By Michaela Gibson Morris
TUPELO – Colon cancer has Mississippi’s number.
Mississippians are dying at the highest rates in the country from colorectal cancer – 23.7 deaths per 100,000 population. The national rate is 18.7 deaths per capita according to 2010 data from the Centers for Disease Control.
The numbers are eye-opening, even for colon cancer screening advocates like Tupelo gastroenterologist Dr. Steve Amann.
African-Americans are at particularly high risk. In Mississippi, the colon cancer incidence rate is 75 per 100,000 for African-Americans.
“We’re No. 1 there, too,” Amann said.
Research across the country has found wherever colonoscopy rates increase, rates of colorectal cancer detection and deaths drop, said Professor Roy Duhé, who serves as the associate director of cancer education for the University of Mississippi Medical Center.
“Basically you can cut colon cancer deaths in half with good, available screening,” Duhé said.
Mississippi doesn’t have to lead the nation in colon cancer, Duhé said. Twenty years ago, it had one of the best rates for colon cancer incidence and deaths.
“People have got to get active, and they’ve got to be screened,” Duhe said.
Colon cancer is one of the few tumors that give doctors something to see and act on before it becomes cancer in the form of polyps, which are little outgrowths in the colon. Not all polyps will become cancer, but almost all colon cancer starts as polyps.
“We have to get the word out,” said Amann, who is currently serving as Mississippi’s representative to the American College of Gastroenterology. “Colon cancer is preventable, treatable and beatable.”
If the polyps are detected during a colonoscopy, the physician can remove them on the spot, Amann said. The precancerous types never develop into full-fledged malignancies.
“The incidence of colon cancer is decreasing (nationally) due in good part to increased screening,” Amann said.
Colonoscopy is considered the gold standard for colorectal screening because it allows for the examination of the entire colon and allows for intervention – the removal of polyps.
The current screening recommendations from the American College of Gastroenterologists suggest people without risk factors start colorectal screening at age 50. Because of the higher risks they face, African-Americans are counseled to start screening at 45.
For people with no risk factors and no polyps, the colonoscopy doesn’t need to be repeated for 10 years. For others, the test needs to repeated every three to five years depending on family history and the types and number of polyps found.
The alternative tests – flexible sigmoidoscopy and CT colonography – are typically done for people who need to avoid sedation, Amann said. The flexible sigmoidoscopy only looks at the lower third of the colon. The CT colonography doesn’t offer the opportunity to remove polyps.
Both tests require the same prep as the colonoscopy, and if there are any findings on either test, a colonoscopy would be recommended, Amann said.
“Any of the alternative tests would be better than nothing,” Amann said.
Only the fecal occult blood test doesn’t require any prep. It screens only for microscopic traces of blood. If it’s positive, it indicates a need for a colonoscopy.
Part of the issue in Mississippi is access to colonoscopy and other colon cancer screening options. It’s important to make sure Mississippi has an adequate supply of gastroenterologists – who have the most training in performing endoscopic procedures.
“If (a colonoscopy) is done by a gastroenterologist, the polyp detection rate is higher, there’s less risk of missed lesions,” Amann said.
Insurance coverage for colorectal cancer screening has been steadily improving. The test is covered by Medicare, making the screening widely available to people over 65. Currently 35 states require insurers to cover screening colonoscopies for the recommended groups.
“It probably would help if we had some legislation in Mississippi,” Amann said.
Beyond affordability and access, people are still squeamish about colonoscopy, Amann said.
“People are just fearful, and some people are embarrassed,” Amann said.
Usually once people have their first colonoscopy, they wonder what they were worried about, Amann said.
“Their first words usually are, ‘It wasn’t bad at all,’” he said. “You sleep through the test, so you don’t remember anything.”
The endoscopy suites are private, and the physicians, nurses and technicians are very focused on maintaining privacy, Amann said. For people who are worried about their modesty, Amann often suggests wearing an oversized pair of boxers backwards for the procedure.
People do need to plan for a day at home before the test. The colon has to be cleared of fecal matter so the gastroenterologist can get a good look at the colon. The volume of liquid in the preps have gotten smaller so they’re easier for people to manage.
“It’s a lot easier than it used to be,” Amann said.