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Cystic Fibrosis and CRC: A Surprising Connection

By Parker Lynch

According to the Mayo Clinic, cystic fibrosis (CF) is a disorder in which there is severe damage to the lungs and other organs in the body. This condition presents itself differently in each patient when comparing manifestations of symptoms; however, wheezing, difficulty breathing, exercise intolerance, constant lung infections, and recurrent sinusitis are all very common among individuals with CF. People with cystic fibrosis are very strong and admirable, as their condition can be very arduous in terms of treatment and monitoring: the need for consistent medication (bronchodilators, mucus thinners), using special devices and techniques to assist with breathing, monitoring what they eat, etc. 

Though it seems like CF and colorectal cancer (CRC) wouldn’t even be remotely related, adults with CF actually have a 5-10 times higher risk of developing CRC as opposed to adults without CF. On top of this, individuals with CF who receive lung transplants (or any other solid organ transplant, for that matter) are 20 times more likely to develop CRC, which requires them to complete their preventative screenings at the age of thirty rather than the standardly-recommended age of forty-five.

You can read about a CF patient’s experience with her surprise diagnosis of CRC. 

Where is This Connection Coming From?

As with any other condition or diagnosis, researchers aren’t completely certain of what the singular cause is of a CF patient’s higher chance of developing CRC. However, it is believed that mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene may have a role to play. Mutation in the CFTR gene not only leads to the development of CF, but can also lead to the development of CRC, though more research needs to be done on this topic to be able to analyze the strength of the correlation between the two. 

Moving Forward With This Information

Patients with CF are recommended to receive regular colonoscopies beginning at the age of 40 (which is five years younger than typically recommended among the adult population). Those who have received lung transplants are recommended to get their screenings at the age of 30, due to the aforementioned risks that come with organ transplantation and CRC development. 

Outside of preventative screenings, monitoring CF and CRC requires collaborative efforts among different healthcare providers as well as the individual themselves. The important factor here is that CF patients are made aware of their increased risk of getting CRC, and have a support system in navigating appointments, physician communication, screenings, etc. 

Monitoring one condition alone is extremely stressful and taxing on an individual, let alone having to deal with two. The American Cancer Society has a list of psychosocial resources for individuals who need support with navigating their healthcare, while also helping provide financial assistance, individual therapy, and group therapy. Health concerns are never easy to deal with, and it is always okay to reach out for help. 

 

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

Image credit: Gordon Johnson from Pixabay

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Closing the Gap: A Tale of Enhanced Mailers and Colorectal Cancer Screening

By Laiba Ahmad

Once upon a time, in a community served by a Federally Qualified Health Center (FQHC) clinic, a group of researchers embarked on a mission to enhance colorectal cancer (CRC) screening among a unique demographic—those aged 45 to 49. Using the U.S. Preventive Services Task Force screening recommendations as their guiding light, the researchers started their journey of measuring the impact of a mailed fecal immunochemical test (FIT) intervention.

The journey began in February 2022 when 316 eligible individuals in this age group received a mysterious package in the mail—a FIT, the key to unlocking early detection of CRC. This diverse group included 57% females, 58% non-Hispanic Blacks, and 50% commercially insured individuals. The researchers eagerly awaited the outcome of their intervention.

A Surprise Finding

The randomized trial discovered the difference between an improved mailing envelope and a plain one. The enhanced envelope, with a tracking label and a splash of colored messaging stickers, aimed to captivate the recipients.

As the days unfolded, the results emerged. A total of 54 out of 316 individuals (17.1%) observed the call, completing the FIT within 60 days. The enhanced envelope wielded a stronger enchantment, with 21.5% of recipients returning the test, compared to 12.7% from the plain envelope group—a significant difference of 8.9%. The researchers extended their gaze to the entire clinic population in the 45-49 age group, observing the collective transformation in CRC screening over the span of six months. The clinic-level screening soared, rising by a remarkable 16.6%, from a baseline of 26.7% to a triumphant 43.3%. 

A New Strategy to Increase Screening Compliance 

As the researchers concluded their quest, they discovered a promising path forward. The mailed FIT intervention had cast a spell of increased CRC screening among the vibrant 45-49-year-old FQHC patients. They recognized that this was just the beginning of the story. Larger studies would be needed to unravel the mysteries of acceptability and completion rates in this younger population. 

The story of enhanced mailers and CRC screening echoed through the halls of healthcare, reminding all that visually appealing enchantments can indeed pave the way for a healthier tomorrow.

Laiba Ahmad is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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Blood-Based Testing Could Improve Colorectal Cancer Screening Rates

Regular screening, surveillance, and high-quality therapy can help prevent colorectal cancer (CRC) incidence and mortality. However, a lot of people put off being tested for a variety of reasons, including:

  • Hearing from others that the test could be challenging or uncomfortable and that talking to their doctor about CRC or handling feces could be embarrassing
  • In the absence of a family history of CRC, they believe they are not at risk and don’t need to be screened
  • Cost of getting tested
  • The complexity associated with screening, which could include out-of-pocket costs, taking time off work, and transportation to the clinic 

Here’s information on the different types of screening options for CRC.

Blood Tests Are Emerging as a Potential Screening Option

While legitimate, these concerns have over time created obstacles to CRC detection at an early stage, when the cancer is easier to treat. But, alternative options are being developed that do not require handling stool samples or undergoing a colonoscopy (which may need time off from work), such as blood-based testing. 

A study that was recently presented at the annual meeting of the American College of Gastroenterology, found that patients who were given the option to undergo a blood-based CRC screening test were more than twice as likely to finish the screening process than those who were given the stool-based option.

Of the 1,927 eligible study participants, 924 were assigned to the blood draw group and 1,003 to the stool-based testing group. More than 50% of participants in the blood-draw group made an appointment with the research team after they were contacted by phone. After three months, CRC screening was 19.4% higher in the blood-test group than the stool test group (32.4% vs. 13.0%). 

Traditional CRC Screening Options

Traditionally, the following screening options have been use for those with an average risk of CRC (meaning no family history of polyps of CRC or personal history of polyps or CRC):

  • Fecal immunochemical test (FIT) test is performed annually
  • FIT-DNA test is performed every three years
  • Guaiac-based fecal occult blood test (gFOBT) is performed annually to screen for CRC
  • Colonoscopy is performed once in ten years

The FIT and gFOBT tests are at home and require a small bit of stool sample to be collected with a stick or brush and sent to a laboratory for testing. On the other hand, a whole bowel movement is taken for the FIT-DNA test and sent to the lab to be examined for altered DNA and the presence of blood. 

A colonoscopy is a little more complicated in that it requires some preparation the previous day and anesthesia during the procedure.  

On the contrary, extracting blood may be less painful, awkward, or time-consuming. Blood-based tests for CRC can have several benefits and lower testing barriers. Nevertheless, patients need to be properly informed of their options, and more research is required to gauge the extent to which blood tests for CRC are effective and comparable to other screening options in detecting cancer.

 

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

 

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Race and Gender Impact CRC Diagnostic Testing Among Young Veterans With Iron-Deficiency Anemia

By Parker Lynch

The Veterans Health Administration recently conducted a retrospective study of data on veterans who received care between 1999 and 2019. This study included US veterans between the ages of 18 and 49 with diagnoses of iron-deficiency anemia (IDA) and/or hematochezia. When examined for their diagnostic testing completion rate and the time to diagnostic testing, race and gender were found to result in disparities.

Study Outcomes and Findings

For those with IDA, diagnostic test completion was characterized by whether or not these individuals had received bidirectional endoscopies (a procedure that includes both a colonoscopy and an upper endoscopy). For those with hematochezia, diagnostic test completion was defined as either receiving a colonoscopy or sigmoidoscopy (a less-invasive procedure in which the lower part of the large intestine is examined, rather than the entire organ).

Candidates were also evaluated with respect to age, sex, race, ethnicity, and hemoglobin test value.

Out of Among the 59,169 veterans with IDA:

  • 37,719 were aged 40 to 49 years
  • 28,667 were women
  • 24,480 were black
  • 4,161 were Hispanic
  • The estimated cumulative diagnostic test completion rates were 7% at 60 days and 22% at the end of the two years as per the evaluation period.

 

Out of the 189,185 veterans with hematochezia:

  • 106,730 were aged 40 to 49 years
  • 86.5% were men
  • 4,4939 were black
  • 17,317 were Hispanic
  • The estimated cumulative diagnostic test completion rates were 22% at 60 days and 40% at the end of the two years.

The study found very low diagnostic testing among both veterans with IDA as well as those with hematochezia. Additionally, black, Hispanic, and female veterans were less likely to receive testing than their white male counterparts.

This testing is vital to detecting and treating early onset colorectal cancer (CRC), so the low levels are concerning for healthcare professionals and researchers and may have resulted in missed opportunities for early diagnosis of CRC.

Veterans’ Inadequate Health Coverage

This study raises questions around why many veterans aren’t receiving the preventative screenings they need. A 2020 study conducted by Harvard and Public Citizen found that 1.53 million veterans nationwide were uninsured. On top of this, 1 in 12 veterans (approximately 2 million individuals) go without vital physician care annually due to the associated cost.

An estimated 9 million veterans are registered with the Veterans Health Administration, but not all of them are eligible for VA healthcare coverage. This leaves a lot of veterans (many of whom have chronic conditions) unable to receive adequate care, unless they are directly paying out of pocket or have the means to purchase private insurance.

Should veterans have proper health care coverage, there would hopefully be a substantial increase in the amount of diagnostic testing that is completed, and therefore a decrease in the national incidence rate of early onset CRC.

 

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

Image credit: Clker-Free-Vector-Images from Pixabay.

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Holiday Card Uses Humor to Send Serious Message About Colon Cancer Screening

By Matthew Tolzmann

Twenty years ago, my dad was diagnosed with stage 3B colon cancer. He was 60 years old, and he had scheduled his first-ever colonoscopy schedule—but he required colon cancer surgery before the day of his scheduled screening. My dad started chemotherapy, but landed in the hospital when the treatment nearly killed him. A pastor by profession, the only time he didn’t feel nauseous for his year of chemotherapy was when he was preaching.

My dad is a cancer survivor of twenty years now. I’m so grateful that he was given these twenty years and counting, but I feel bad that he had to go through that year of hell. I’m positive that if he were to have had a colonoscopy at age 45, he would never have needed that year of chemotherapy.

Because of this family history, I am considered high risk and my doctor recommended that I have my first colonoscopy when I was 35. My dad actually gave my brother and I colonoscopies for Christmas presents that year! My dad was willing to pay whatever it cost, to save us from what he endured, but I was fortunate that my insurance covered everything. When I was 35, I had incredible insurance through my employer and my first three colonoscopies were covered with basically no extra cost to me. My insurance changed to a marketplace plan and it appeared I was going to have to pay quite a bit because all of my colonoscopies are considered “diagnostic.” The insurance, however, ended up covering most, if not all, of the cost. I was amazed. My insurance has changed again, so in another few years I’ll see if it’s still covered!

Editor’s note: Additional information about screening guidance and insurance coverage can be found here.

My first screening colonoscopy showed several precancerous growths that the doctor removed right then and there. Over the next 15 years, I had three more colonoscopies. The most recent one, at age 50, for the first time ever, resulted in a clean scan with no growths to remove whatsoever. I am positive that colonoscopies have saved me from what my dad went through, or worse.

I’ve had two friends pass away from colon cancer and each death really affected me. In their memory and in honor of my dad, we sent out holiday cards with a call to action to get screened for colon cancer. I love sending out irreverent and creative holiday cards that make people smile, but I felt really good about the higher purpose of this year’s card. If my card can get even one person to get screened and they find even one growth… Then that could translate to one life extended by twenty years… or thirty… or forty…

 

Matthew has a Bachelor’s of music in Music Theory & Composition from the University of Northern Colorado. He has been the violin photographer for Bein & Fushi Rare Violins since the year 2000 and has photographed some of the world’s most valuable stringed instruments. Matthew is also an author and an artist and is currently writing and illustrating a nature science book as well as several collections of humorous essays. He lives in Chicago with his wife, Andrea, and his youngest son, Peter. His oldest son, Simon, is in college in Colorado.

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Personalized Approach to Prioritize Colorectal Cancer Screening in Average-Risk Adults

Regular screening between the ages of 45 and 75 is an ideal strategy to lower the risk of colorectal cancer (CRC). However, one of the biggest obstacles to screening for people who want to get examined is the expense and wait time. ​​According to a 2022 study, the average cost of a colonoscopy screening in the U.S. was $2,125, with an out-of-pocket cost of $79. But there are other options to screen for CRC besides colonoscopy. 

The CDC recommends guaiac-based fecal occult blood test (gFOBT) stool testing, which is a test type that finds blood in the stool by using the chemical guaiac, and it’s performed once a year. 

Fecal immunochemical test (FIT) test, is a test type that looks for blood in the feces using antibodies. It is conducted annually in the same manner as a gFOBT. Additionally, there is the FIT-DNA test, which is performed every three years and combines the FIT with a test to identify altered DNA in the feces.

Flexible sigmoidoscopy involves the insertion of a small, flexible, lighted tube into the rectum by the doctor. The doctor does an examination to look for polyps or cancer in the bottom portion of the colon and the rectum. It is done every 5-10 years.

CT colonography (virtual colonoscopy) uses X-rays and computers to produce images of the entire colon, which are displayed on a computer screen for the doctor to analyze; it is done every 5 years. 

Why Is This Important?

The choice to get screened has never been easy, particularly for older adults, especially since evidence-based tailored screening guides for average-risk individuals have been developed for those between the ages of 76 and 85, while a personalized approach is yet to be developed for those between 45 and 75 years of age. The population is exposed to a variety of preventive screening measures, often a part of the annual physical or wellness visit. Therefore, clinicians guiding average-risk patients between the ages of 45 and 75 sometimes find it difficult to explain why screening should  CRC screening should be stopped, since there are no evidence-based studies to back up their claim. 

Individualized awareness of the advantages and disadvantages of screening by providing alternative forms of support was found to reduce the likelihood that patients would use screening altogether and increase the likelihood that they would receive screening orders that were in line with the benefits of screening, based on a recent study involving 436 older patients (70-75 years).

Conclusion

In order to support average-risk patients (45–75 years old) in making individualized decisions, policies and screening protocols should be designed, similar to those for adults 75 years of age and above. A multi-level intervention that provides personalized information about the benefits and risks of screening, along with patient education and system-level support, can potentially lower overall screening use and align screening orders with benefits, while also cutting down on screening costs and wait times all over the country without compromising benefits. 

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

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Reviewing CRC From an Anthropological Lens: Who Is Most At Risk and Why?

By Parker Lynch

One cannot deny the importance of considering an individual’s risk of colorectal cancer (CRC) on the basis of their diet, exercising habits, and genetic predispositions. However, many other demographic factors can influence the likelihood of being diagnosed with CRC, as well as subsequent quality of life and survival outcomes. 

Lower socioeconomic status, for instance, is associated with a very high risk of developing CRC. Most of these community members are uninsured, which makes it difficult for them to receive the screenings that are otherwise readily accessible for those with insurance plans. A colonoscopy (one of the most important preventative screening measures for CRC) can cost anywhere from $500 to $6,000 without insurance, depending on the site where the procedure is conducted. For those on tight budgets, paying such amounts out-of-pocket every 5-10 years (depending on their personal risk of CRC) is quite unrealistic.

Tampa Bay Study

In a retrospective study conducted in 2021 by the CDC, researchers analyzed 13,982 uninsured patients with CRC who had received services at various free clinics in the Tampa Bay area between 2016 and 2018. These patients’ demographics are as follows: 

  • 5,139 (36.8%) were aged 50 years or older
  • Most were female (56.8%)
  • A large majority were non-Hispanic White (41.1%)
  • Majority were unemployed (54.9%)

Less than 7% of these patients had received any sort of preventive colorectal screening in their lives. 22.7% of these patients were smokers, and another 28.3% had diabetes. Not only are these patients more at risk for CRC because of their predisposed comorbidities, but they also don’t have the means to receive proper preventative screenings.

Bridging the Gap: Free Clinics

This study is one of many that sheds light on the healthcare treatment discrepancies among people of different socioeconomic statuses in America. The concerning statistics presented by these retrospective studies have motivated healthcare professionals and non-profit organizations to provide free clinics across the U.S. to make screening accessible to those who wouldn’t be able to otherwise afford it.

The NYC Health Department’s NYC Community Cares Project, for instance, provides free colonoscopies for uninsured residents referred from primary care sites. This program collaborates with various endoscopy centers and allows patients to work with primary care physicians, while also receiving free anesthesia and pathology services. Other interventions, such as the ColonoscopyAssist program, assists uninsured individuals in 30 states with the fees associated with CRC screening. This organization strives to eradicate a lot of the costs that are accumulated when someone gets preventative screening done, and reduces a colonoscopy’s cost to around $1,000 for a patient. Though this program doesn’t entirely eradicate colonoscopy costs, it still helps patients by significantly reducing the price, inherently making them much more feasible. 

Moving Forward

These public health interventions are vital to treating patients that suffer from America’s healthcare inaccessibility issues that run rampant throughout the country. Even though the U.S. spends more money on healthcare than any other wealthy country in the world, we have struggled to match other countries in patient satisfaction, accessibility, and life expectancy. 

Movements like the Community Cares Project in NYC, ColonoscopyAssist program, and other free/reduced-cost screening resources across the country are making huge strides in the CRC community. Should these endeavors continue to be subsidized by non-profit organizations, philanthropies, donations, and government support, uninsured individuals can receive timely preventative screenings. Increased access to these resources can ensure that patients from all socioeconomic backgrounds can receive the care that they need. 

 

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

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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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