Colon cancer survivors and advocates often lean on potty humor to get conversations about colon cancer prevention started.
At the “Get Your Rear in Gear” 5K race supporting the Colon Cancer Coalition last weekend, an event organizer dressed in a poop emoji costume led kids in a fun run, and adult runners traveled through an inflatable archway designed to look like a human colon. One woman formed a team for the race at Camp Mabry, donning crowns and calling themselves the “Royal Hineys.”
“We're trying to lighten it up and get people to talk about it,” Mary Harris, a board member for the Colon Cancer Coalition, said at the race. “People don't want to talk about things like this, unfortunately, but we have to.”
Harris got involved with the organization after her wife, Vonda Todd, died from colon cancer in 2019. Todd followed the recommendations in place by the U.S. Preventive Services Task Force at the time by going in for her first colonoscopy at age 50. But for her, this wasn’t soon enough: The screening revealed she already had Stage 3 colon cancer.
Americans are now told to begin screening at 45 in recognition of a rising rates of colorectal cancer among younger people, like Todd.
Having seen firsthand how devastating the disease can be, Harris now works to raise awareness about colon cancer risk, especially in her own community. Harris is Black, and Black Americans are 40% more likely than people in most other ethic groups to die from colon cancer, according to the American Cancer Society.
“I want to be that person to say, ‘Go get the screening. Don't worry about it, just go get the screening,'" she said. "If you can't afford the screening, there are resources out there to help you."
In Texas, those resources are growing right now, thanks to an effort by researchers at Dell Medical School called the Coordinating Center for Colorectal Cancer Screening across Texas, or CONNECT. CONNECT is creating a network of stakeholders — including universities, community health centers and insurers — who together will work to raise Texas’ colorectal screening rate over the next five years. Texas rate was among the five lowest in the nation in 2022, according to data from the National Cancer Institute.
“No other state ... that I’m aware of has this kind of organized system of delivery of care for colorectal cancer screening across the continuum,” said Dr. Navkiran Shokar, who leads the CONNECT initiative. “I think we’ll be kind of one of the pioneering states for a state as complicated and as large as we are.”
A problem with a solution
Shokar, a family physician and a professor of population health at Dell Medical School, became interested in colorectal cancer around 20 years ago. She was dismayed by the disparate outcomes among disease sufferers in different demographics; Black patients fared worse, for instance, as did people without access to regular health screenings and insurance. Because colorectal cancers are often preventable or curable with early detection, she also knew it was possible to close these gaps.
“People aren’t always aware that they’re supposed to be getting screened, so that’s one factor,” she said.
Shokar was able to show this with a program in a predominantly Hispanic community in West Texas that had particularly low screening rates. A high proportion of residents in the area were also low-income and uninsured.
“We made appointments with them, we followed up, we provided reminders and we provided transportation so that we met all these barriers that people have in their lives,” she said.
Along with concerted education efforts, these steps worked. Screening rates jumped to 80% in the county where the program was implemented, compared to about 17% in a neighboring county used as a control group.
Shokar’s challenge now is to connect programs like this that already exist in Texas — and fill in gaps where they don’t — to improve the state's overall screening rate. As of 2022, the National Cancer Institute reported that around 61% of Texans were up-to-date on recommended screenings. The National Department of Health and Human Services has a goal to raise rates nationwide to more than 74% by 2030.
Innovative approaches
CONNECT launched when Shokar and her colleagues received a $3 million grant last year from the Cancer Prevention & Research Institute of Texas (CPRIT), a state agency that funds cancer research.
Carlton Allen, a program manager for CPRIT, said his team hopes this grant will have a trickle-down effect, bolstering screening efforts in remote areas of the state.
“With the seed funds from this grant, maybe these smaller organizations or rural organizations are able to increase their screening rate and develop systematic changes,” he said.
In a rural area where access to in-person health care is spotty, Shokar’s team might implement something like a mail-in stool testing program. That’s something Shokar’s partner, Dr. Michael Pignone, has done successfully with clinics that serve low-income people in Austin.
A stool test is a lot less cumbersome than a colonoscopy, which requires you to go on a clear liquid diet for a day and take laxatives to clean out your colon so your doctor can see your bowels with a tiny camera. The upside is that a once-a-decade colonoscopy is usually frequent enough to stop any suspicious growths in their tracks and prevent cancer from forming.
A mail-in stool test has to be repeated annually, but is less invasive: Simply collect a sample of your poop at home and mail it back to the lab. Blood in the stool is a sign of a potential problem and triggers a follow-up colonoscopy. One of the CONNECT program’s challenges will be to help programs like this navigate and pay for follow-up colonoscopies and treatment.
“If you just screen without those downstream steps happening, you're not going to make an impact, and it's futile, frankly,” Shokar said.
Shokar’s goal at the end of CONNECT’s initial five-year funding period is to show that raising screening rates is possible if the state and other partners, such as insurers, buy in. She hopes to show that investment in prevention lessens long-term costs to the health system.
“We want to be able to advocate with policymakers, payors and legislators, to see if there are pieces of this that could be funded and supported going forward," she said, "because we've shown the benefit and the cost benefit."
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