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News Room: ENQUIRER: More colon screenings needed to cut cancer

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By: Mark Hansel

Kentucky has the highest incidence rate of colon cancer in the country, and health experts say it is not likely to decline without a substantial increase in patient screening.

That’s why Louisville-Jefferson County, which has the highest incidence of colon cancer among the top 50 most populous metropolitan areas in the country, announced a new screening program this week.

The public-private partnership will provide screening for about 1,200 low income, uninsured people at no cost.

In Northern Kentucky, prevention efforts continue to be largely limited to increased awareness and education due to a lack of funding. In recent years, community campaigns have included billboards and bus ads that encourage screening, but the region has had no campaign like the one coming to Jefferson County.

A total of $282,600, which includes a $133,170 grant from the Kentucky Department for Public Health, has been committed for the Jefferson County screening project. The remaining money will come from the private Kentucky Cancer Foundation.

In addition, 13 private physicians recruited by Louisville’s Colon Cancer Prevention Project have each agreed to donate at least one free colonoscopy screening each month. Officials there credit Dr. Whitney Jones, who founded the prevention project in 2004, with spearheading local efforts.

Lisa Heck, quality assurance manager with the Northern Kentucky Health Department, said the efforts in Louisville are admirable, but it takes a long time to build that kind of community support.

“What they have done is impressive, and Dr. Jones is very passionate about colon cancer awareness,” Heck, a registered nurse, said. “Unfortunately, we don’t have that type of champion in this community yet.”

Colorectal cancer, commonly called colon cancer, can occur in the colon or rectum and has many of the same characteristics, but is treated differently depending on where in the body it is located.

According to the National Cancer Institute, the statewide incidence rate for colon cancer was 52.8 per 100,000 people in 2009, the last year for which statistics are available.

Kentucky also had the third-highest colon cancer death rate in the country in 2009, at 19 per 100,000 people.

Metro Louisville’s colon cancer rate is 55.4 percent, according to the study.

Campbell County at 64.8 per 100,000 people, has the highest incidence rate in Northern Kentucky, followed by Kenton (59.3), Grant (59.1), and Boone (42.1) counties.

Heck said Boone County’s lower rate could be attributed to a number of factors, including a higher number of residents with health insurance and a younger median age.

Dr. Pratish Shah is a radiation oncologist with Oncology Hematology Care, which has offices in Cincinnati and Northern Kentucky. He said Kentucky’s high rate of colon cancer is not surprising when looking at contributing factors for the disease.

“The risk factors that are associated with colon cancer includes tobacco use, obesity, and a poor diet can also play a role,” Shah said. “Unfortunately, Kentucky typically ranks pretty high in those areas as well.”

The likelihood of developing colon cancer usually increases when people reach their 60s, but it can occur earlier and screening should generally begin at age 50.

Some people are genetically predisposed to colon cancer, and if there is a family history of the disease, Shah said people should discuss the type and frequency of screening with their physician.

“Colon cancer is very treatable and curable if it’s found early enough,” Shah said. “Frequency of testing depends on which test is used. A colonoscopy is normally given every 10 years and a flexible sigmoidoscopy is every five years, with the caveat that they don’t find anything abnormal.”

A flexible sigmoidoscopy only examines the lower part of the colon, up to the sigmoid, and is less invasive and less expensive. A colonoscopy is a more thorough procedure that examines the entire colon.

The cost of a colonoscopy varies widely, from about $1,500 to more than $3,000. A sigmoidoscopy, if performed in a physician’s office, usually costs a few hundred dollars. As deductibles have risen in many health insurance programs, screening can become a financial burden even for those with coverage.

Shah said there has been an increased emphasis on screening as the benefits of early diagnosis have been realized, but many people still avoid the procedure because it is unpleasant or expensive.

“We’ve seen a decline in incidents over the past 15 years which is probably due to an increased emphasis on screening, but many people still put it off,” Shah said. “We have tried to start discussing it with patients when they are in their forties, so when the time comes, they will be more receptive.”

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