The Colon Cancer Prevention Project is the largest nonprofit organization focused on colon cancer education and prevention in the state of Kentucky. The nonprofit has been featured on multiple television shows, in professional journals and distributed more than 1.2 million educational brochures. In August, the Project raised more than $90,000 at its 8th Annual Walk Away for Colon Cancer & 5k Run. Louisville, Ky.-based gastroenterologist and Colon Cancer Prevention Project founder Whitney Jones, MD, answers questions on how the organization got started, what the group is working on today and the role colonoscopy has to play in the GI field.
Q: Why is colonoscopy an important tool for gastroenterologists?
Dr. Whitney Jones: GI physicians provide a variety of preventative services and manage a variety of conditions. Colonoscopy is perhaps the most widely used procedure for these conditions and colorectal cancer screening. If we are able to find and remove polyps, we are preventing cancer or finding it soon enough so chemotherapy and radiation are not necessary.
Q: How did you first decide to begin the Colon Cancer Prevention Project?
WJ: I was primarily a pancreatic and biliary physician. Ten years ago, I saw three patients with insurance and all had advanced colon cancer diagnoses. They had not had any prior screening. I stepped outside my box of pancreatic practice.
At the time, we were the 49th worst state for screening rates and lead the country in colon cancer deaths. I began working with a friend and we started a 501(c)(3) nonprofit organization. Since then, the state has had a 22 percent reduction in incidence and mortality. In the city, we have had a 37 percent reduction. In the area typically known as the southeastern cancer belt, this has been the most dramatic alternation.
Q: What other goals is the organization working towards now?
WJ: We are working on leading the funding for the treatment of the uninsured. In 2012, we received funding from an executive budget of a cancer survivor, funding which was matched by the Kentucky Cancer Foundation. We are now in the process of planning a budget, which we hope to spread statewide. We want to make sure that no patient that seeks out help or screening is denied care. Through this work, I have gained a great deal of public health knowledge. This has brought a business edge to my experience.
Recently, our focus has been on a supply chain of screening. This starts with research, clinician and provider awareness and network and institution involvement. Until screenings are actually done, there is no benefit.
Q: Has the organization broadened its focus beyond colonoscopy?
WJ: We have also begun to work fecal immunochemical testing. We are essentially checking stool samples for blood, which is a great alternative to colonoscopy. Though this can be seen as disruptive to the colonoscopy model, in reality it will not replace colonoscopy.
Q: Do you think colonoscopy could eventually be replaced?
WJ: The holy grail would be to replace colonoscopy. Companies are working on better stool testing and we have just scratched the surface of genetic testing. Any company working on blood tests for colorectal cancer screening would love its test to become the one that replaces colonoscopy. A lot of ASCs and GI physicians base their practice on colonoscopy. For them, these new tests will be disruptive. But looking at an accountable care model, such as Kaiser, colonoscopy screening volume has increased. We have to be lead by the science and patient care more than our own economic interests.
Q: How can gastroenterologists stress the importance of colonoscopy screening for patients?
WJ: We need to be getting the message out in communities and in our states. I would encourage people in the South and rural areas to step up. People in public health appreciate the help of practicing GI physicians. Gastroenterologists should be playing a key role in educating patients on colorectal cancer. One in 20 people are affected. It is the number one cancer in non-smokers.
We now have better technology and medication. We can do a meaningful test, which absolutely can save lives. Gastroenterologists should partner with primary care physicians to reach patients.
Q: Are there any changes in the way GI physicians should approach colonoscopy as a colon cancer screening tool?
WJ: The trend that is going to start gaining steam down the road is colorectal cancer and mortality in people under the age of 50. Right now, 20 percent of cases occur in people younger than 50. We need to update our communication strategy. GI physicians should start talking to patients about getting screened at age 40, not 50. Identify risk factors, understand the symptoms and promote awareness that screening should be done earlier.
We need to have in place a policy that physicians begin talking to patients about colonoscopy at age 40. GI physicians need to unlink colonoscopy from the 50-year tag. This doesn't necessarily mean there will always be an earlier screening, but you don't advertise a concert the day you want people to come.
We need to shoot ahead with public health policy. There is a huge change coming down the road. The behavior of colon cancer will change and we need to change our strategy to keep up. Within the next five to 10 years, we will have shifted the colonoscopy conversation back a decade.
Q: What changes do you foresee for the future of colonoscopy?
WJ: The Affordable Care Act is resolving a lot of issues of coverage denial for preexisting and genetic conditions. We will begin to see a wave of these patients. But, if we are going to have this expensive test that no one likes, we have to deliver the best product possible. There has to be an extreme focus on the quality of colonoscopy. We need to make sure physicians are collecting benchmarks and keeping track of adenoma detection rates. This will be the focus for the next decade.
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