March 10, 2014

Colon cancer prevention efforts expanding in SC

Gary Hemingway twice had been scheduled for colonoscopies. He’d been prescribed the laxative preparation to use the day before the exam. And then he backed out.

Gary Hemingway twice had been scheduled for colonoscopies. He’d been prescribed the laxative preparation to use the day before the exam. And then he backed out.

“They just gave me some stuff,” Hemingway said. “They didn’t really explain it all to me.”

Then he ran into Renay Caldwell, who helps patients navigate through the colonoscopy process in her role with the S.C. Colon Cancer Prevention Network. Caldwell, and the network, likely saved Hemingway’s life. The Columbia resident finally went through with a colonoscopy, a large polyp was found and it was removed before it would almost certainly have become cancerous.

The even better news is that increased funding and more participation by physicians this year will allow the network to increase the number of free colonoscopies it can provide – from about 100 per year to 800. Each of those procedures has the potential to send out ripples that will improve the health of many more than the patients checked.

“It’s advocacy,” said Dr. Frank Berger, the leader of the network. “The people who do this are going to their family and friends and telling them. … So much of (the reluctance) to getting colonoscopies is a social issue. We’re chipping away at that barrier one patient at a time.”

For instance, Hemingway now helps the network spread the word about the need for colorectal exams. He has recruited colonoscopy candidates at his church, telling them the process isn’t a big deal but the results can be life-saving.

“If I hadn’t run into Renay Caldwell, I wouldn’t have went,” Hemingway said. “I thank the Lord she was there.”

Colon cancer is the fourth most common cancer in the country and the second leading cause of cancer death in South Carolina. Yet it’s preventable with early detection, and removal, of polyps in the colon through colonoscopies.

“The goal with prostate and breast cancer screening is to detect it early to treat and cure it,” said Dr. March Seabrook, a Columbia gastroenterologist. “The goal with colon cancer screening is to prevent it.”

The rule of thumb is for most people to get checked around age 50, though African-American men and those with family history of colon cancer should get checked in their 40s.

While South Carolina ranks near the bottom in the number of colon cancer deaths per capita, the state ranks in the middle of the pack in cancer screening rates. About 64 percent of South Carolinians age 50-75 reported having had a colorectal screening test, according to a 2012 accounting by the Centers for Disease Control and Prevention. Massachusetts was No. 1 with 76.3 percent getting tested. Arkansas was worst with 55.7 percent.

One major problem in South Carolina is that the percentage getting tested is lowest among a group statistically most likely to develop colon cancer – African-American men. And testing rates are especially low for people without insurance because of the expense of colonoscopies.

The S.C. Colon Cancer Prevention Network has focused its efforts at those groups.

This year the network should be especially busy because, after running a pilot screening program for several years thanks to grants from BlueCross BlueShield of SC, others jumped on board to increase funding.

BlueCross came through with another $171,950, two-year grant for clinical services, the Duke Endowment provided a $450,000, two-year grant for navigators to help patients through the process and for evaluation of the effort, and the state legislature kicked in $500,000.

The network estimates it will be able to provide free colonoscopies for 800 people this year, compared with 550 in the 2008-2013 period. The effort has expanded from two counties to 28.

Most patients are referred from free clinics or federally qualified health centers to gastroenterologists who have volunteered to perform a certain number of the free exams each year. (Their practices are paid the Medicaid rate for the procedure, but the physicians waive their separate fee.)

Despite the procedures being free, many candidates still balked at the opportunity. “When you give away something, it’s not appreciated,” Seabrook said.

That’s why navigators such as Caldwell are important. She not only explained the procedure’s importance to Hemingway, she also sat down with him and watched a video on the subject. She thoroughly detailed the preparation process. She reminded him what needed to be done each step along the way.

“If we get them in the front door, they get it,” Caldwell said. “We try to make it a personal experience, not just wham, bam, you’re done.”

Based on general population statistics, the 800 exams this year will save two or three lives and about $500,000 in medical costs, Berger said. And those savings will be multiplied if more patients follow the lead of Hemingway.

“I talked to one of my friends at church about how important it was,” Hemingway said. “I called Ms. Caldwell and gave her his number. And now he’s scheduled for an exam.”

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