Where you live could impact your colon cancer risk

The Means Report

AUGUSTA, Ga. (WJBF) – The death of actor Chadwick Boseman put a spotlight colon cancer and the fact that it is a disease that does not discriminate. In fact, hot spots are showing up across the country, and younger more younger adults are being diagnosed. Dr. Justin Moore, an epidemiologist at the Medical College of Georgia is on hand to talk about the signs and symptoms of colon cancer, and what you can do to lead a healthy life for yourself and your loved ones.

Brad Means: Dr. Moore, thanks for everything you do, and thanks for being with us today.

Dr. Justin Moore: Thank you, Brad it’s a pleasure to meet you.

Brad Means: You know, this really hit home for a lot of folks. This disease, a few short weeks ago, when we lost actor Chadwick Boseman, 43 years old. It surprised me, because I thought it was an older person’s disease, colon cancer. Did it surprise you that someone that young could succumb to it?

Dr. Justin Moore: No, sir. So it, it actually didn’t, and I actually have some recent evidence that suggests that people, based on where they live at, are at a higher risk of dying from early-onset colorectal cancer. And when we say, I’m sorry, what was that?

Brad Means: Yeah, no, I’m sorry. I was just gonna ask you, why does it matter? Why can certain parts of the country be more conducive to getting this disease? Is it the way we eat in those parts of the country? Is it, are there other factors?

Dr. Justin Moore: Yeah so, there are a number of different factors, risk factors, for early-onset colorectal cancer, but for this particular type. So when we say early-onset colorectal cancer, we’re talkin’ about people who are diagnosed before the age 50. Now, some of the known risk factors include diet, right, so that’s the first one that you brought up. And I would have definitely said that it is, and some research that I’ve done, we’ve seen that a higher adherence to the Southern-based dietary pattern, that basically means that, if you eat more foods that have saturated fats, more processed meat, fried chicken, you know, if you have pork in your greens, we saw that that was associated with a two-fold increased risk of death from any cancer. So, we’re seeing, and other research has also suggested, that diet is associated with that. Obesity, drinkin’ alcohol, sedentary behavior, and smoking are also associated with these, with colorectal cancer.

Brad Means: You know, we’ve had people on from MCG before to talk about telemedicine and how helpful telemedicine is to reach people in our rural communities. And just sort of a broad question here, is that something, that kind of technology, helpful when it comes to reaching people and maybe spotting or preventing early-onset colorectal cancer? Because if they’re out in the country, if they’re out in these rural areas, they might not come into town to go to the hospital, especially when they’re not 50 yet. Could the telemedicine be a way to reach them and help?

Dr. Justin Moore: Yes, most certainly, I believe so, but we have to think about those areas, right. So if you’re more likely to live in a rural area, rural community, then you’re probably, we’ve also seen that that’s associated with having less broadband support. So we have to think about how do we get assets to telemedicine for those people, but most certainly, yes, I would say that any type of intervention where you can increase the communication between a patient and a provider would most certainly help. I actually have images and figures that actually show you, just at a national level, how early-onset colorectal cancer looks. We, we identified the hot spots.

Brad Means: Yeah, go ahead, go ahead. And I didn’t mean to interrupt you doctor, go ahead and pop that up on your screen, we’ll see if we can do this Zoom technology together. And while it pops up on your screen, you just sort of talk about it and tell the viewer what we’re seeing.

Dr. Justin Moore: Yeah, so let me go ahead and just pull this up really quickly for you. So can you all see?

Brad Means: Oh that’s perfect, yeah, it’s perfect.

Dr. Justin Moore: Yeah, so if you look nationwide, what we did was we took data from the CDC from a period between 1999 and 2017, and we identified 232 counties that were considered significant hot spots. And all that basically means is that in these areas, in these areas we see a higher risk of dying from colorectal cancer before the age of 50. And when I zoom in, and if you look at this image here, one thing that you do notice is that it’s more likely to be in Southern counties, right. You see that the Southern Mississippi River Valley area is a dense area for hot spots, but then we also, when you think about regionally, for us in Georgia and South Carolina, let me see if I can go to my next slide here. You see that we have about eight counties in Georgia that were identified as hot spots. These counties were Burke, Dade, Effingham, Franklin, Hart, Morgan, Newton, and even here in Augusta, we see that Richmond County is a hot spot for early-onset colorectal cancer. Ah, one more thing, you brought up Chadwick Boseman, so with that tragic passing of, you know, celebrity Chadwick Boseman, what was really interesting is that we did this analysis. This was published earlier this year, and these hot spots were contingent upon, you know, dates between 1999 and 2017. If you were to guess where he’s from on this map, it actually highlights as a hot spot. He’s from Anderson County, which is about right here.

Brad Means: Right there in the middle of the red.

Dr. Justin Moore: Right there, in this, that’s this county right here, which borders like Georgia and South Carolina, but Anderson County, South Carolina is where he’s from. So, basically the whole point behind even doin’ this analysis and doin’ this study was to just identify where are the areas of need, what is actually happenin’ on a national level. And it unfortunately is a very unfortunate coincidence, but this gives us a chance to at least try to mitigate this burden of disease by at least, you know, just informin’ people who live in these areas and tell them about the risk factors. And hopefully, as you were just saying earlier about telemedicine, maybe that can be a way that we can mitigate the burden. Other factors that we saw correlated to these hot spot areas was there was higher poverty, higher adult obesity, higher levels of physical inactivity, limited access to healthy foods, higher uninsured rates, and fewer primary care physicians per population.

Brad Means: That seems like such a tall task though, doctor, to try to change the way that people live. To try to go into those hotspots, to try to travel to those areas where people have those risk factors and say, “Look, don’t do this anymore, don’t eat this. “I need you to take a walk each day.” You’re rewiring people in order to make them healthier, that seems too difficult, too impossible.

Dr. Justin Moore: So yeah, I wouldn’t put all the burden on just our physicians and our clinicians in terms of trying to change major health behaviors. But one of the, I guess, reasons that we’re having this conversation is the more awareness that we have about people who were born around 1990 basically havin’ double the risk of colorectal cancer as people who were born around 1950, right. We want to just inform our public that, hey, colorectal cancer is takin’ on a different manifestation now, and that can be attributed to diet, it can be contributed to a multitude of different factors. But earlier screening is one thing that we can, you know, argue for and see if we can get some of the national guidelines, you know, modified.

Brad Means: What would you say? What would you say right now? You know, cause everybody thinks 50. What’s an age that you’d like to see somebody come in and get screened?

Dr. Justin Moore: So right now, the US Preventive Task Force, they recommend at age 50, but if you go to the American Cancer Society, they actually recommend at age 45, and that was actually modified within the past few years. With having a family history of colorectal cancer or any type of polyp, I would suggest if it, you know, I’m thinkin’ that over the next few years that, especially with the increasing numbers of early-onset colorectal cancer cases that we’re gonna see that recommendation age lowered, to at least 40. I personally would, again, bein’, if you’re high risk, if you have a family member that’s had a cancer, colorectal cancer, if you have Crohn’s Disease, which is Inflammatory Bowel Disease, if you have other risk factors, known risk factors, genetic risk factors, I would most certainly say that 35 plus would probably be a better starting age.

Brad Means: What about actual symptoms for young and old people? But since we’re talking about early-onset, especially those in their forties, or maybe even younger, what might be a red flag to let you know something might be wrong inside of me.

Dr. Justin Moore: Yeah, so I’m glad that you asked that, I’m gonna actually share a screen one more time here. So these are just some of the known symptoms, and I first list the localized symptoms, so when we say localized, we’re basically sayin’ that’s an earlier stage disease, so stage one, maybe stage two. So some of the things that you’re gonna notice would be rectal bleeding, narrow stools, anemia, persistent abdominal pain, unexplained weight loss, and chronic constipation and diarrhea, so those are some of the symptoms that we know for localized, or stage one and two, colorectal cancer. Now, in terms of more advanced stage, you would have more systemic symptoms, so a feeling that the bowel doesn’t empty completely, unexplained weight loss again, unexplained loss of appetite, and jaundice. So these are some of the symptoms that we commonly see with newly diagnosed colorectal cancer patients.

Brad Means: When we talk about screening, does that mean getting a colonoscopy? Is that what screening means?

Dr. Justin Moore: Oh, that’s a great question. So we mainly have two types of screening, one is stool based and then another one is structural or visual, which is the colonoscopy, which you were just referencing to. So in terms of a stool base, that basically means that you have these certain tests that is noninvasive. You’re able to basically take a sample of someone’s stool and actually test whether they have certain components or compounds within your stool that would be indicative of basically cancer cells. And those tests can start again, these can start as early as 45, based on guidelines from ACS. Again, US Preventive Task Force, their recommendation is age 50. I strongly feel that they’re gonna probably change that soon. And, for some of the more structural or visual tests, like the colonoscopy, or like your virtual colonoscopy, those are a little less frequent, and those occur either every 10 or five years, depending upon the type of test that you get. of course with I’m sorry, but.

Brad Means: No go ahead.

Dr. Justin Moore: One last thing, with these tests, the one thing that you have to take into account is what we call the sensitivity, so the ability to actually test and figure out whether a person actually has the disease. So as you do the more structural visual types of tests, which would be a colonoscopy or a virtual colonoscopy, it will be a bit more indicative of whether you actually have the disease.

Brad Means: Does a colonoscopy hurt?

Dr. Justin Moore: It’s uncomfortable.

Brad Means: Yeah.

Dr. Justin Moore: It’s, definitely uncomfortable. I, if I’m being honest, it doesn’t feel good.

Brad Means: Sure, people are scared of ’em though, you know, and I think that fear, you may have even referenced fear at the beginning of this interview or hesitancy to go to the doctor. That’s something that you in the health care community have to help patients overcome, isn’t it?

Dr. Justin Moore: Yes, sir. So, and that’s one of the main barriers that we do see oftentimes with very vulnerable populations. So one of the things that we observed when I did this analysis, lookin’ at early-onset colorectal cancer, was we saw specifically that Black men actually had like a 32% increased risk of dying from this disease when compared to their White counterparts. And a lot of that was either based on the fact that they were less likely to see a primary care physician or an oncologist within the past year and then they actually had a later stage diagnosis. And a lot of this can be rooted back to the simple fact that a lot of African Americans and, you know, Black Americans don’t necessarily feel comfortable going to a primary care physician or any health professional when they don’t necessarily have the cultural competency, or they may not have the health literacy themselves to, you know, vouch or speak their concerns. They may not even have the rapport with a primary care physician. So, so one of the issues again, is just access, but inadequate access to care for a lot of these patients, so we should continue to work on that. And as an epidemiologist, I do a lot of work within the community, and a lot of my work is based on meeting people where they are.

Brad Means: I’m sorry, go ahead. I was just gonna say real quickly, we have time for one more question. What are your hopes going forward? What are your hopes looking down the road and maybe one day reaching a point where we have less red on that chart, we reduce those hot spots?

Dr. Justin Moore: So, some of my hopes just goin’ down the road is to continue to increase the awareness. It’s unfortunate that, you know, the late passing of Chadwick Boseman occurred. I really want people within these areas of high risk to just have the information so that they can at least begin a conversation with a health professional or one of their healthcare providers. I think that is gonna be one of the most important, pertinent hurdles that we need to get over before we see a reduction in, you know, this morbidity and mortality from this disease.

Brad Means: Well I certainly think that your information today goes a long way toward creating that awareness, Dr. Moore. And maybe, just maybe, something positive can come out of this tragedy that we’ve all witnessed and endured with Mr. Boseman’s passing, and people should just play this interview back for their loved ones and overcome some of those fears. I really appreciate your research and your time today, doctor.

Dr. Justin Moore: Thank you.

Brad Means: Absolutely, Dr. Justin Moore, Medical College of Georgia at Augusta University, doing some great work in the field of epidemiology and helping to fight early-onset colorectal cancer by making people aware of it.

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Brad Means

The Means Report first aired in January of 2009 offering coverage that you cannot get from a daily newscast. Forget about quick soundbytes -- we deliver an in-depth perspective on the biggest stories. If they are making news on the local or national level, you will find them on the set of The Means Report. Hosted by WJBF NewsChannel 6 anchor, Brad Means, The Means Report covers the topics impacting your life, your town, your state, and your future.