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Screening for colorectal cancer

Louisiana’s diagnosis rate is the second highest in the U.S.



Many people know lung cancer is a major killer in Louisiana, but few realize that colorectal is the next deadliest cancer in the state.

  That doesn't mean it's the most aggressive cancer out there. In fact, colorectal cancer is rather slow-growing. Yet, according to the Louisiana Tumor Registry, more men and women here die from colorectal cancer than they do from prostate or breast cancer, fueling a colorectal cancer death rate that places Louisiana as the fifth highest in the nation.

  "With Louisiana having the second highest rate of colorectal cancer diagnosis in the United States and the fifth highest death rate from this form of cancer, the time for action is now," says Dr. Keith Winfrey, chief medical officer at the NOELA Community Health Center and Louisiana Colorectal Cancer Roundtable member.

  One reason the rate is so high is that black men suffer disproportionately from the disease nationwide, with Louisiana's black men having even worse rates than their counterparts elsewhere in the country. And a recent Tulane/LSU study found that Cajuns have some of the highest colorectal cancer incidence rates in the United States, which researchers suspect may be due to genetic factors.

  Yet all this disease and death results from a cancer that, like lung cancer, is almost entirely preventable. Unlike lung cancer, preventing colorectal cancer does not require anyone to conquer a long-held habit or beat back an addiction. It just requires people 50 and older to get screened on a regular basis.

  The combination of those stark figures and easy potential remedies were the impetus for state House Speaker Pro Tem Walt Leger, D-New Orleans, and Rep. Tom Willmott, R-Kenner, to introduce House Concurrent Resolution 67 during the 2014 legislative session. It passed, establishing a Louisiana Colorectal Cancer Roundtable (LCCRT) modeled after the National Colorectal Cancer Roundtable (NCCRT), and which is charged with the ultimate goal of meeting the NCCRT's "80% by 2018" initiative — a drive to ensure that everyone age 50 and over has been screened by the year 2018.

  "Right now, there are people all over the state taking action to help prevent colon cancer," says Colleen Huard, manager of the Louisiana Comprehensive Cancer Control Program (LCCCP). "Look at us — we're teaching people about the disease by having them walk through our inflatable walk-through colon. Others are handing out FIT and FOBT tests (do at-home tests that can help detect colon cancer). What we need to do now is connect all the dots and get people working together to meet that goal."

  The LCCCP works in the state to create awareness about six preventable cancers, including colorectal. With the help of LCCCP, housed at the LSU HSC's School of Public Health in New Orleans; the Feist-Weiller Cancer Center at LSU HSC Shreveport; and the American Cancer Society, the LCCRT's steering committee has been formed and will meet for the first time on March 13 at the state capitol.

  "I'm encouraged to see Louisiana commit to the national goal of '80% by 2018' and I am really looking forward to working with this diverse coalition to reduce the burden of this cancer in the state," Winfrey says.

  The LCCRT will work to shape up and corral colorectal cancer prevention efforts in the state, including setting up task forces to deal with different aspects of the issue. And what are those issues? More people are getting colorectal screenings than ever before, but, according to the NCCRT, the "newly insured," the "insured, procrastinator/rationalizer" and the "financially challenged" are the groups most likely not to get screened, with the problem being even more pronounced among African-Americans and Hispanics in those groups. They share the following characteristics:

Rationalized avoidance. Even though people know they should get screened, they don't recognize the importance of colorectal cancer screening and rationalize away the need for it.

No symptoms or family history. People think they can't get the disease if they don't have symptoms or family history. This is wrong, and symptoms often don't surface until the disease is advanced.

Negative connotation. No one loves the idea of a colonoscopy, but having an overly negative view of it costs lives.

No doctor recommendation. Many people say their doctor did not recom-mend the screening to them. This is

the No. 1 reason why black people do

not get screenings and the No. 3 reason Hispanics don't.

No personal connection. The unscreened are less likely to have had a close friend or family member with cancer or are unaware of their family history.

Lack of affordability. Lack of affordability is the No. 1 reason people don't get screened. Yet the Affordable Care Act ensures that preventive care screenings, such as colonoscopies, are covered for anyone with insurance.

Low levels of healthy behavior.

Despite claiming to be as healthy as

those screened, the unscreened population tends to have less healthy behaviors, and is less likely to visit or talk to a doctor about screenings.

  The LCCRT will work on issues such as these and, as Huard hopes, others as well. For instance, there now are mechanisms in the state to help make sure that eligible women diagnosed with breast cancer will receive Medicaid in time to get treatment; Huard would like to see the same done for patients diagnosed with colorectal cancer. She also wants women to be aware that they can get the disease. "Women seem to think they can't get it, but they have colons too," she says.

  And finally, though colonoscopies are considered the gold standard for colorectal cancer screening, there are other medical facility and take-home options, such as the FIT and FOBT kits. Huard recommends that everyone 50 and older talk to his or her doctor about getting screened for colorectal cancer and quotes health experts who say, "Remember, the best test is the one you're going to get."

Laura Ricks is communications coordinator at Louisiana Cancer Prevention & Control Programs (LCP).

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