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Lifeline: Increasing access to cancer screenings

Network - Spring 2014

By Mary Brolley


Lewis Foxhall, M.D., doesn’t mince words about colon cancer, which is expected to cause more than 50,000 American deaths in 2014.

“If the disease is caught and treated in its early stages, the overwhelming majority of patients survive. In fact, they do well,” says Foxhall, professor of Clinical Cancer 
Prevention and vice president, Office for Health Policy.

But too many are diagnosed and start treatment at the late stages of disease, he says. “At that point, good outcomes are much more difficult to achieve.”

“It’s that stark.”

Colorectal cancer is the second leading cause of cancer-related deaths in men and women, according to the American Cancer Society.

How can we catch this deadly 
cancer early?

In contrast to other well-established cancer screening tests — the PAP for cervical cancer, the mammogram for breast cancer, and skin checks for skin cancer — the colonoscopy, recommended to screen for colon cancer, is more of an ordeal.
It’s relatively expensive and requires dietary changes and hours of preparation.

Yet, because it’s so effective in catching colon cancer at early, treatable stages, it’s considered the gold standard in colon cancer screening.

Still, only half of eligible Americans have any type of screening test for colon cancer.

Encouraging screening in 
underserved populations

Health advocates and policymakers want to reach those who haven’t been screened, especially those with low incomes and limited access to primary care.

Through its FIT-flu program, MD Anderson collaborates with community health clinics like 
Access Health in Richmond, Texas, to make 
screening tests available to qualified clients.

The program is available to low-income, uninsured, Medicaid or Medicaid-eligible adults age 50 to 75. It’s funded by a grant that allows communities and hospitals to form regional partnerships that support more localized health care solutions.

Since last fall, more than 500 clients have picked up a FIT test when they came to the clinic for their flu shots.

Also called a fecal immunochemical test, the FIT checks for blood in the stool, which can be a sign of colon cancer before any symptoms develop. The test is offered in conjunction with the annual flu shot as a convenient time to remind eligible people to get tested.

A positive test spurs a referral for a free colonoscopy test. If cancer treatment becomes necessary, FIT-flu program staff work with the Access Health team to find resources for the patient’s treatment.

So far, more than half of the 522 tests distributed have been mailed back to labs for testing, says Daniel Pacheco, program coordinator for the FIT-flu program. At least 18 tests have been positive, and two people were diagnosed with early stage cancer after further testing.

Who’s more likely to get colon cancer?

The lifetime risk of getting colon cancer is about one in 20. Factors that increase the risk include:

  • age,
  • a history of polyps,
  • a family history of colon cancer, 
  • inherited syndromes such as familial adenomatous 
polyposis (FAP) and hereditary non-polyposis colorectal cancer  (HNPCC), and
  • inflammatory bowel disease

Racial and ethnic background, having Type 2 diabetes, and lifestyle factors like poor diets and inadequate physical activity may also increase risk.

‘The best screening test is the one that gets done’

The program will distribute 2,000 FIT-flu tests during flu season through 2015.

The partnership is “a stroke of genius,” Foxhall says.

David Vining, M.D., agrees. A professor of Diagnostic Radiology, he spearheaded the program with funding from a CPRIT grant in 2010.

“Community health clinics offer a great avenue for distributing the test,” he says. “Colon cancer is a largely avoidable type of cancer, if people get screened.”

It’s an evidence-based intervention, Vining says. “Research has proven that this test reduces incidence and mortality associated with colon cancer.”

If successful, the FIT-flu program could be used across Texas and beyond to increase cancer screening and reduce the chance that people will die from this disease.

“The best screening test is the one that gets done,” Foxhall adds. “I tell my patients they should aim to die young — as late in life as possible,” he jokes.


© 2014 The University of Texas MD Anderson Cancer Center