ALBANY — Data from the Georgia Department of Public Health Office of Health Indicators for Planning shows there were 1,610 deaths in the state from colon cancer in 2016, including 75 in the 14-county Southwest Public Health District based in Albany.
Some of these victims are dying because they do not have easy access to the screenings that may catch their cancer before it is too late. That fact prompted the establishment of a program a decade ago to reach out to those who are otherwise unlikely to get a colonoscopy.
Dr. Ira Knepp with Phoebe Gastroenterology said about 60 percent of the population that should be getting screened are following through, and that there are 50,000 deaths a year overall from colorectal cancer — a third of whom are succumbing within three years.
“When you get symptoms of colon cancer, it is too late,” he said. “(We need to) discover it at an early stage or before it develops into cancer.”
Colonoscopies usually begin for most people at age 50, unless they have a personal or family history of colorectal cancer. The screenings can find polyps before they develop into cancer. Knepp said most polyps take about 10-15 years to develop into cancer, so finding them at the pre-cancer stage can ensure their removal before they become a threat.
The fecal immunochemical test, or FIT test, is an at-home screening for hidden blood in the stool. It is usually the first line of testing for those of low-risk, with other screening methods including CT colonoscopy and a regular colonoscopy.
“If someone has a family history or personal history, a colonoscopy is the only method because the chances of them needing a colonoscopy are pretty high,” Knepp said.
The screening rate goal is to get it to at least 80 percent — well above the current 60 percent. Horizons Community Solutions, Albany Area Primary Health Care and Phoebe began working together 10 years ago to reach out to the uninsured and underinsured whose screenings would not otherwise be covered.
“We have something here a lot of communities do not have,” Knepp said.
AAPHC identifies those in their patient base who they believe would benefit from the program. From there, Horizons has the task of bringing in a navigator to guide the patient through the process and make sure they follow through with an appointment at a partnering health provider — specifically either Phoebe or Tift Regional Health System.
For many people, getting screening this way may be the only option.
“Normally, they would not have any options,” Knepp said. “Phoebe is being a good steward by providing care to people who would not ordinarily be able to have it. It is a very unique program (Horizons and AAPHC) have piloted and put together.
“It is true dedication to the community when we can do something like this.”
Out of those being screened through the program, there has been a 30 percent higher chance of finding “significant” polyps. If they can be removed before becoming cancerous, early intervention saves the expense of surgery and chemotherapy that the community might have to ultimately take on.
“Not only do you have an improvement on your life, but you are making a better economic impact,” Knepp said. “It allows money to be devoted to other things in the community.
“Our goal is to be worker bees for what we are trying to accomplish.”
The gastroenterologist said that while the program could be expanded, it is currently doing a good job of meeting the need. Denise Ballard, chief missions officer at Horizons, said that while the difference made has been significant, she would like to see it grow.
Ballard said the program started in 2008 with a partnership with Phoebe and AAPHC. The position of AAPHC as a federally qualified health center meant a high number of its patient base having little to no health coverage, making them a good target population for reducing disparities.
She said the program allows for system changes to ease the referral process and to make it easier for patients to get in the door. An uninsured patient can call the screening site after the referral, and it has been worked out so that those determined to be indigent at AAPHC do not run into that obstacle when they go to either Phoebe or Tift Regional.
It is the job of Horizons to equip navigators to remove any barriers the patient has, including transportation, and that the bowel preparation needed ahead of the colonoscopy is done. Colonoscopies usually require a pre-screening, and there has been a method devised through the program to save money on that step.
“They would usually be seen at the gastroenterology center three months before to see if they are healthy enough to have the colonoscopy,” Ballard said. “(Through the program) the primary care provider would do the initial health screening to make sure they are healthy enough to have the procedure.
“They just show up the day of and have the procedure.”
She added that she would not only like to spread it to other hospitals, including South Georgia Medical Center in Valdosta, but to use navigators more to increase the screening rates among those with insurance — especially since many doctor’s offices are unable to dedicate their staff to properly follow up on screening progress.
“We are posed to help to get screening rates up among insured patients,” Ballard said. “(Their doctor) may think they have followed through, and they don’t.”
Ballard said the program has made a noticeable impact, with patients being seven times more likely to get screened if they are in a practice that participates in it. She said it has made a difference in the death rates in Southwest Georgia resulting from colorectal cancer.
“It is still higher than what we would like, but we are not No. 1 in mortality,” she said.
The bottom line is that the higher death rates were due to lack of access, so there was a need to increase awareness among physicians and patients alike. The FIT test is considered to be highly reliable, making it ideal for those of lower risk.
“About 20 percent of those taking the FIT test need a colonoscopy, so the good news is that most people don’t (need the colonoscopy),” Ballard said. “Most people only have colonoscopies every 10 years.”
She said more primary care clinics are set to come online with the program, with 20 new sites over the next 18 months, to get rates up in other areas of Southwest Georgia. A couple of sites are already near the 80 percent mark, which officials were hopeful would be met by the end of this year.
“I don’t think we will get there (this year), but some Albany Area Primary Care clinics are very close,” Ballard said. “We will continue to strive toward that to make sure the clinic sites get their screening rates up to 80 percent.”
Dr. Jim Hotz, clinical services director for AAPHC, has a family history of colorectal cancer, losing a parent and uncle to the disease. That, and the reality that screening can reduce death rates by 70 percent, makes him passionate about the program and its potential.
He said the 80 percent screening goal could save 20,000 a year. Testing among the uninsured is 20 percent, and many of the thousands treated by AAPHC are uninsured — and rates are especially bleak among those without a college education.
The program, Hotz said, has brought the screening rates up, with more than 2,600 additional people being screened in a two-year period, saving up to 92 lives in that timeframe.
“These are real numbers and a real effective program,” he said.
Hotz said the program is nationally highlighted, and is highly evidence-based. He said he has done 18 presentations informing others of the work it has accomplished.
“This is something we have been working long and hard on,” he said.
At AAPHC, population managers use tools to check to see who in their patient base is due to be screened. They send the FIT tests out and call the patient to make sure it gets done. If the FIT comes back positive, they are then navigated through the colonoscopy.
Advanced colorectal cancer, Hotz said, is a “real tragedy” in that those who cannot get screened until it is too late often fight a losing battle.
“In my 40 years of practice, I saw too many people die,” he said. “There is a great need and a great need for public awareness.”
Hotz said that while many of those not getting screened are actually insured, there is a definitive link between uninsured and lack of access. He too would like to see the program spread throughout the region.
“We need to have people coming together,” he said. “This is a team effort. … There is not a good reason not to get screened. Not knowing is dangerous.”