Breaking Barriers

Published 10:31 am Tuesday, October 3, 2017

AHOSKIE – A 2015 study pinpointed three “hotspots” across the United States where rates of colon and colorectal cancer mortality rates were higher in comparison to the rest of the country. One of these hotspots included the Roanoke-Chowan area, and in an effort to combat the problem the Carolina Cancer Screening Initiative (CCSI) was launched in collaboration with UNC doctors and local health partners.

The Roanoke-Chowan region along with five other surrounding NC counties as well as several counties to the north in Virginia were identified as an area with high cancer death rates. CCSI was developed in order to provide people better access to preventative cancer screenings.

“This particular initiative is really about getting screening done in rural areas and vulnerable populations,” explained Dr. Dan Reuland, a member of the UNC Lineberger Comprehensive Cancer Center and Director of CCSI.

“Although there are many other issues related to cancer screening, we chose to focus strategically, at least initially, on colon cancer or colorectal cancer screening, in part because there’s a pretty good consensus we should be doing it more than we do,” Reuland continued. “There’s also evidence that underserved populations, particularly in rural areas, have lower rates of screening.”

Roanoke Chowan Community Health Center (RCCHC) is a key local partner in working with Dr. Reuland and his team at the UNC Center to effectively carry out the initiative.

“They’ve got a fantastic group there. They’re very energetic, they’re very smart, and do a lot of great quality improvement initiatives,” Reuland said, praising the staff of RCCHC, but also added the Ahoskie-based facility needed more resources to help carry out the initiative.

Kim Schwartz, the CEO of RCCHC, echoed Reuland’s emphasis on the importance of early cancer screening, and explained that the health center has been focused for years on pushing for more screenings, educational awareness, and interventions.

“We drew the attention of the UNC Lineberger Program because of our aggressive measures of trying to improve, and then our commitment,” Schwartz explained, adding their goal for 2018 is to get at least 80 percent of the local population screened.

Currently, Schwartz said, that number is at 40 percent.

“We’re very excited to be able to partner with them. We’re thrilled that they’ve made this long-term commitment,” Schwartz said of working with the UNC program. “Having their expertise, their generosity, their willingness to work with us and work with our team, we’re pretty excited about that.”

Both Reuland and Schwartz agree that overcoming barriers to get screened is one of the most important things.

“There are a lot of barriers,” Reuland explained, listing a few. “In addition to being something that people don’t really care to do, there are financial barriers, knowledge barriers, access barriers.”

Reuland also mentioned information transfer between different health care providers and transportation as other potential obstacles they want to overcome.

Schwartz cited cost as being one of the biggest factors.

“There are many people that are gravely underinsured,” she said, expressing a need to address insurance issues going forward.

RCCHC, however, is a Federally Qualified Health Center which means, as Schwartz explained, that they serve everyone regardless of ability to pay. They work with other local health providers, such as Vidant Roanoke-Chowan Hospital in Ahoskie, to help people get the care they need.

“Colon cancer screening is recommended for most people starting at age 50 going until 75,” said Reuland, continuing with listing smoking and obesity as risk factors, but also emphasizing the importance of getting everyone screened.

“Because the whole population is a hotspot,” Schwartz agreed, “everyone needs it.”

Ernie Carter is a member of RCCHC’s Board of Directors and knows well the importance of getting regularly screened for colon cancer. His father is a colon cancer survivor who was diagnosed in 1973.

“Because my dad had it, we’re at high risk,” Carter explained. “My sister and I have had to do colonoscopies on a routine basis. It’s kept us abreast of what we needed to do and probably prevented us from having some issues that would go undetected had we not been screened early.”

For people like Carter who are at higher risk, routine screening colonoscopies are recommended every five years instead of every 10. He said the procedure isn’t as bad as people usually make it out to be.

“The preparation for the colonoscopy is a whole lot worse than the colonoscopy,” he explained.

In addition to a colonoscopy, there are other less invasive screening procedures that people can do as well. Carter said he also does a yearly fecal immunochemical test (FIT) which is simply done with a kit at home.

“It sounds gross,” Carter explained, “but there really is nothing to it. They give you the whole kit, you take it home, you [collect the sample] in the privacy of your own home. It’s not like you’re under pressure.”

“If people would do that, that would eliminate so many issues that go undetected,” Carter continued. “Colon cancer now, if it can be detected early, it’s so treatable. When people don’t do the colonoscopies, they don’t do the pre-screening, they get to a point where it’s too late to do anything by the time they find out they have it.”

Schwartz said RCCHC provides the stool-based test kits to people who need to be screened, and afterwards, if there is any indication of a problem, the health center helps those people set a colonoscopy appointment for further screening.

“We call it the ‘we’re right behind you’ campaign,” Schwartz explained with a laugh, saying that normalizing the screening process and humorously acknowledging the awkwardness of it helps make people more comfortable.

Dr. Reuland said the screening initiative and local partners like RCCHC will be provided with as much support as possible to facilitate improvement in the area. They plan to help write grants and advocate in Raleigh for additional resources. Additionally, a Population Health Manager will be hired soon to work from the main RCCHC office in Ahoskie to help coordinate screening efforts and overcome the aforementioned barriers to screening.

As for why the Roanoke-Chowan region is a part of the colon cancer hotspot, Dr. Reuland answered they still are not exactly sure.

“But part of the issue is probably related to screening and treatment issues, so we’ll be looking into that in more detail,” he explained. “Most importantly trying to improve screening because that’s the thing that we know works.”

One thing is certain: the Carolina Cancer Screening Initiative will do as much as possible to make a difference in detecting cancer early.