Friday, April 21, 2017

Colorectal Cancer: Still a problem

Author: David J. Holcombe, M.D., M.S.A., Regional Medical Director, Region 6 (Alexandria Region)

Colorectal cancer remains a significant problem in Louisiana.  Even though we have a highly effective screening method (i.e. colonoscopy), only 64.3% of adults over 50 have been screened. The inevitable result of low screening is a high number of new cases of colorectal cancer (3rd in the U.S.) and the 4th highest mortality rate among states.

Louisiana’s 5 year incidence rate for colorectal (new cases) is 92.9/100,000 Louisianans, significantly higher than the 70.8/100,000 nationally.  As with most cancers, the earlier the diagnosis, the better the outcomes (and the lower the 5 year mortality).  Since many Louisianans are diagnosed in late stages (over half in Stage III or Stage IV), death rates are correspondingly higher.

The other sad reality is that death rates are higher depending on your insurance status, with lower survivals among those with Medicaid or who are completely uninsured.  Since African-Americans are over-represented among Medicaid recipients and the uninsured, their death rates remain higher (an example of so-called health disparities).

The Louisiana Colorectal Cancer Roundtable is a collaboration among insurers and providers with a goal of increasing the screening rates from the current 64.3% up to 80% or higher.  By so doing, we could eliminate 3,471 deaths due to colorectal cancer and save at least some of the over $350 million spent on this avoidable disease.  If 80% colorectal cancer screening could be achieved, 277,000 new cases would be averted and over 200,000 lives could be saved within 20 years.

The 80% screening by 2018 goal remains an achievable one.  Every person over 50 years of age would require a colonoscopy every 10 years (if the results were normal).  They could alternatively undergo a stool Fecal Immunochemical Test (FIT) every year or a stool DNA test (sDNA) every 3 years. 

The Louisiana Colorectal Cancer Roundtable, working with providers in the New Orleans area (including Federal Qualified Health Centers and major health systems) is trying improve access to colonoscopies.  Many patients, especially those with Medicaid, may have issues locating a gastroenterologist willing to perform the test.  By working directly with this group, access should be increased.  Once piloted in New Orleans, this improved access program should be extended to other parts of the state.

Colorectal cancer remains an avoidable killer.  Screening tests should be used with all appropriate candidates (those 50 and above, plus some selected younger people).  We must also eliminate the disparities that plague colorectal cancer rates.  Providers and patients need to pitch in to lower our unacceptable death rates from colorectal cancer, especially among those who are uninsured or receiving Medicaid.  

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