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Dr. Whitney Jones Discusses Colorectal Cancer

Dr. Whitney Jones is a national expert and frequent speaker on early-age onset colorectal cancer prevention, genetic GI cancer syndrome testing and risk management, and communication strategies for population-based cancer prevention.

On this episode of KET’s Kentucky Health, Dr. Jones explains how we can decrease incidents and mortality rates of colorectal cancer.

Colorectal cancer is the second cause of death due to cancer in the United States. Prior to 2004, Kentucky had one of the highest death rates from colon cancer. One major factor was a lack of screenings. However, now the mortality rate has decreased by more than 20% and we have gone from being 49th in the U.S. for people being screened for colon cancer to a current ranking of 20th.

This is due in large part to the development in 2003 of the Colon Cancer Prevention Project by Dr. Whitney Jones; an organization dedicated to spreading the message of colon cancer.

While the rates are decreasing for those over the age of 55, for reasons unknown, rates of colorectal cancer, specifically rectal cancer, have increased in those under the age of 55. Genetics and lifestyle habits could be prominent factors in this increase. Early screening is an important preventive tool as these rates are projected to continue to rise. 

Causes of Colorectal Cancer

  • Obesity
  • Tobacco use
  • Diets high in red processed meat and low in fresh fruits or veggies
  • Lack of exercise 
  • A family history
  • Excessive or ongoing alcohol use

Symptoms of Colorectal Cancer

  • Rectal bleeding
  • Change in bowel habits
  • Weight loss
  • Unexplained abdominal pain

However, the most common symptom of colon cancer is no symptom at all. It is known as the silent killer and early onset colon cancer has an average 6 month delay from the time a person has symptoms until they see a doctor. 

Screenings

Those with a family history should start screening a decade before their family history indicates, even as early as one’s twenties. 20% of those with a family history of colorectal cancer are at more of a risk themselves. 

If no warning signs or family history exist, screenings should being at the age of 45.

All colonoscopy screenings are covered in the state of Kentucky due to the Affordable Care Act. For those who don’t want a colonoscopy,  there are other options available. However, colonoscopies are still the gold standard of screenings as they remove polyps and the removal of polyps help prevent cancer from developing.

Knowing Your Family History

Genetic medical grade testing is an important proactive tool in diagnosing colorectal cancer. It is now more affordable and accessible than ever before.

Lynch syndrome for example is the most common genetic trait for colorectal cancer. Polyps in the colon develop into cancer faster for persons with Lynch syndrome than those with other genetic predispositions. Those who have it are also at an increased risk of ovarian cancer, endometrial cancer, and pancreatic cancer, among several others. 

Other Preventative Measures

  • Increase the amount of veggies in your diet.
  • Aspirin has been known to reduce the formation of polyps, but has it’s side effects.
  • If you have had polyps in the past, keep up with your follow up surveillance.

Watch the full episode of Dr. Whitney Jones on Kentucky Health here: 


Dr. Whitney Jones is a practicing Gastroenterologist, former therapeutic endoscopist and Clinical Professor at the University of Louisville from 1994 until 2017. He joined GHP in 2017 cofounding its new east Louisville division, Gastroenterology & Endoscopy Associates, PLLC, alongside Drs. Ashok Kapur and Laszlo Makk.

Prevent Colorectal Cancer: Get Screened

Colorectal cancer is the second leading cause of cancer death in the United States. It’s expected to kill more than 50,000 Americans this year alone. The good news? If caught early, the survival rate is very high.

Colorectal Cancer in the U.S.

That’s why screening for colorectal cancer is so important. Screening is generally recommended for all average-risk patients aged 50-75.

People who have a family member with colorectal cancer or polyps are at increased risk and might need to start screening before age 50.

High-risk factors include a personal history of polyps, inflammatory bowel disease, chronic ulcerative colitis, or a family history of colorectal cancer or polyps.

What are the Options for Screening?

There are four main ways to screen for colorectal cancer:

Colonoscopy: Colonoscopy uses a flexible, lighted tool called a colonoscope to view the entire colon and remove cancerous and precancerous growths called polyps if they are detected.
Fecal immunochemical test (FIT): This test checks the stool for tiny amounts of blood given off by polyps or colorectal cancer.
CT colonography: This involves a CT scanner and computer programs to create a three-dimensional view of the inside of the colon and rectum that can be used to identify polyps or cancer.
Cologuard: This tests the stool for tiny amounts of blood and identifies altered DNA from cancer or polyps that end up in the stool.

Colonoscopy is The Best Colorectal Screening Method

Which Screening Option is Best?

Preventing cancer should always be the first goal. Most colorectal cancers begin as polyps. Finding, quantifying, localizing, and removing polyps through screening colonoscopy is the most effective strategy for preventing colorectal cancer. That’s why colonoscopy remains the gold standard for colon cancer screening.

The Multi-Society Task Force on Colorectal Cancer recommends that physicians should offer colonoscopy first. For patients who decline to have a colonoscopy, the FIT test should be offered next, followed by second-tier tests such as Cologuard and CT colonography for patients who decline both first-line options.

A 2014 study published in the New England Journal of Medicine of 10,000 patients found that screening colonoscopy was better at finding cancer than both Cologuard and the FIT test. FIT and Cologuard were also not as good as colonoscopy at finding pre-cancerous polyps – and unlike colonoscopy, FIT and Cologuard can’t remove polyps.

Cologuard missed 1 in 13 people who had colorectal cancer detected by screening colonoscopy. Cologuard also missed more than 30 percent of polyps that will soon be cancer and almost 60 percent of polyps that may become cancer.

The FIT test missed almost 1 in 4 people who had colorectal cancer detected by screening colonoscopy. FIT also missed more than 50 percent of polyps that will soon be cancer and more than 75 percent of polyps that may become cancer.

Which Colorectal Screen Test is Most Effective

Check with Your Insurance Provider

Patients may also have insurance considerations when choosing a test. A follow-up colonoscopy is recommended for positive FIT and Cologuard tests. Individuals with a positive FIT test or Cologuard test who are covered by Medicare may face a costly co-insurance bill after the recommended follow-up colonoscopy.

While insurance covers 100 percent of the preventive screening test, a follow-up colonoscopy for a positive FIT or Cologuard is considered a diagnostic or therapeutic service and may not be fully covered.

Almost one in six people who use the Cologuard test will have a positive result that suggests the presence of colorectal cancer. For almost half of those patients (45 percent), the colonoscopy will show their result from the Cologuard test was a false positive.

Check with your insurance provider before you are screened. Ask how much you should expect to pay if you need a follow-up colonoscopy for a positive FIT or Cologuard test result. This can help you avoid surprise costs.

Insurance Coverage for Colorectal Screening

Talk with Your Doctor

There are several ways to be screened. Remember, Colonoscopy is the gold standard, but if you’re unable to be screened by colonoscopy there are other appropriate options. Talk with your primary care physician about which screening test is best for you and do research about the available options to ensure you’re choosing the best test according to science.