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.

By Parker Lynch

According to the national census data for 2020, Kentucky was found to have the highest incidence of colorectal cancer (CRC) in the country—41.2 new cases of CRC per 100,000 people in the state  that year. This number is concerning, especially when comparing it to other states with significantly lower rates: Utah, Colorado, Delaware, Arizona, and Vermont (about 20 new cases per 100,000 in 2020). 

Why Is CRC Incidence High in Kentucky?

There are several risk factors associated with CRC: tobacco use, poor dietary habits, lack of exercise, genetic predispositions, etc. Unfortunately, the residents of Kentucky exhibit each of these poor lifestyle habits much more than other states. Two-thirds of adults in Kentucky are overweight, less than a tenth eat a sufficient amount of fruits and vegetables, and more than a third are not getting enough exercise. On top of these, family history of CRC is common among many families in the state, making it much more likely for individuals to develop the disease. 

On a national level, Kentucky is known for having some of the poorest diets, which includes a regular consumption of fried foods, meats, and bread. Fried foods and over-processed meats, in particular, can expose one’s body to carcinogens that have been linked to CRC as well as various other cancers. 

Kentucky Culture 

Born out of Corbin, Kentucky, Colonel Sanders’ fried chicken restaurant quickly grew to become a very popular and profitable chain of fast food spots. Known for serving bowls, pot pies, mashed potatoes, and loads of fried chicken, KFC has been a hot-spot since the 1940s. It might seem like an easy fix to tell residents to just “eat healthier”, but unhealthy diets that are deeply ingrained in a state’s culture and history are very hard to just simply eradicate. 

Telling residents of Kentucky to stop eating their fried foods is like telling residents of New York to stop drinking coffee; they may just laugh in your face. Changing the standard American diet and encouraging healthy eating habits remains a challenging endeavor for healthcare workers, researchers, community educators, and the population itself. 

Educating Communities

For starters, access to dietary and lifestyle counseling should be expanded throughout all states in America. In doing so, people would inherently have the opportunity to reflect on their own eating habits, and create plans to maximize their nutrient intake, while also learning how to be financially feasible in doing so. Many people may not even be aware of the significant health consequences of their dietary habits, and they will never know unless people are intentionally educating communities about these crises. 

People don’t need to entirely restrict certain foods in order to avoid CRC, but a gradual decrease of the consumption of fried/heavily processed foods while simultaneously increasing the consumption of vegetables, fruits, and leaner meats will lead to a new culture: one where CRC is not a common disease in one’s community or town. 

 

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

Picture credit Larry White from Pixabay.

By Parker Lynch

The Colon Cancer Foundation (CCF) has an incredible internship program that encourages interns to review journal articles on healthcare and colorectal cancer (CRC), raises their awareness on CRC, provides a platform for interns to connect with other researchers/students interested in the same field, attend research conferences, among other things! Additionally, interns frequently write articles and create infographics on the latest developments in the CRC space. 

This blog post is dedicated to introducing some of the faces behind all of these articles, and taking a look at what they are doing now in their academic and professional careers.

Emily Edwards (they/them) 

Emily Edwards

After working with CCF, Emily is currently serving as an Infection Prevention Specialist for the CDC Foundation in conjunction with the North Carolina Division of Public Health. Their primary focus is to prevent the transmission of sexually transmitted diseases across 27 counties located in Western North Carolina. They are also responsible for connecting individuals with the necessary healthcare services while simultaneously reaching out to their partners to curb the further spread of the disease. According to Emily, “The skills I acquired during my time as an intern with the Colon Cancer Foundation equipped me with the expertise to communicate intricate scientific data to diverse audiences, which I use in my current role”.

 

 

 

 

Shachi Patel

Shachi Patel (she/her) 

Shachi is currently a second-year physician assistant student. Since September 2023, she has completed her pediatric and surgery rotations and is currently on her OBGYN rotation in Philadelphia. Shachi has loved all of them so far, and is excited for the rest of her rotations and to see what specialty she ends up in as a PA. 

 

 

 

 

Sahar Alam (she/her)

Sahar Alam

Sahar joined the Colon Cancer Foundation (CCF) as a Colorectal Cancer (CRC) Prevention intern while she completed her Master of Public Health with a concentration in Epidemiology from New York University. She was drawn to CCF’s mission because one of her close family members was diagnosed and treated for colorectal cancer in 2019. During her internship, Sahar interviewed researchers about their recent work and notable research findings, wrote blog

posts about CRC research, developed infographics, and coordinated with other interns to raise

awareness about CRC. Sahar says that she is very grateful to have worked with Dr. Surabhi Dangi-Garimella, who mentored and guided her throughout her internship. Currently, Sahar works as a Manager of Scientific and Health Policy Initiatives at ISPOR—The Professional Society for Health Economics and Outcomes Research.

 

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

Picture credit: Gerd Altmann from Pixabay.

Often, colorectal cancer (CRC) doesn’t cause symptoms until it grows or spreads. It is often harder to detect in the younger population who might ignore symptoms due to lack of insurance coverage, and because they are not yet eligible for screening because of their younger age. However, findings from a recent study might provide some clues to identifying the early onset of CRC among young adults not old enough to qualify for CRC screening. 

Those under 45 may not have insurance coverage for any form of CRC screening—colonoscopy, FIT, or FOBT—because the recommended age to start screening for CRC is 45 years. According to the American Cancer Society, 2,001,140 new cases of cancer are projected in the U.S. in 2024,152, 810 of which may be CRC. Another concerning statistic is the 2% rise in the annual CRC incidence rate among young adults (ages <55 years). 

Paying Attention to The Early Signs

The study identified 4 red-flag signs and symptoms occurring at least three months before diagnosis that were associated with a subsequent risk of early-onset CRC:

  • Abdominal pain 
  • Rectal bleeding 
  • Diarrhea
  • Iron deficiency anemia 

A total of 5,075 early-onset CRC cases and 22,378 controls were included in the study. 63% of the cases were diagnosed with CRC. The authors found that in the study population:

  • Abdominal pain and rectal bleeding were the most common symptoms
  • Abdominal pain was associated with a 34% higher risk of early-onset CRC 
  • Signs of rectal bleeding had the greatest association with developing CRC 

Diarrhea and iron deficiency anemia were also identified as a common symptom but did not have a high association with CRC.

Having one, two, or three of these warning signs and symptoms were linked to a 1.9-, 3.6-, and 6.5-fold higher risk of developing CRC, respectively. These correlations were stronger for rectal cancer and young-onset cases (average 43 years).

Despite the possibility that this study helped focus on the early warning signs and symptoms of CRC, it is crucial to remember that the signs and symptoms described above can also be the result of other health conditions such as inflammatory bowel disease, hemorrhoids, irritable bowel syndrome, or infections. In order to properly identify and treat the condition, it is important to see a doctor and get screened if you are experiencing any of those symptoms.

 

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

Picture credit: Muhammad Daudy on Unsplash

By Alexa Kanbergs, MD-ScM, MS

What is IGNITE-TX?

Have you been diagnosed with Lynch Syndrome or a BRCA1 or BRCA2 genetic mutation? Do you have family members who have not yet undergone genetic testing? If yes, then this study may be for you! The IGNITE-TX study explores ways to increase genetic testing for family members of those diagnosed with Lynch Syndrome or a BRCA1 or BRCA2 genetic mutation. This is also known as cascade genetic testing.

What the Study Involves

Individuals eligible for the study will be granted access to the IGNITE-TX website. The website contains information about their genetic mutation and how to share information with family members. Participants and their family members will be placed at random into four groups:

  • Group 1: Standard of care, which is receiving a letter with information on their specific hereditary cancer syndrome that they can share with their relatives
  • Group 2: Free genetic counseling and testing
  • Group 3: The IGNITE-TX intervention, which gives family members access to the website and education modules as well as access to a study navigator
  • Group 4: The IGNITE-TX intervention and free genetic counseling and testing.

All participants (including family members enrolled in the study) will be asked to complete a baseline survey and then follow-up surveys at 6 and 12 months. Participants will receive a $10 gift card after completion of each survey.

Why Should I Enroll? 

There are good reasons to join the IGNITE-TX Study. First, you get to help others. By joining, you can help test your family members, and it also helps us learn better ways to conduct genetic testing for people whose family has a history of cancer. Additionally, everyone who takes part in the study will be compensated for their time.

How Do I Know if I am Eligible to Enroll?

You are eligible to participate in this trial if:

  • You are 18 years of age or older
  • You or your family member has a positive genetic test result  for the BRCA1/BRCA2 mutation or Lynch syndrome (MLH1, MSH2, MSH6, PMS2, EPCAM mutation)
  • You have an email address and/or a U.S. cell phone number
  • You speak English or Spanish

You are not eligible to participate if:

  • You do not have any relatives
  • You do not have one of the genetic conditions listed above or only have been told you have a variant of uncertain significance

Study Locations

We are targeting enrolling patients throughout the U.S.

Study Contact Information

J. Alejandro Rauh-Hain, PI

Heidy Bosch Study Coordinator

Study specific contact information: Ignitiestudy@mdanderson.org, Phone: 713 792 9155

 

Clinicaltrials.gov identifier:

NCT05677048 (https://clinicaltrials.gov/show/NCT05677048)

 

Alexa Kanbergs, MD-ScM, MS, is a Gynecologic Oncology Fellow, MD Anderson Cancer Center.

Photo credit: Rajiv Perera on Unsplash

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.

 

As the year draws to an end, people often make resolutions related to their money, health, spirituality, and overall personal development for the upcoming year. However, the kitchen is a crucial area that one might want to consider when making New Year resolutions. Yes, you read correctly—the kitchen. Research has indicated that cookware may increase the risk of colorectal cancer (CRC). 

Microplastics Increase the Risk of CRC

Microplastics (which result from the breakdown of plastics), for example, have been shown to cause physiological changes in the gut that can increase the risk of CRC, especially in those under 50. Several research studies have shown that microplastics can reduce the thickness of the mucus lining in our intestine, thereby reducing its barrier function. This could increase access of pathogenic bacteria and toxins to the inner layer of the colonic mucus, potentially increasing the risk of CRC. Interestingly, the authors point out an association between the time when plastic use infiltrated our daily lives, and the risk of CRC.

In the U.S., adults have been estimated to ingest between 39,000 and 52,000 particles of microplastics annually, and an additional 90,000 particles if they drink bottled water. 

While plastics are biochemically inert, plasticizers used in their processing may be the source of the biological impact. Their resilience and stability has led to the environmental accumulation of plastics across our planet and they are now a part of the human food chain. 

Risk from Non-stick Coatings on Pots and Pans

Another study has found an association between CRC risk and a chemical called perfluorooctanoate (PFOA). What is PFOA, you ask? Informally called a “forever chemical”, PFOAs were—and maybe continue to be—used in certain cookware, particularly non-stick pots. Safe cookware includes titanium, enamel iron cast, clay, glassware, and non-stick pots with the word “no PFOA”  indicated on them. Aluminum cookware, however, is just as unsafe as non-stick pots containing PFOA.  

These studies confirm some of the health risks associated with our daily exposure to certain environmental factors.

 

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

Photo credit: S’well on Unsplash

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.

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.

There are two kinds of health literacy: personal health literacy and organizational health literacy. Personal health literacy describes the extent to which people have the capacity to locate, comprehend, and apply information and/or services that they have obtained to make informed health decisions and actions for themselves and others. Organizational health literacy is the extent to which organizations and associations equip individuals with what is necessary to draw conclusions and inferences that enhance their understanding and enable them to make informed health decisions and act for themselves and others.

Why is Health Literacy Important?

Health literacy is instrumental in influencing health disparities because it can serve as an essential barrier or bridge to comprehension of health education material. An impactful determinant of health, a person’s health literacy is more likely to accurately predict their behaviors when compared with economic status, age, or ethnic background. Health literacy also has a substantial effect on an individual’s health: those who lack health literacy are twice as likely to be hospitalized as those who possess satisfactory levels of health literacy. The most common cause for this could be: misinterpretation of information or incorrect dosage of self-administered medication or treatments. 

Those who lack health literacy may be ashamed and/or hesitant to open up about this issue with their healthcare providers for fear of judgment, and this may hinder their trust in the healthcare industry. This in turn may be pernicious towards their overall well-being.

How Can We Account for This When Developing Educational Materials?

There are an abundance of ways to make accommodations in health resources in order to account for differences in health literacy.

  • Use Plain Language
      • Avoid technical slang or jargon
        • If technical terms are used, be sure to define them in lay language and contextualize it so that the intended audience understands how and when it is utilized.
      • If the health resource is an article, include a plain language summary (this is something that the database Cochrane practices), a glossary of terms and words with phonetic pronunciation guides, and at least one example of how the term or phrase is used.
  • Be Aware of Appropriate Phrasing and Preferred Communication
      • Be sure to provide materials in the languages that are most often spoken in your area, and to interact with reliable translators to verify that the facts are coming across correctly and fully in all languages.
        • Brochures, forms, and other materials at health education events can be available in multiple languages
        • It is important to be aware of perception of words used in verbal and written communication
          • For instance, avoid the qualifier “disorders” when discussing mental health or the term “co-morbidities”, since they carry negative connotations. Instead, opt for terms such as “mental health conditions”, and “co-occurrences”. 
        • Identity-first vs person-first
          • Identity-first language puts a person’s condition before the person, and person-first language puts the person before their condition.
            • Preferences depend on the community, so it is important to consult a variety of sources and be receptive to your audience(s) and their input.
  • Visual Supplements for Written Materials 
    • Infographics
      • Can provide helpful imagery to highlight main ideas of the research
      • Assists people who may have trouble imagining what the text is conveying
    • Text, Font, and Contrast
      • Large text can be helpful for people with visual impairments
      • Fonts should be clear and legible
      • Colors, hues, or both for background and text should contrast in a way that does not obscure the information

Just as zip code is a salient social determinant of health, health literacy serves as an important indicator of potential health behaviors and outcomes. Being able to consume, understand, and disseminate health information will help people and those they care about immensely in that the decisions made and actions taken will be more robustly supported and informed. 

Reach out to us at info@coloncancerfoundation.org if you would like to collaborate and create accessible health materials pertaining to colorectal cancer, prevention, or another related topic!

 

Vanessa Seidner is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

Photo credit: Alexander Grey on Unsplash.