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Race May Hinder Appropriate Diagnosis and Treatment for Early-Onset CRC

Systemic racism remains an impediment  for the progress of public health in the U.S. Racial disparities continue to reduce access to quality healthcare in the country, as was confirmed by a recently published study. 

The study, published in the Journal of Clinical Oncology (JCO), found that young Black individuals (18-49 years) in the U.S. diagnosed with colorectal cancer (CRC) have a higher death rate than their White counterparts. The authors suggest that young Black patients with CRC are less likely to receive timely and guideline-concordant care (guideline-concordant is the minimal treatment patients should receive according to the National Comprehensive Cancer Network standards), which may be responsible for the increased mortality in that population. Specifically, the study found that Black CRC patients had longer times to receive adjuvant chemotherapy for colon cancer and neoadjuvant chemoradiation for rectal cancer compared to White patients. 

Racial disparity has a long and profound history in the U.S., affecting everything from the housing sector to the criminal justice system to the healthcare system and the economy. But when it comes to healthcare, it becomes even more worrisome and disturbing because the system’s ongoing inequities are impeding the progress made through years of public health effort. As a national goal, the Agency for Healthcare Research and Quality is dedicated to reducing racial disparities in health outcomes across the country. 

Interestingly, the American Cancer Society reports that, with the exception of pancreatic and kidney cancer, Black people had lower survival rates than White people for all cancer types. 

Barriers to CRC Screening and Treatment

Back to the JCO study – the authors found that access to CRC screening is difficult for Black people in the U.S. for a number of reasons, including:

  • Health insurance coverage: Often your health insurance determines the type of healthcare you receive. However, obtaining quality private health insurance is primarily dependent on having a job. But when it comes to employment, a substantial percentage of Black people are disadvantaged. Compared to White people, Black people have the highest unemployment rate in the country and are more likely to work in blue-collar jobs. Consequently, Black individuals have lower rates of private insurance coverage. 
  • Facility type: Black people are more likely to receive treatment at facilities with limited resources and are less likely to have access to high-performing facilities like teaching hospitals and cancer centers with a National Cancer Institute designation. However, research indicates that there could be a 5% reduction in the disparity in the provision of guideline-concordant care if Black and White patients were treated in the same healthcare facilities. 
  • Access to specialists/Lack of diversity in the medical workforce: For Black patients with metastatic CRC, fewer consultations with specialists and subsequent multimodality therapy treatments are provided. Nonetheless, even in cases when the rates of specialist visits are comparable to those of White patients, Black people are less likely to undergo treatment for CRC. A lack of cultural sensitivity and diversity in the medical workforce erodes good patient-provider communication, including the kind and caliber of information that clinicians deliver to patients, and makes the health care system appear less trustworthy. Disparities in patients’ access to high-quality care can be made worse by this, which can result in clinicians making insufficient treatment recommendations and creating obstacles to treatment adherence for patients from marginalized populations.

Over the years, a lot of work has been done to boost access to healthcare and remove barriers that might prevent it. Despite that, racial disparities in healthcare in the U.S. remain. However, no one should be denied access to high-quality healthcare due to the color of their skin or race. More work is needed to eradicate the disparities that Black Americans and other minority races face throughout the country.

 

Emmanuel Olaniyan is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

 

Photo credit: Nathan Dumlao on Unsplash

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NEHI Report Proposes Solutions for CRC Screening Disparities

The Network for Excellence in Health Innovation (NEHI) conducted research to shine a spotlight on disparities in colorectal cancer (CRC) screening and has proposed short-term and long-term recommendations to address these disparities. The report, Addressing Persistent Disparities in Colorectal Cancer Screening Among Racially and Ethnically Diverse Populations, proposes solutions that would help close existing gaps and legislative involvement for long-term resolutions.

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Colon Capsule Endoscopy with AI: A Promising Approach for Early Cancer Detection

By Deepthi Nishi Velamuri

Colon cancer is the third most common cancer in the U.S., and early detection is essential for improving survival rates. Colon capsule endoscopy (CCE) is a minimally invasive procedure that uses a small camera to examine the colon. It is a good alternative to colonoscopy for people who are unable to undergo traditional colonoscopy, such as those who are obese or have a history of bowel obstruction.

However, CCE can be time-consuming and labor-intensive to analyze. This is where artificial intelligence (AI) can help. AI-powered software can be used to automatically analyze CCE footage, identify potential polyps, and flag them for further review by a doctor.

A study published in the journal Colorectal Disease found that AI-powered software was able to detect polyps with a high degree of accuracy. The study also found that AI-powered software could reduce the time required to analyze CCE footage by up to 70%.

These findings suggest that AI-powered software could make CCE a more feasible option for wider use. This could lead to earlier detection of colon cancer and improved survival rates.

Here are some of the benefits of using AI-supported footage analysis in CCE:

  • Increased accuracy: The software can identify polyps with a high degree of accuracy, even those that are small or difficult to see.
  • Reduced time: The software can reduce the time required to analyze CCE footage by up to 70%. This frees up time for doctors to focus on other tasks, such as providing patient care.
  • Improved patient experience: The software can make CCE a more comfortable and convenient procedure for patients. This is because patients do not have to undergo sedation or gas insufflation, and they can return to their normal activities sooner.

Overall, AI-supported footage analysis is a promising approach for improving the accuracy, efficiency, and patient experience of CCE. It is a technology that is worth watching as it continues to develop.

 

Deepthi Nishi Velamuri is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

Image by Gerd Altmann from Pixabay

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Colorectal Cancer in Young Adults: What Are We Learning?

By Deepthi Nishi Velamuri

Colorectal cancer (CRC) is a disease that typically affects older adults, but it is becoming increasingly common in young adults. In fact, data indicate that 15% of patients diagnosed with CRC in the U.S. are under the age of 50 years and the mean age at diagnosis is 42.5 years.

There are a number of factors that may contribute to the rising risk of CRC in young adults. These include:

  • Changes in diet and lifestyle: Young adults are more likely to eat a diet high in processed foods and red meat, and to be less physically active than previous generations. These factors can increase the risk of developing CRC. Young adults with CRC are more likely to be obese. This suggests that obesity may be a modifiable risk factor for the disease in young adults.
  • Genetics: Some people have a genetic predisposition to CRC. If you have a family history of the disease, you are at an increased risk.
  • Inflammatory bowel disease: People with inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease, are also at an increased risk of CRC.

Prevention, Genetics, and Disease Outcomes

The good news is that CRC is often preventable. If you are at an increased risk, you should talk to your doctor about getting screened for the disease. Screening can help identify polyps, which are growths that can develop into cancer. If polyps are found, they can be removed before they have a chance to turn cancerous.

Young adults diagnosed with CRC are more likely to have advanced-stage disease at the time of diagnosis. This suggests that young adults are less likely to be screened for the disease—often despite showing symptoms such as rectal bleeding, abnormal or changing bowel patterns, fatigue, etc—which can lead to later-stage diagnosis and poorer outcomes.

A number of genetic mutations associated with CRC in young adults have been identified. These mutations can help identify people who are at an increased risk of the disease, and they can also be used to develop new targeted therapies.

Need for Improved Management of Young Adults

While we are still trying to understand the mechanism of CRC development in young adults, it is clear that this is a serious and growing problem. By understanding the risk factors for the disease and getting screened, young adults can protect themselves from CRC.

Here are some tips to reduce your risk:

  • Eat a healthy diet that is low in processed foods and red meat
  • Get regular exercise
  • Maintain a healthy weight
  • Don’t smoke
  • Limit your alcohol intake
  • Talk to your doctor about getting screened for CRC if you are at an increased risk

 

Deepthi Nishi Velamuri is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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Sensitivity of Double Fecal Immunochemical Testing for Detection of Colorectal Cancer

Fecal immunochemical testing (FIT) is a commonly used method for screening and diagnosis of colorectal cancer (CRC) in patients who are exhibiting typical signs and symptoms of the disease. FIT testing is widely used in preventing CRC as test kits can be mailed to patients to collect the sample and shipped back for laboratory analysis. This allows patients who may be ambivalent about more invasive testing to engage in a safe and effective preventative method in the comfort of their home. This form of testing, while an effective way of assessing and prioritizing patients with the highest risk, exhibits low levels of sensitivity (approximately 87%). 

Double FIT More Sensitive

In order to improve the sensitivity levels of FIT assessments, researchers from Scotland conducted two sequential, prospective cohort studies to measure and compare the sensitivity levels of both single and double FIT. Following a general practitioner referral, patients selected for the study were shipped either one or two FIT kits depending on their assigned study group, and results were analyzed following kit return. 

In the single FIT cohort, assessments were able to detect the presence of CRC with 84.1% sensitivity and advanced colorectal neoplasia with 64.4% sensitivity. These results were significantly lower than the sensitivity levels of the double FIT strategy, with this strategy being able to detect colorectal cancer with 96.6% sensitivity. Double FIT testing was also able to significantly improve detection of advanced colorectal neoplasia, with this strategy detecting disease at 81.6% sensitivity. 

This research reveals that double FIT may be an effective way to increase the accuracy of preventative testing measures, especially in symptomatic populations. 

While double FIT testing can provide increased accuracy and sensitivity when screening for CRC, obtaining two FIT submissions from patients is more difficult than obtaining a single test result. In this specific study, 22% of patients in the double FIT cohort only returned a single test, which reveals that this strategy may require innovative follow-up methods. 

A 2017 study by researchers within a hospital system in Texas found that mailed outreach literature and free testing kits increased rates of preventative screening measures, including FIT completion. In order to ensure that double FIT is an effective strategy, hospitals and clinics can develop and mail out literature that invites and encourages patients to complete two consecutive FIT’s tests. Other strategies could include social media, email, and notifications in patient portals.

 

Emma Edwards is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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Colonoscopy Reminders Increase Screening Rates Among High-Risk Individuals

By Deepthi Nishi Velamuri


Colorectal cancer (CRC) is a significant health concern, particularly for those with a family history of the disease. Unfortunately, many existing screening programs overlook this high-risk group. However, a recent study conducted at the University of California Los Angeles (UCLA) has introduced an innovative intervention aimed at improving CRC screening rates in individuals with a family history of CRC. 

The study was presented at Digestive Disease Week 2023.

A Game-Changing Intervention

The researchers at UCLA conducted a study within their large academic health center that already had a screening program for average-risk individuals. They aimed to engage individuals with a family history of CRC who were resistant to screening and determine the effectiveness of the intervention in increasing colonoscopies ordered, scheduled, and completed.

Study participants were divided into two groups:

  1. Group 1 received reminders to schedule a colonoscopy. The attending doctors also received a reminder.
  2. Group 2 received reminders along with educational materials on CRC risk and the colonoscopy procedure, as did their doctors.

Promising Results and Implications

The study included 150 patients, evenly divided between the two groups. The primary outcome showed that both groups had similar rates of completed colonoscopies. However, both groups experienced a significant increase in the number of colonoscopies ordered, scheduled, and completed.

The multicomponent intervention successfully engaged high-risk individuals who had been hesitant about CRC screening. The combination of reminders for doctors and patients proved effective in increasing screening rates. Surprisingly, the additional educational materials did not significantly impact outcomes, suggesting that they may not be necessary in future interventions.

The study’s findings offer hope for improving CRC prevention and control in high-risk individuals with a family history of the disease. By refining and expanding this intervention, we can raise screening rates, detect CRC at an early stage, and potentially save lives.

Take Action

Regular screening is crucial for early detection of CRC. If you have a family history of CRC or are overdue for screening, consult your healthcare provider to discuss the best screening options for you. Together, we can fight CRC and make a meaningful impact on public health.

The Colon Cancer Foundation remains committed to supporting advancements in CRC prevention, early detection, and treatment. Join us in our mission to raise awareness and promote lifesaving screenings. 

Reference-
Impact of a Multicomponent Health System Intervention to Increase Colorectal Cancer Screening Participation in Patients with a Family History of Colorectal Cancer. Jain S, Galoosian A, Badiee J, Meshkat S, Popoola F; Presented at Digestive Disease Week 2023.

 

 Deepthi Nishi Velamuri is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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How Can We Improve Access to Blood-Based Colorectal Cancer Screening?

In a recent blog post, Parker Lynch discussed the accuracy of blood-based colon screenings that are becoming increasingly popular in colorectal cancer (CRC) prevention efforts. The non-invasive nature of these tests has the potential to improve CRC screening rates in the general population, which is becoming increasingly necessary with the rise in early-onset CRC rates. 

While these tests have high specificity and sensitivity, their newer status on the market raises questions about whether they will be covered by insurance plans for most Americans. 

At the recent American Society of Clinical Oncology meeting, researchers presented their findings on a new multi-cancer detection test that utilizes only a blood sample for cancer screening. This test is groundbreaking in its ability to quickly and accurately provide positive test results for a broad spectrum of cancers. It will be essential to cancer prevention movements in the colorectal sphere and across the board. 

While these new tests are groundbreaking for prevention efforts, ensuring that the population has equitable access to these tests will establish their validity as a public health tool. The much heralded Galleri multi-cancer detection test has a list price on the company website of $949 and states that most insurance plans do not cover it. Considering that a significant portion of Americans (40%) cannot afford to cover a $400 emergency bill, the Galleri test’s pricing and lack of coverage will create access barriers to the general American public. 

Blood-based biomarker tests specifically for detecting CRC will be more easily accessible to the public, but still can be challenging to obtain. The Centers for Medicare & Medicaid Services, for example, will cover a blood-based biomarker test every three years, for an individual who is between 45 and 85 years old, asymptomatic, and at an average risk for developing CRC. This leaves out the early-onset population (<45 years), many of whom are diagnosed at an advanced stage and may benefit from a blood-based testing approach.

To advance health equity in CRC prevention and care, these innovative new tests must become more accessible through pricing and insurance coverage. When all individuals can access high-quality cancer prevention, regardless of income or socioeconomic status, we can protect the most vulnerable members of our population. 

 

Emma Edwards is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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Serving the Underserved: Transportation, Physician Access for CRC Prevention

By Deepthi Nishi Velamuri

Colorectal cancer (CRC) remains a serious health issue in the U.S. It is the second most common cause of cancer-related deaths in both men and women, and it is the third most frequently diagnosed cancer. An average of 50,000 Americans die from CRC each year. However, CRC is quite treatable if diagnosed early through routine screenings for average- and high-risk adults. The incidence and mortality rates associated with this disease are being reduced through public health initiatives, such as awareness campaigns and improving access to screenings. To prevent and identify CRC in its earliest stages, people must fully comprehend the risk factors, symptoms, and significance of regular screening.

The studies in the infographic below were presented at Digestive Disease Week 2023 and were focused on understanding the factors that impact screening rates for CRC in the U.S. The researchers delved into various aspects such as patient education, healthcare policies, socioeconomic disparities, and the effectiveness of screening methods and aimed to enhance screening efforts, raise awareness, and develop targeted interventions to increase screening rates.

 

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Breaking Barriers: Effective Approaches for Boosting Colorectal Cancer Screening Rates

By Deepthi Nishi Velamuri

Colorectal cancer (CRC) remains a serious public health issue in the U.S. that affects people from all walks of life, independent of race, gender, or age. The third most commonly diagnosed cancer in the U.S., an estimated 150,000 new cases and 53,000 deaths are attributed to CRC each year, highlighting the urgency for effective prevention and early detection strategies. [1]

Early and regular screening can improve detection rates and lead to better outcomes for CRC. However, there are significant disparities in the rates of CRC screening for some groups, such as medically underserved communities. Race and ethnicity, socioeconomic status, and access to healthcare services have a significant impact on CRC screening rates . 

During the annual Digestive Disease Week 2023 meeting,  several research studies were presented that identify interventions to improve CRC screening rates, specifically in medically underserved populations. The following interventions were identified in the systematic review to increase CRC screening rates among medically underserved populations:

  1. Multicomponent interventions: These interventions involved multiple elements, such as patient education, provider reminders, patient navigators, and mailed outreach. [2][3]
  2. Patient navigation: Interventions that included the use of patient navigators, who assist patients in navigating the healthcare system and overcoming barriers to screening, were effective in increasing screening rates. [3]
  3. Mailed stool-based kits with provider letters: Sending screening kits to patients by mail, along with a letter from their healthcare provider recommending the screening, was found to be a successful intervention. [3]

Multiple Elements to a Successful Screening Program

The study conducted by Shailavi Jain et al., [3] highlighted the impact of a multicomponent health system intervention to increase screening participation among patients with a family history of CRC. This intervention involved:

  • Electronic health record reminders to primary care providers
  • Reminders to patients to schedule a colonoscopy
  • Additional educational resources about familial CRC risk and the colonoscopy procedure 

The intervention increased colonoscopies ordered, scheduled, and completed among high-risk patients.

Another study focused on using patient-level structured data elements to optimize population-based CRC screening. The study utilized individualized health data, such as laboratory results and diagnosis codes, to identify patients with significant comorbidities who were unlikely to complete routine screening. This approach allowed for targeted screening efforts to be directed towards patients most likely to complete screening as intended by their primary care team. [4]

A meta-analysis examined the efficacy of an opt-out outreach method  to optimize screenings. [5] This approach involved giving patients the option to either opt-in or opt-out of receiving fecal immunochemical test (FIT) kits. The analysis showed that patients who were given the option to opt-out had a significantly higher FIT completion rate compared to those who were given the option to opt-in. 

Additionally, a quality improvement project evaluated the effectiveness of mailed reminders in increasing uptake of FIT. Mailed reminders were found to be an effective strategy in improving screening rates. [6]

Overall, these studies highlight the effectiveness of various interventions, including multicomponent approaches, patient navigation, mailed reminders, and opt-out outreach methods in increasing CRC screening rates among medically underserved populations and individuals with a family history of CRC. These interventions can inform the design of programs aimed at improving CRC screening in these populations.

References-

  1. American Cancer Society.
  2. Vella J., Patel, S, Bowman B., et al. Interventions to improve colorectal cancer screening among medically underserved populations: A systematic review. In: Digestive Disease Week 2023; May 6-9, 2023; Chicago, IL.
  3. Jain S, Galoosian A, Badiee J., et al. Impact of a multicomponent health system intervention to increase colorectal cancer screening participation in patients with a family history of colorectal cancer: A systematic review. In: Digestive Disease Week 2023; May 6-9, 2023; Chicago, IL.
  4. Corren R., et al. Flagging comorbidities using patient-level structured data elements to optimize population-based colorectal cancer screening: A systematic review. In: Digestive Disease Week 2023; May 6-9, 2023; Chicago, IL.
  5. Battepati D., et al. The efficacy of opt-out outreach method to optimize colorectal cancer screenings: A systematic review and meta-analysis.: A systematic review. In: Digestive Disease Week 2023; May 6-9, 2023; Chicago, IL.
  6. Ahmad Abu-Heija, Abdelnour D, et al. Effectiveness of mailed reminders in increasing uptake of fecal immunochemical testing for colorectal cancer screening: A quality improvement project.: A systematic review. In: Digestive Disease Week 2023; May 6-9, 2023; Chicago, IL.

 

Deepthi Nishi Velamuri is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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Could Blood-based Testing Improve CRC Screening Barriers?

By Parker Lynch

Despite the current methods that exist for people to receive preventative screenings, colorectal cancer (CRC) screening rates remain below the 80% national goal. Since the utilization of the current testing methods are subpar among average-risk adults in America, researchers are testing the reliability of a blood-based test, which remains a preferable screening method for a variety of preventive tests in the general population. The hope is that a preferred screening method would improve screening rates for CRC among average-risk adults. 

Testing the Reliability and Validity of a Blood-Based Test

The ECLIPSE clinical trial evaluated the performance of a cell-free DNA blood-based CRC screening test. Individuals who were average-risk (those with no identifiable risk factors or abnormal predispositions to being diagnosed with CRC), 45 years of age or older, and presenting for colonoscopy screening were recruited from 265 U.S. clinical sites between October 2019 and September 2022. This population was diverse, which makes the findings generalizable:

  • 54% female
  • 7% Asian
  • 12% Black/African-American 
  • 79% white
  • 12% Hispanic/Latino 

Prior to their colonoscopy, participants provided whole blood samples. In doing so, researchers were able to compare the validity of the blood-based tests when compared to the actual results that were obtained from the colonoscopy procedures. 

The trial found that the blood test was:

  • 90% sensitive to detecting Stage I – III CRC
  • 100% sensitive to detecting Stage IV CRC
  • 90% specific

In another study, researchers retrospectively analyzed blood samples of 425 individuals who were to undergo a colonoscopy. The blood samples were tested for specific genetic and epigenetic changes and these were then correlated with the individual’s colonoscopy results. 

Here’s a fun video that explains what genetic and epigenetic changes are.

The test was found to be:

  • 82% sensitive for CRC
  • 90% specific

Overall, the researchers concluded that this test provides clinically meaningful performance and has utility for CRC screening.  A limitation of the specificity/sensitivity study was the utilization of an older version of the assay. However, should the results of up-to-date versions of the assay remain statistically significant, blood-based screening could be a very effective and preferable CRC screening method. 

Both these studies demonstrate the effectiveness of blood-based tests, which will hopefully improve the rate at which people get their preventative testing for CRC.

 

Parker Lynch is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

 

Photo credit: Photo by Testalize.me on Unsplash  

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