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Colorectal Cancer and Age, Race, and Ethnicity

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Colorectal cancer is not experienced equally by everyone. In the past several years, younger people have experienced increased colorectal cancer rates and deaths. Additionally, Black people and American Indians experience more cases of this cancer and related deaths. Here’s what you need to know about how this disease affects different people.

Colorectal Cancer in Younger Adults

Rates of colorectal cancer have been on the rise for younger and younger adults over the last several years. According to the American Cancer Society, while rates for adults 50 and older have fallen due to increased screenings, the opposite trend has occurred for younger adults. Recently, people 65 and older have experienced a decrease of around 3% per year from 2011 to 2016. In contrast, people ages 50 to 64 have seen rates rise by 1% per year in the same time frame. People under 50 have actually seen rates rise by 2.2% per year in the same window. Clearly, younger adults are seeing steeper increases in cases. Death rates have followed similar patterns. Death rates for colorectal cancer also vary by age group. Between 2008 and 2017, death rates fell by 3% per year in people 65 and older and dropped by 0.6% in people 50 to 64. However, they rose by 1.3% in people younger than 50.

Fortunately, colorectal cancer can be very treatable if it’s caught early. Younger adults should be aware of warning signs. These include changes in bowel movements (particularly over two weeks or more), rectal bleeding, unusual stools, and tiredness or low energy. If they have any of these symptoms, they should see their doctor.

Disparities Based on Race and Ethnicity

Along with age, looking at colorectal cancer rates and death rates based on race and ethnicity shows significant variation. The American Cancer Society’s data from 2012-2016 showed that rates were dramatically different based on race. Rates for Asian people and Pacific Islanders were the lowest at 30 per 100,000. Non-Hispanic white people had a rate of 39 per 100,000, and Black people had a rate of 46 per 100,000. Alaska Natives and American Indians had the highest rate, at 89 per 100,000. Death rates vary significantly as well- colorectal cancer rates are around 20% higher for Black people than non-Hispanic white people, but death rates are nearly 40% higher in Black people. Additionally, for Alaska Natives and American Indians, death rates are about double the rate for Black people.

Early Screenings Save Lives

While many of these statistics are troubling, we do know that screening early is an effective way to catch more cases of colorectal cancer. More and more organizations, including Gastro Health Partners, are pushing for earlier screenings and research on the disparities around this disease. Early screenings save lives.

Our experienced team at GHP has years of experience screening for and treating colorectal cancer. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Lynch Syndrome: An Overview

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Lynch syndrome is an inherited genetic condition that increases risk for colorectal and other cancers. It is the single most common cause of hereditary colorectal cancer. Here’s what you need to know about the condition.

What causes Lynch Syndrome?

Lynch syndrome, sometimes called hereditary nonpolyposis colorectal cancer, is inherited by children from their parents. It is inherited in an autosomal dominant pattern, meaning that only a single copy of the altered gene needs to be present. So, if someone inherits a mutation in a gene related to the syndrome, they will still have a normal copy. However, cancer occurs when a second mutation affects the normal copy of the gene.

The specific genes involved in the syndrome are all involved in repairing errors that occur during DNA replication. If any of the genes (MLH1, MSH2, MSH6, and PMS2) have a mutation, errors occurring in replication accumulate, which can end up leading to uncontrolled cell growth and cancer.

Complications from Lynch Syndrome

If you have Lynch syndrome, you have a higher risk of developing colorectal cancer, and developing it at a younger age. People with the syndrome also have a higher risk of developing kidney, stomach, brain, liver, uterine, and some skin cancers. There are several other inherited conditions that can increase your risk of colon cancer, but this syndrome is the single most common. A rough estimate is that around 3% of all colorectal and endometrial cancers are caused by the syndrome. Around 1 in 279 people in the United States have Lynch syndrome.

In addition, having Lynch syndrome has impacts on the rest of your family. First, a positive diagnosis means that your blood relatives may have a chance of having the syndrome. In addition, any children you may have are at a higher risk of having it. If one parent has a genetic mutation related to the syndrome, a child has a 50% chance of inheriting it. This is because the syndrome is autosomal dominant, as discussed previously. You may want to meet with a genetic counselor to talk through these implications if you have a Lynch syndrome diagnosis.

The Importance of Family History

Since you inherit Lynch syndrome, knowing your family history related to colorectal cancers is crucial. If your family has a history of colorectal or endometrial cancer, you should talk with your doctor to evaluate your risk. In particular, you are more likely to have the syndrome if your family has a history of colorectal cancer at a young age, endometrial cancer, or other related cancers.

Your doctor may recommend a genetic evaluation of your family history and risk. Genetic counselors can help you understand Lynch syndrome and whether genetic testing is a good option for you. Usually, family members with the syndrome share the same specific genetic mutation. If any of your family members have a known a syndrome mutation, you may be tested for the same mutation if you are pursuing genetic testing.

The good news is that we can prevent a lot of the cancers caused by Lynch syndrome with early screenings. Screening early and often can help catch cancer early and lead to better outcomes.

Our experienced team at GHP has years of experience screening for and treating cancers caused by Lynch syndrome. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Colorectal Cancer Screening at 45

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Colorectal cancer screening is a crucial step to identify cancer early and save lives. Previous medical guidance has dictated that screenings should start at age 50 in most cases. However, the American Cancer Society now endorses screenings starting at age 45. Gastro Health Partners endorses this approach as well. Here’s an overview of why screening is so important, and what your options are.

Colorectal Cancer

Colorectal cancer, sometimes called colon cancer, is cancer that occurs in the rectum or colon. Abnormal growths called polyps can grow in the colon or rectum and become cancerous. When this happens, cancers grow into the wall of the colon or rectum over time. They then have the potential to spread into lymph vessels or blood vessels and travel to other parts of the body.

Screening is important because it can prevent the development of colorectal cancer and more widespread cancer in the body. If caught early, colorectal cancer is often very treatable. For example, during a screening, precancerous polyps in the colon or rectum can be removed before they become cancerous. Screening is a life-saving preventative measure: in this case, there is a 90% survival rate when cancer is found and treated early on. It is also helpful because many people will not exhibit symptoms until their colorectal cancer has progressed significantly. Getting screened can help doctors catch and treat cancer before it develops or spreads significantly.

Who Should be Screened and When?

Screening is the key prevention strategy for all adults. Everyone should get a screening regularly at a certain point. As mentioned before, the previous guidance was most people should be screened starting at age 50. Now, guidance has shifted to starting at age 45.

Additionally, other factors can influence when and how often you should be screened. If your family has a history of colon cancer, if you have had polyps, or if you have an inflammatory bowel disease or some genetic disorders, you may need to be screened earlier and/or more often.

Types of Screening and How Often to Get Screened

There are a few main screening options. You should talk with your doctor to determine the best path for you. As alluded to, the colonoscopy is the gold standard for screenings. During a colonoscopy, your doctor is able to look at your entire colon and can remove polyps. You may only need a colonoscopy once every 10 years if you have a negative screening. Another screening option is a Flexible Sigmoidoscopy, which is performed every 5 years with negative screenings. The downside of this method is that it doesn’t give a full view of the colon like a colonoscopy does. Only the lower parts of the colon are viewable with this test.

There are also a few stool-based screenings available. With stool tests, you collect a stool sample at home and send it in to your doctor for analysis. This method does not identify abnormalities as effectively as a colonoscopy. Doctors may also pursue follow-up testing if they confirm a positive result. There are a few other screening options that may be available as well, like a Capsule Endoscopy or a CT Colonography. Your doctor will recommend the best option based on your specific case.

Getting screened for colorectal cancer is an extremely effective way to prevent cancer. Our experienced team at GHP has years of experience performing screenings. We can help establish the best plan of diagnosis and care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Featured press release: DHPA Supports USPSTF Recommendations to Begin CRC Screening at 45, Calls for More Research on Disparities in Communities of Color

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The Digestive Health Physicians Association recently announced its support for the U.S. Preventive Services Task Force (USPSTF)’s draft recommendation to begin colorectal cancer screenings at age 45. Gastro Health Partners endorses these changes as well. Read more about the DHPA’s support for the changing guidance in this press release:

“Washington, DC – The Digestive Health Physicians Association (DHPA) voiced its support for a draft recommendation by the U.S. Preventive Services Task Force (USPSTF) that Americans begin screening for colorectal cancer at the age of 45, an update of 2016 guidelines that had recommended that adults without risk factors for CRC should begin screening at age 50 and continue periodically until 75.”

Click here to read the full press release

Actor Will Smith and His Colonoscopy

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Actor Will Smith recently posted a vlog on his YouTube channel documenting the process of getting a colonoscopy. His video is a great up-close look at the process and why it is so important for everyone.

The Colonoscopy Video

Will uploaded the video on YouTube on November 6, 2019. Will Smith turned 50 in 2019 and his doctor advised him to get screened for colorectal cancer. The video starts with him asking his doctor about the logistics of the procedure. He also documents the effects of the colonoscopy prep, and shows footage of him entering the exam room on the day of the procedure. We also see Will after the procedure under lingering effects of anaesthetic. The video ends with Will’s doctor talking through the exam results with him.

During the procedure, doctors actually found a polyp and removed it. Polyps are pre-cancerous lesions that are common in the colon. They removed the polyp and sent it to biopsy, where it was determined to be a tubular adenoma, a benign type of polyp that has the potential to become cancerous.

Will’s doctor speaks about her gratefulness that he was a compliant patient who took her recommendation for screening. She explains that the type and location of polyp Will had could have made it virtually unnoticeable if he hadn’t gotten screened; it is likely that by the time he started to show symptoms, it would have spread to other parts of his body. The video ends with his doctor talking through all of this and recommending a follow-up screening in the next two or three years, since he had a polyp. You can watch the video here.

A History of Celebrities Raising Awareness of Screenings

Will isn’t the first celebrity to publicize their own experience with a screening. Back in 2000, Katie Couric got a colonoscopy on the Today show to raise awareness on the importance of colon cancer screenings. Her husband had died of colon cancer in 1998. She went on to co-found the National Colorectal Cancer Research Alliance. In 2018, Couric also accompanied TV host Jimmy Kimmel through the colonoscopy process on his show.

The impact of celebrity promotion of screenings may be significant. In the year following Katie Couric’s Today show colonoscopy, there was a significant increase in screenings in the United States. A study from 2003 found that colonoscopy utilization rates increased in two large data sets following Katie’s promotion.  The first data set found an increase in the number of colonoscopies performed per month from 15 to 18.01. Additionally, analysis of the second data set, which was comprised of adults in a managed care organization, found that colonoscopies increased from 1.3 per 1000 people per month to 1.8 per 1000. This finding of increased screenings is called the Katie Couric Effect.

The Importance of Destigmatizing Colonoscopies

This video is important in a lot of ways. Having a celebrity share their experience with colon cancer screening can impact a lot of people and save many lives. As of the writing of this blog post, over 3.2 million people have watched the video.

Many people are uncomfortable with the idea of a colonoscopy, and avoid screenings for far too long. In particular, the idea of having an endoscope enter your body through your anus and the bowel prep associated with the procedure are barriers for some people. This is a problem, because screenings are extremely effective: colon cancer is the second leading cause of cancer-related death in the US and the survival rate for early detection of colon cancer is around 92%. Clearly, screenings save lives.

Our experienced team at GHP has years of experience performing colorectal cancer screenings. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Colonoscopy: What to Expect

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A colonoscopy is a procedure that allows a physician to examine a patient’s colon. Colonoscopies are often used to evaluate GI disorders and screen for colon cancer. Here’s what you need to know if you are preparing for a colonoscopy.  

When it’s used

There are a few reasons your doctor may recommend a colonoscopy. The procedure is commonly used as a screening tool for colon cancer, which starts from polyps in the colon. A colonoscopy can help your doctor examine your colon for any polyps and other warning signs of colon cancer. You may also need a colonoscopy if you have previously had polyps. In this case, your doctor will likely look for more polyps and remove any, as a preventative measure against colon cancer. Last, you may need a colonoscopy if you have any GI pain or distress that your doctor needs to identify and diagnose through examination. 

Preparing for a Colonoscopy

There are a few important pre-procedure steps you need to take leading up to a colonoscopy. You will be asked to adhere to a cleansing routine the day before the procedure. This typically consists of taking a liquid laxative the day before to empty your bowels, and switching to a clear liquid diet. You may be asked to drink plenty of liquids as well. Following the instructions on laxative use is a crucial step to properly prepare for the exam, so always be diligent in this regard. 

In addition to the cleansing routine, you should also discuss any medications you use with your doctor. You may have to stop use of some medications like blood-thinners prior to the procedure. This is because some of these medications can increase the risk of excessive bleeding. If you use insulin, you may need to adjust dosage and timing the day of the procedure. Your doctor will also want to know about any allergies to medication you have. 

What to Expect During the Procedure

A colonoscopy takes about 20-30 minutes in total. You will be sedated for the entire procedure, so there is no discomfort during it. Your doctor will monitor your heart rate, blood oxygen levels, and blood pressure throughout the process as well. During the procedure, your doctor will insert a colonoscope (a thin, flexible tube with a light and camera) in your anus while you lay on your side and advance it to the end of your colon. The camera and light allow your doctor to fully examine the colon lining. 

If your doctor sees anything they want to analyze further, they may take a small tissue sample (biopsy) for later analysis. In the case that they see any bleeding during the examination, they can feed instruments through the colonoscope to medicate, cauterize, or clip affected areas and control bleeding. If they find any polyps, they can use an instrument threaded through the colonoscope to remove them. None of these techniques cause discomfort during the procedure. 

After the Procedure

It typically takes around an hour to mostly recover from the sedation after a colonoscopy. As such, you should always have someone take you home afterwards. The effects can linger to an extent for the next 24 hours, so you should avoid driving, making important decisions, or working for that period of time as well. If any polyps were removed during the procedure, you may be prescribed a temporary special diet. It’s common to pass gas and feel bloated for a few hours after the exam. Walking can help ease some of this discomfort. 

You may see a small amount of blood in your stool during your first bowel movement post-procedure; this is not cause for alarm most of the time. However, if bleeding persists or you develop a fever or consistent bowel pain within a week or two of the procedure, you should contact your doctor. 

Our experienced team at GHP has years of experience performing colonoscopies. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

What is Colorectal Cancer?

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Colorectal cancer refers to a cancer that starts in the colon or rectum. While cancers that start in either place may be called colon cancer or rectal cancer, respectively, they are often known collectively as colorectal cancer because of similarities between the cancers. 

Here’s what you need to know about colorectal cancer. 

Causes and Risk Factors

Scientists are not exactly sure what causes colorectal cancer. We do know that colorectal cancer begins when healthy cells’ DNA mutates. These cells can then overgrow and divide, creating tumors. Cancerous cells can also destroy healthy tissue and travel to other parts of the body and form deposits. However, there are several well-documented risk factors. These include being over 45, having diabetes, smoking, drinking alcohol, having a high-fat diet, having an inflammatory bowel disease, and having a family history of colon cancer or polyps. 

Types

Most colorectal cancers (around 96%) are Adenocarcinomas. This kind of cancer starts in mucus-producing cells which lubricate the colon and rectum. 

There are a few other kinds of colorectal cancers that are much more rare. Lymphomas, cancers of immune system cells, can start in the colon or rectum (although they typically start in lymph nodes). Carcinoid tumors start from hormone-producing cells in the intestine. Gastrointestinal stromal tumors start from cells in the colon wall, and while most are non-cancerous, some can be. 

Symptoms

It’s common for colorectal cancers to have few symptoms until they have advanced. There are some potential warning signs, but they may be indicators of other issues. These symptoms include lower abdominal pain, blood in stool, bloating, cramps, vomiting, unexplained weight loss, and changes in bowel functions. As always, it’s best to consult a medical professional to determine what your symptoms are caused by. 

Diagnosis

The best way to cure colon cancer is to identify it at an early stage. However, since symptoms may not present early on, doctors recommend screenings for healthy people, usually beginning around age 50. People with more risk factors, as discussed above, may be advised to be screened at a younger age. 

A colonoscopy is one of the most common methods of screening. This involves using a scope to examine the inside of the colon. Your doctor can pass tools through the scope to take tissue samples if they see something suspicious. Biopsies of these tissue samples can help determine if cancer is present. Doctors also may remove polyps found during a colonoscopy to prevent them from becoming malignant. 

Treatment and Prevention

There are three main treatments for colorectal cancer- surgery, chemotherapy, and radiation therapy. These three treatment options are often used together in various combinations, depending on a patient’s situation. The best treatment options for each person depends on factors including overall health, the cancer’s stage, and whether the cancer is recurring. 

Localised, small, early-stage cancer in a polyp can be removed during a colonoscopy. A more invasive surgical procedure called a partial colectomy can remove the cancerous area of the colon and some surrounding healthy areas. This can prevent the cancer from growing back. Lymph nodes near the surgical site are removed and tested. Surgery can also be pursued to relieve symptoms and provide comfort for people in very poor conditions. 

Chemotherapy is another treatment option, often used after surgery to destroy remaining cancer cells. If the cancer has spread beyond the colon lining, this may be recommended. 

Radiation therapy utilizes beams of intense energy to destroy cancer cells. Radiation may be utilized before surgery to reduce tumor sizes, or after surgery to kill off remaining cancer cells. 

Preventing colorectal cancer is extremely important, and it starts with screening (as discussed above). Additionally, you can reduce your risk of developing colorectal cancer by avoiding smoking, reducing or avoiding alcohol consumption, staying active, maintaining a healthy weight, and eating a healthy diet. 

Our experienced team at GHP has years of experience helping people manage and treat colorectal cancer. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

 

 

October’s MD Update: Dr. Jones Speaks “Going on Offense Against Cancer”

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Our very own Dr. Whitney Jones graced the cover of MD-Update’s October issue.  Read about how he embraces preventative measures to beat colon cancer before it starts in the following article.

“We spend a lot of money on healthcare and health insurance. The problem is, we’re not spending enough on prevention.”— Whitney Jones, MD

 In the movie “Karate Kid,” there’s a scene where Mr. Miyagi asks the title character if he’s training to fight. In his light bulb moment, the student responds that he trains, “So I won’t have to fight.”

Make no mistake, Whitney Jones, MD, knows how to treat cancer. He’s trained for it and has years of experience in it. But it’s a fight he would prefer doesn’t take place.

“We’re going on offense against cancer,” says Jones, a gastroenterologist at Gastroenterology Health Partners (GHP) in Louisville. “We are working on becoming the number one state and the first in the nation to develop programs where we can use genetic testing. We spend a lot of money on healthcare and health insurance. The problem is, we’re not spending enough on prevention. The cost of cancer treatments totally overwhelms the cost of prevention.”

That has been the central message and purpose of the Kentucky Colon Cancer Prevention Project, which Jones helped found in 2004. The project’s work includes education, advocacy, survivor support, and health system change.

“It put the work of the state in front of the legislature,” Jones says, noting that a diverse group of leaders from across the state formed the project’s advisory committee. “It added a mix of healthcare, politics, and business that was catalytic.”

The project has received state funding as well as additional funding from the Kentucky Cancer Foundation, which Jones also helped found in 2012. “We have helped pay for a lot of uninsured people to get colorectal cancer screening,” Jones says.

The impact of the Colon Cancer Prevention Project is reflected in the state’s improvement versus the rest of the country. Jones notes that Kentucky ranked 49th out of 50 in the nation in colon cancer prevention statistics when the project was launched. The state also had the highest rates of incidence and mortality in the nation. Earlier this year, Kentucky ranked 17th best in the nation in the same colon cancer related categories and earned an American Cancer Society Achievement Award for the most improved state in the nation for colorectal screening over the past 15 years.

“When we started our work at the Colon Cancer Prevention Project, there was a huge gap between what could be done and what we were doing,” Jones says. “It’s been a broad coalition, including many of our state leaders and city officials. I think it’s proven that Kentucky can address its own problems, we can develop solutions, we can implement them locally, and we can save lives and save money.”

Read the full article here:

Common Causes of Constipation

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Constipation is often defined by tough, hard to pass bowel movements that occur infrequently. Other signs and symptoms include bloating, having the sensation of an incomplete evacuation, abdominal pain and blood present in the stool.

While constipation is known for being both physically uncomfortable and embarrassing, the condition is more common than one might think. Constipation affects approximately 30 percent of the general population, and is most prevalent in women, children and the elderly. Persistent constipation should not be ignored as it could be the sign of a more serious condition, such as colon cancer or Irritable Bowel Syndrome (IBS).

What are some of the Common Causes of Constipation ?

Dehydration

“If you don’t have enough water in your body already, the large intestine soaks up water from your food waste,” making for harder to pass stools. Caffeine can cause dehydration, and even dairy has been known to constipate some people. Proper hydration however, can help move food through the intestines and create softer stools.

Lack of Fiber

Fiber encourages regular bowel movements by allowing more water to remain in your stool and hastening it’s passage through the gut. Foods like fruits, vegetables, whole grains, beans and nuts are the best natural source of fiber. However, fiber supplements can be helpful as well.

Stress

Just like most of your bodily functions, the nervous system is in constant communication with your digestive system. During periods of intense stress, the digestive system can slow down resulting in constipation. Waiting too long to go to the bathroom for example, can cause a build up.

Not Enough Physical Activity 

Regular activity helps to stimulate the muscles in intestines and can also help alleviate stress.

Medication

Though laxatives can help ease constipation, they can also become habit forming meaning that one’s bowel movements end up depending on them. Overusing laxatives can over time can weaken the bowel muscles. Additionally, many anti-depressants and pain medications are common causes of constipation. It is recommended that any and all medications should be discussed with your doctor.

While many lifestyle changes can help to relieve constipation, if you experience chronic constipation, schedule an appointment with one of our fellowship-trained gastroenterologist today.

 

2019 Kicking Butt 5K

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Join us Saturday, August 24th at at the beautiful Big Four Bridge on Waterfront Park in Louisville, Kentucky for the 2019 Kicking Butt 5k!

This annual family friendly event is put on by the Colon Cancer Prevention Project whose mission it is to eliminate preventable colon cancer death and suffering. Participants are encouraged to spend the morning walking, strolling, running, and rolling to a world without colon cancer! Whether you’re a survivor, fighter, advocate, healthcare provider or community partner, all are welcome!

You can donate to the cause or register for the event online. The race starts at 8:30am with day of registration beginning at 7:30am.

Kicking Butt 5k

About the Colon Cancer Prevention Project

Our very own Dr. Whitney Jones founded the Colon Cancer Prevention Project in 2004. Since then, colon cancer is down more than 25% in the state of Kentucky. The project works to bring awareness to what is a highly preventable disease as well as offer support to those fighting it.

While colon cancer is the 2nd leading cause of all cancer deaths in the United States, when it is detected early, colon cancer is up to 90% curable. According to the Colon Cancer Prevention Project, “It is estimated that 6 out of 10 (60%) deaths from colon cancer could be prevented if everyone were screened at 50.” However, even young people are at risk for developing the disease. 1 in every 10 patients diagnosed are under the age of 50.

How to Take Action

Prevent colon cancer by talking to your doctor about the right time to get screened. It is recommended that men and women of average risk should start screenings by age 50. However, those with a family history or symptoms may need to be screened sooner. Don’t be afraid to ask your family if they’ve been screened as doing so could save their life.

The Gastroenterology Health Partners proudly sponsors the 2019 Kicking Butt 5k. Get screened and schedule an appointment by contacting us today!