As reported by New Haven Independent, January 8, 2009.

Health Centers Pioneer $951K Colonoscopy Study

By Abram Katz

Early screening for colon cancer is not pleasant, but the disease is much, much worse.

This is why the state Department of Pubic Health is conducting a $951,379 pilot study on the effectiveness of colonoscopy among 600 uninsured or underinsured men and women at eight of Connecticut’s 13 community health centers.

In New Haven patients at the Fair Haven Community Health Center and Hill Health Center are eligible to participate in the study.

Experts at the University of Connecticut Health Center in Farmington will study the project and decide whether it should become a permanent service, like the Connecticut Breast and Cervical Cancer Early Detection program.

“The colonoscopy is a major prevention tool, but not everyone has access,” said Dr. Joseph C. Anderson, clinical director of the UConn Health Center’s Colon Cancer Prevention Program. “The more people we can screen, the more people we can help. Polyps in the colon will become cancerous whether you have insurance or not. People who can’t afford a colonoscopy also can’t afford to not get screened.”

Colonoscopy is usually performed if blood is discovered in a patient’s stool, or at age 50. Bleeding, a sudden change in bowel habits, and other symptoms also warrant the test. The Connecticut study is restricted to people without symptoms to measure the procedure’s effectiveness as a screening tool.

During a colonoscopy a gastroenterologist examines the large intestine from one end to the other using a small video camera mounted on a flexible tube. The doctor watches the image on a monitor.

Pre-cancerous growths, such as certain types of polyps, can be removed before they expand and spread.

The whole test takes 20 to 90 minutes, depending on what the doctor finds.

Nationally, 108,700 new cases of colon and rectal cancer are diagnosed every year in the U.S., according to the National Cancer Institute. Together these cancers annually kill about 49,000 people.

“This is the first time free colonoscopies have been made available to uninsured patients,” said Dr. Laurie Bridger, medical director at the Fair Haven Community Health Center.

Doctors recommend regular colonoscopies starting at age 50, unless a patient has a family history of colon cancer, in which case testing should start earlier.

The alternatives to colonoscopy are sigmoidoscopy, which examines a smaller section of the colon, and the now less-used barium enema, which shows polyps in relief because barium is opaque to X-rays. Doctors are evaluating a non-invasive test called the virtual colonoscopy, which yields a computer image of the interior of the colon.

However, both virtual and physical procedures require a clean colon. Thus, one of the least pleasant parts of the test is the preparation is fasting and a course of laxatives the night before. Any material or mucus remaining in the large intestine may conceal a polyp or a patch of abnormal tissue.

The pre-test purge and the idea of a four-foot-long tube exploring your insides may make some people hesitant to undergo the test, doctors said. Consequently, the program will emphasize education, Bridger said.

In practice, sedatives are routinely administered to blot out any discomfort during the colonoscopy. The test does include the risk of perforating the colon, which could lead to a serious infection.

“We will be hiring educators to explain the test to patients. As long as it’s explained well, a lot of the anxiety is dispelled,” she said.

“There’s not much public knowledge about colon cancer or colonoscopies,” she said. Nationally, about 20 percent of the medically eligible people obtain colonoscopies, Bridger said.

Dr. Suzanne Lagarde, a gastroenterologist in private practice in New Haven is administering colonoscopies for the two community health centers in the city. The state department of health is paying for a small portion of the test, she said.

Since point of the colonoscopy is to identify pre-cancerous cells, removed tissue must be analyzed by pathologists. Lagarde convinced Yale pathologists to work almost for free.

“Colon cancer is the second most common cancer, and the third leading cause of cancer deaths,” she said.

The leading type of cancer in the U.S. is (male) prostate cancer. Next in prevalence is female breast cancer, then colon and rectal cancer, according to the federal Centers for Disease Control and Prevention.

Lung cancer is the top cancer killer, followed by cancer of the prostate, breast and colon, CDC statistics show.

“It’s pretty well established that screening for colon cancer is fairly effective. Forty-seven million Americans don’t have health insurance, which is a big problem,” Lagarde said.

“I’m very excited about this program. If we can demonstrate that this can be done at a reasonable cost. then it’s win-win for everybody. I’m hopeful that the data will support a continued program,” she said.

Jennifer Granger, chief operating officer of the Community Health Center Association of Connecticut, said, “The goal is to promote, improve and optimize the appropriate use of high quality colo-rectal cancer screening and follow-up services, and eliminate or decrease racial, ethnic, and socio-economic disparities in access to those screenings.”

Screening for early detection of colon cancer may seem like an obvious benefit. However, attempts at early detection of lung cancer have revealed many suspicious but benign “spots” on lungs, leading to unnecessary anxiety and surgery.

If fact, American Gastroenterological Association researchers published a paper in Tuesday’s Anals of Internal Medicine, finding that screening colonoscopies do lower the risk of death from cancer. The association is primarily limited to deaths from cancer developing on the left side of the colon.

Other experts argue that the patients in the study were enrolled more than a decade ago, and that optics and technique have improved since then.

If screening with colonoscopy can reduce the colon cancer risk by 50 percent, rather than 70 percent, the savings in money and human suffering is still incalculable, Lagarde said.