Colorectal Cancer Prevention in the Neighborhood

1. Colorectal Cancer Prevention in the Neighborhood.

Colorectal Cancer Prevention in the Neighborhood is an innovative program of MedStar Washington Hospital Center where a group of community navigators work in partnership with community-based organizations to serve underrepresented populations to deliver approved colorectal cancer screening information and conduct culturally-tailored outreach within Washington, D.C.'s Ward 5.

In collaboration with the American Cancer Society and Cigna Foundation, the navigators and partnership members identify evidence-based resources for use within local communities with ethnically sensitive navigation as part of colorectal cancer screening and follow-up care after screening. Focused on reducing structural and economic barriers to colorectal cancer screening, these resources will be a key component of the initiative. 

2. 80% by 2018 Campaign

The 80% by 2018 campaign is a movement in which hundreds of organizations have committed to eliminating colorectal cancer as a major public health problem and are working toward the shared goal of reaching an 80% colorectal cancer screening rate of eligible individuals by 2018. MedStar Washington Hospital Center has signed the pledge to reach this goal.

Any organization can sign the pledge to reach 80% screened for colorectal cancer by 2018, including, medical practices, hospitals, insurers, employers, and community organizations. You can access the pledge and other relevant tools and resources at http://nccrt.org/tools/80-percent-by-2018. The 80 campaign is spearheaded by a National Colorectal Cancer Roundtable and American Cancer Society partnership.

3. Early Screening Saves Lives

MedStar Washington Hospital Center's Ward 5 Colorectal Cancer Prevention in the Neighborhood Project

FACT: Women and men 50 years and older living in the District's Ward 5 neighborhoods had some of the highest rates of advanced late stage colorectal cancer diagnosis in the city.

Why is it important to find colorectal cancer early? Regular screening can often find colorectal cancer early, when it is most likely to be curable. But only about 4 out of 10 colorectal cancers are found at this early stage.

Through screenings such as a fecal occult blood test (FOBT) every year or a colonoscopy every 10 years, colorectal cancer can be detected months or years before the tumor can be felt by you or your doctor.

This project provides community education presentations as well a FOBT home Kit to Ward 5 residents who are 50 years and older. We will follow up with the participants with the results and will help navigate if they need a colonoscopy.

To obtain a kit and/or get more information about community presentations on the subject, contact Ms. Courtney Williams at 202-710-0298 or [email protected].

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Colorectal cancer symptoms and risks.


 

Tips to make colonoscopy prep more bearable

At least once a month, a patient asks if I’ve read Dave Barry’s column about getting a colonoscopy. The humor writer discusses how fear kept him from getting the procedure until he was 60 – a decade after the recommended age to begin screening. After learning his brother had colon cancer, he finally scheduled an appointment and began his amusing journey into preparing for a colonoscopy.

Not everyone finds such humor in colonoscopy prep. Who wants to choke down a large amount of sometimes disgusting-tasting bowel-clearing liquid and then cope with the resulting diarrhea? Many find it more uncomfortable than the actual procedure, during which they’re usually sedated and don’t remember it.  

Colonoscopies may eventually be replaced by less-invasive, less-preparation-intensive screening methods, but for now, they are the best way to protect yourself from colorectal cancer. So let’s look at how the colonoscopy prep process works and how you can make it a little less uncomfortable.  

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How does colonoscopy prep work?

Colonoscopies detect colon and rectal cancers while they are still small and treatable, but they also are used to find and remove polyps, which are small growths that can develop into cancer. To see these growths, the doctor needs a clear view during the procedure. This requires emptying the colon of its contents.  

If the colon isn’t completely clean, the danger is we may miss tumors or polyps. It also could lead to a longer colonoscopy because we need to spend more time washing away waste to see more clearly.  

The preparation process may differ slightly between medical centers and doctors, or from patient to patient. You doctor will explain exactly what you should do. In general, the process involves a liquid diet and laxatives.  

The form of laxatives can vary. We generally prescribe four liters of a generic lavage solution, which is cheap and easy to get. Four liters is a lot to drink. It’s the equivalent of nearly seven 20-ounce bottles of soda. Some patients can get away with drinking half of that if they take Dulcolax tablets first.  

Many patients ask us about alternatives to this part of the prep: “I heard from a friend you can just take a pill.” This is sort of true, but it’s not one pill, it’s 32. And it has a “black box” warning – the strongest warning the Food and Drug Administration issues – for its risk to the kidneys. It’s also not recommended for people older than 65.  

We sometimes use an off-label prep that’s basically MiraLAX dissolved in 64 ounces of Gatorade. It’s still a lot to drink, but it tastes better.  

We ask that you do a split prep, which means you drink half the night before and the other half six hours before the procedure. I know this can be annoying if your procedure is at 8 a.m. and you need to get up at 1 or to finish the drink, but you’ll get a more thorough cleansing.

How to make your colonoscopy prep easier  

I know this process isn’t fun. But it’s important, and there a few things you can do to make it a little easier:

  • Listen to your doctor’s instructions: Take notes and ask questions if you don’t understand something.
  • Arrange your schedule: You’ll want to be home – and in your own bathroom – during colonoscopy prep. If you have children, find someone to help care for them while you’re indisposed.
  • Cut back on fiber a couple days beforehand: Fiber is the indigestible part of plant foods and leaves a high amount of residue in the colon. Stick to a low-fiber diet, and avoid foods such as:
    • Beans
    • Nuts
    • Raw fruits and vegetables
    • Whole grains
  • Maintain a liquid diet: Water gets boring pretty quickly. Have a few other options on hand.
    • Clear broth
    • Coffee or tea
    • Italian ice
    • Jell-O
    • Popsicles
  • Drink your prep: Some of these solutions don’t taste great, but as mentioned, it’s the most important part of the prep process.
    • Add flavoring such as Crystal Light or Kool-Aid powder if the prep isn’t flavored.
    • Drink it cold.
    • Use a straw.
    • Suck on a lemon or hard candy afterward.
  • Prepare the bathroom: Once the prep solution starts working, you’ll want to stay close to a bathroom.
    • Wear loose clothing.
    • Stock up on soft toilet paper.
    • Use skin-soothing products such as baby rash ointment.
    • Keep entertainment handy; you may be there a while. This could include books, a laptop or a tablet.

Finally, remember that this screening could save your life. Excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in the United States, with more than 135,000 cases expected to be diagnosed in 2017. 

When should you be screened for colon cancer?

The U.S. Preventive Services Task Force recommends that people at average risk for colorectal cancer begin screening at age 50.

Your doctor may recommend starting before age 50 if you have factors that put you at increased risk, such as:

  • Family history of colorectal cancer or polyps
  • Personal history of colorectal cancer or polyps
  • Personal history of chronic inflammatory bowel disease
  • African-American descent

Click the button above to schedule your screening or call 202-877-7108 to learn more.

There are alternative screening methods, but colonoscopy is considered the gold standard for colorectal cancer screening. Don’t let the hassle and discomfort of colonoscopy prep keep you from getting this potentially life-saving procedure. Take it from Dave Barry: “If I can do it, you can do it. Don't put it off. Just do it.” 

MedStar Washington Hospital Center Receives $232,000 to Combat Crisis of Advanced Colon Cancer among African-Americans in Ward 5

American Cancer Society and Cigna Foundation Grants Support “Colon Cancer Prevention in the Neighborhood”

Washington, D.C., March 23, 2017 – The American Cancer Society and the Cigna Foundation have collectively awarded $232,000 in grants to MedStar Washington Hospital Center’s innovative community-based program to address the crisis of advanced colon cancer, occurring largely among African-Americans with health insurance living in Washington D.C.’s Ward 5. The American Cancer Society provided $99,000, and Cigna awarded $133,000 to support “Colon Cancer Prevention in the Neighborhood,”  a program recognized in former Vice President Joe Biden’s Cancer Moonshot Initiative, as an innovative effort to promote equitable access to cancer screening and care for underserved populations. 

From 2006 to 2011, 68% of the colorectal cancer patients treated at MedStar Washington Hospital Center presented with stage 2 through stage 4 cancer, with a 5-year survival rate of those diagnosed with stage 2 at 63%, and only11% for those diagnosed with stage 4. Of those, nearly 50% of stage 3 and 4 patients were from Ward 5. Alarmingly, 97% of those presenting with advanced colorectal cancer had health insurance at the time of their diagnosis. The data also showed that 91% of those patients with late stage colorectal cancer were African-Americans.

The goal of “Colon Cancer Prevention in the Neighborhood” is to significantly increase colorectal cancer screening rates among Ward 5 residents, age 50 and older, and those younger than 50 who have a family history of the condition, with a longer term goal to reduce disparities and save lives. The program will deploy community health workers/patient navigators to work with Ward 5 residents, building community-based partnerships to deliver colon cancer education, perform risk assessments and distribute easy-to-use fecal immunochemical tests (FIT) to use at home. It will also help connect patients with colonoscopy services at the Hospital Center. In addition, education on insurance utilization for preventive cancer screening will be provided at community events.

“We’re truly grateful to the American Cancer Society and the Cigna Foundation for their generous support to our innovative program, which is such an important initiative for the community we serve,” said Elmer Huerta, MD, MPH, director of the Cancer Preventorium at MedStar Washington Hospital Center. Dr. Huerta, who was the American Cancer Society’s past president, leads the “Colon Cancer Prevention in the Neighborhood” program with David Shocket, MD, director of Gastroenterology, who will perform the program’s colonoscopies.

The program has also pledged to support the American Cancer Society’s “80% by 2018” national initiative, which aims to reach 80% of the eligible population to be screened for colorectal cancer by 2018, thus saving thousands of lives.

In Washington, D.C., it is expected that 210 new cases of colorectal cancer will be diagnosed and that 90 deaths will occur due to colorectal cancer in 2017.

The present overall colorectal screening rate in the District is 67.9% according to the District of Columbia Department of Health BRFSS (Behavioral Risk Factor Surveillance System) for 2014. Reaching 80% by 2018 would avoid 453 new cases of colorectal cancer and 332 deaths by in the District by 2030. In order to reach this goal, close to 40,000 people in the District need to be screened.

Colorectal cancer is the third most commonly diagnosed cancer and the second most common cause of cancer deaths in the U.S. for men and women combined.

 


About MedStar Washington Hospital Center
MedStar Washington Hospital Center is a 912-bed, major teaching and research hospital. It is the largest private, not-for-profit hospital in the nation’s capital, among the 100 largest hospitals in the nation and a major referral center for treating the most complex cases. Its cardiology program is highly acclaimed and its cardiac surgery program has consistently earned the highest national rating–three stars–from the Society of Thoracic Surgeons. It also is a respected top facility in the areas of cancer, diabetes & endocrinology, Ear, Nose & Throat, gastroenterology & GI surgery, geriatrics, gynecology, nephrology, pulmonology and urology. It operates MedSTAR, a nationally-verified level I trauma center with a state-of-the-art fleet of helicopters and ambulances, and also operates the region’s only adult Burn Center.

About the American Cancer Society
The American Cancer Society is a global grassroots force of 2.5 million volunteers saving lives and fighting for every birthday threatened by every cancer in every community. As the largest voluntary health organization, the Society's efforts have contributed to a 22 percent decline in cancer death rates in the U.S. since 1991, and a 50 percent drop in smoking rates. Thanks in part to our progress, 15.5 million Americans who have had cancer and countless more who have avoided it will celebrate more birthdays this year. We're determined to finish the fight against cancer. We're finding cures as the nation’s largest private, not-for-profit investor in cancer research, ensuring people facing cancer have the help they need and continuing the fight for access to quality health care, lifesaving screenings, clean air, and more. For more information, to get help, or to join the fight, call us anytime, day or night, at 1-800-227-2345 or visit cancer.org.

About the Cigna Foundation
The Cigna Foundation, founded in 1962, is a private foundation funded by contributions from Cigna Corporation (NYSE: CI) and its subsidiaries. The Cigna Foundation supports organizations sharing its commitment to enhancing the health of individuals and families, and the well-being of their communities, with a special focus on those communities where Cigna employees live and work.

Media Contact

So Young Pak
202-877-2748
[email protected]

Walk away from colorectal cancer: Exercise can lower risk

In January 2017, researchers reported that exercise is associated with a lower risk of death from metastatic colorectal cancer. Metastatic colorectal cancer is cancer of the colon or rectum that has spread to other areas of the body. This study found people who were physically active for four or more hours per week reduced their risk by 20 percent. People who exercised for at least five hours per week lowered their risk by 25 percent.  

These results reinforce other data researchers have collected on how exercise affects the risk of colorectal cancer. Though we don’t fully understand why, exercise plays a role in the development of colorectal cancer—for people who may be at risk for the disease, people who already have it and people who have been treated for it.

Who’s at risk for colorectal cancer?

Several lifestyle factors can increase the risk for colorectal cancer, including:

  • Diets high in red meat, such as beef and pork
  • Diets high in processed meats, such as hot dogs and bologna
  • Heavy alcohol use
  • Obesity, particularly excess belly fat
  • Smoking

Other factors can also increase the risk of developing colorectal cancer. These include:  

  • A history of inflammatory bowel disease, including Crohn’s disease and ulcerative colitis
  • Family history of colorectal cancer or colon polyps (growths in the colon)
  • Being African-American
  • Having type 2 diabetes

Colorectal cancer tends to affect people in older age groups. That’s why we recommend people over 50 get a colonoscopy on a regular basis to lower their risk for colorectal cancer. Your doctor may recommend starting earlier if you have one or more of the above risk factors. For instance, we recommend African-Americans start getting regular colonoscopies at age 45. Though there are other tests available to screen for colorectal cancer, colonoscopy is still the best option for finding and treating the disease as early as possible. 

Getting active to stay healthy

As we age, we tend to be less active and at higher risk for conditions like heart disease and diabetes, which can further limit our activity levels. But even a little exercise every week can lower your risk of colorectal cancer. Studies cited by the National Cancer Institute have found adults who increase their physical activity can reduce their risk of developing colorectal cancer by 30 to 40 percent compared to people who don’t exercise. That’s on top of the benefit researchers have found exercise has in people whose cancer has spread.  

Modest amounts of moderate exercise can help. I tell patients that if they’re breaking a sweat for about 20 minutes at a time two to three times a week, that seems to be enough. Walking is a great way to do this. Some other examples of moderate exercise, according to the Centers for Disease Control and Prevention (CDC), include:

  • Aerobics
  • Biking
  • Climbing stairs or using a stair climber
  • Dancing
  • Playing basketball
  • Swimming
  • Yoga 

Research shows that people don’t have to do intense exercises to get these survival benefits. When it comes to lowering your risk of colorectal cancer, just getting up and doing something is important. If you can do more, that’s great! If you can’t, do what you can. Just make sure you’re doing something. And talk to your doctor about starting any new exercise plan, especially if you have conditions like heart disease, lung disease, diabetes or other serious conditions.

Exercise even helps after a patient has had surgery to treat colorectal cancer. The American Cancer Society notes that people who exercise regularly after being treated for colorectal cancer have a lower chance of the disease coming back, as well as a lower chance of dying from the disease. In addition, exercise has been linked to an improved quality of life and less fatigue after colorectal surgery. If you’re starting or resuming an exercise routine after colorectal surgery, be sure to talk to your doctor beforehand about the types of exercise you can do safely. 

Controlling your colon cancer risk

I realize that getting active is easier for some people than others. By the time people are in their 60s and 70s, if they haven’t exercised regularly before, making that sort of lifestyle change can be tough. But I encourage my patients to do what they can to lower their risk for colorectal cancer. I let them know that even little changes in their activities or walking just a little bit can benefit them in the long term.  

Older adults who have never exercised before may not know where to start. It can be intimidating to walk into the local gym and get started on a fitness plan. The National Institute on Aging has examples of sample exercises for older adults based on four key fitness areas: endurance, strength, balance and flexibility. Your doctor can also provide guidance on the types and amount of exercise you should do.  

And exercise isn’t the only thing I advise people do to lower their risk. Other ways you may be able to reduce the risk of colorectal cancer include:

Take the first step

We need more research in this area of medicine to find out exactly why exercise lowers the risk of death from colorectal cancer and the risk of developing it in the first place. For now, though, the data show a clear link between the disease and activity levels.

 You don’t have to live at the gym or train for marathons to reduce your risk for colorectal cancer. Take a brisk walk around the block once a day, or watch your favorite TV show while you walk on the treadmill. Every step is one you’re taking to live a healthier, more active life—and one free from colorectal cancer.