whole. Maine has enough specialists, but across the entire United States there simply are not enough specialists to do regular colonoscopies for all people with just average risk of disease. And of course the problem is worse in rural areas where specialists are in short supply and based at great distance from many residents. In rural areas, it makes little sense to use up specialists’ time doing routine screenings, when these doctors are needed to take care of patients with unusual or chronic gastrointestinal diseases.
Nationally, 142,000 Americans will be diagnosed with colon cancer each year, and 52,000 will die. Regular, universal testing can prevent many tragedies – just as cervical cancer, once a silent killer of so many American women, has been greatly reduced. Widespread simple screening has reduced cervical cancer by 75%. We now have a variety of tools at our disposal to combat colon cancer, and we should deploy them all – not just the most expensive, high-tech approaches. For rural Maine, and other rural areas, this new approach could be a life saver.