Colon Cancer Deaths Tumble, But Not In These Hotspots

by Maggie Fox

Dr. Pedro Jose Greer, right, preparing to do a colonoscopy at Mercy Hospital in Miami. Greer has made a career of offering treatment without regard to patients' ability to pay. Lynne Sladky / AP

Colon cancer deaths are moving briskly down across the U.S. — with the exception of three large hotspots, researchers reported Wednesday.

A "perfect storm" of high obesity rates, low education and a lack of access to medical care make for frighteningly high colon cancer rates in the Mississippi delta, western Appalachia and the borderland between Virginia and North Carolina, the American Cancer Society finds. 

"In the Mississippi delta, rates among black men are not declining at all," said Rebecca Siegel of the

American Cancer Society, who led the study.
Colon cancer has become one of the most easily prevented cancers. Colonoscopy can spot and remove pre-cancerous growths before they become malignant, or find tumors early, when they are still easy to treat. Surgery can remove colon cancers, and there are several good chemotherapy drugs that can control it.

"It really is like a perfect storm."

And the 2010 Affordable Care Act means that health insurers must pay for colon cancer screening. But that only works if people actually have health insurance, and that's a challenge on some of these areas, Siegel said. 

"Particularly in the lower Mississippi delta and Appalachia, there are longstanding challenges, with high poverty, unemployment which coincides with less insurance coverage," she told NBC News.
A diet that's rich in fat, sugar and red meat and low in fiber doesn't help.

These three regions are 'hotspots' for colon cancer deaths, a new study finds. Graphic Courtesy of the American Cancer Society

"It really is like a perfect storm," Siegel said.

Politics may be interfering, too. The Affordable Care Act, widely known as Obamacare, helps subsidize health insurance for low-income people. But it also relies on states expanding Medicaid, the joint state-federal health insurance plan for the poor. "Only half of the 12 states that are involved in these high-risk areas have expanded Medicaid," Siegel said. 

That means many people whose incomes are too low to qualify for subsidized insurance are left with very few options for paying for health care.

Study: Changing diet may affect colon cancer risk 0:28

 

Colorectal cancer is the second leading cause of cancer deaths in the United States and the fourth worldwide. More than 132,000 new cases and 50,000 deaths from the disease are expected this year in the U.S. alone.

But rates have been heading steadily down, part of a larger trend for many common cancers. In 2011, more than 140,000 Americans got colon cancer. That's even though only about 60 percent of people advised to get screened do so now. 

Siegel and colleagues used software to calculate death rates from colorectal cancer on a county-by-county basis, comparing trends from 1970 to 2011. Deaths from colon cancer were 40 percent higher in the Mississippi delta than in average areas across the country in 2009-2011, according to their report in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

Ironically, in the early 1970s, colon cancer death rates in the Mississippi delta were 18 percent lower than the average death rates in the country. But they began to rise, by a steady 3.5 percent a year for black men between 1970 and 1990. They haven't moved since, even as rates fall in the rest of the country.

"Targeted interventions, like using people within the community to talk to their neighbors about screening, are likely to be effective."

"These areas are low-hanging fruit for colorectal cancer screening interventions," Siegel said.
"Although we've made great strides against colorectal cancer in a fairly short time period, there are a lot of vulnerable populations that aren't benefiting. Now that these groups have been identified, there is a moral obligation to do something about it," Siegel added. "Targeted interventions, like using people within the community to talk to their neighbors about screening, are likely to be effective."
Programs that target churches and other community organizations are often effective, experts say.