Written by Linda Howell Skidmore

There’s no debating it – colon cancer screening isn’t a favorite topic of conversation. Yet everyone is at risk for colorectal cancer, making screening for the disease essential, particularly for West Virginians.

“Colorectal cancer is more prevalent in West Virginia than the national average in terms of new diagnoses per year and we’re not entirely sure why,” said Dr. Emily Groves, assistant professor of colon and rectal surgery and general surgery residency associate program director in the WVU School of Medicine Department of Surgery and a WVU Cancer Institute surgical oncologist. “We also see patients present with a later stage of tumor in general, which means that it’s caught later in the process in West Virginia as compared to the national average.”

According to the National Cancer Institute, the incident rate for colorectal cancer in West Virginia is 44.3 per 100,000 people while the national figure is 36.4 per 100,000 people. It’s also the fourth-most-common cancer among men and women combined in the Mountain State.

Like all cancers, early detection is key to successful treatment. The American Cancer Society recommends that everyone begin a regular screening for colorectal cancer at age 45 and continue to age 75. Colonoscopy is also recommended for patients with gastrointestinal bleeding or changes in bowel movements, regardless of age.

“When caught early in stages one and two, colorectal cancer has a good prognosis,” Groves

said. “In the later stages, it’s still a highly treatable and an often-curable cancer with a combination of surgery and chemotherapy. That’s why screening is so important.” For the past decade, the West Virginia Program to Increase Colorectal Cancer Screening – WV PICCS – has partnered with primary care clinics across the state to ensure that more people are tested. The program is operated by WVU Cancer Institute Cancer Prevention and Control and funded by the Centers for Disease Control and Prevention.

From 2015 to 2020, WV PICCS’ partnership with 44 clinics resulted in a 42% increase, meaning an additional 100,000 West Virginians were screened for colorectal cancer.

Those rates continue to climb. In 2020 and 2023, the program added 20 more clinics to the partnership in two cohorts, both of which saw an increase in screenings.

“Clinics in WV PICCS showed an overall increased colorectal cancer screening rate of 13.85%, which was a statically significant change,” said Susan Eason, program director for WV PICCS. “This suggests that a clinic participating in WV PICCS for at least two years can anticipate at least a 5% increase in colorectal cancer screening rates from baseline.” To target areas where their services are most needed, Eason said WV PICCS uses data from the state cancer registry and clinic screening rates to determine which counties have late-stage diagnosis and high rates of cancer incidence and mortality. “Primary care clinics in those counties with clinic colorectal cancer screening rates at or below 60% are invited to partner with WV PICCS,” Eason said.

The three-year partnerships include implementation of evidence-based interventions, such as client and provider reminders, provider assessment and feedback, reduction of structural barriers and patient navigation, to increase colorectal cancer screening into their practice workflow.

WV PICCS partnered with the Communicating for Health in Appalachia by Translating Science – CHATS – Lab at the WVU Cancer Institute to identify ways to more effectively communicate with West Virginians and encourage colorectal cancer screening action.

Dannell Boatman, an assistant professor in the WVU School of Medicine, Department of Cancer Prevention and Control, a cancer communication researcher with the WVU Cancer Institute and director of the CHATS Lab, said their team conducted a study to understand current colorectal cancer screening perspectives in eligible West Virginians.

They found that West Virginians frequently did not know there were colorectal cancer screening options or when they should begin testing. There was also a low sense of urgency about colorectal cancer risk, which could affect their willingness to screen. These finding were used to develop a communication approach that the CHATS Lab team was able to show increased West Virginians’ intention and motivation to complete colorectal cancer screening.

Previous research has found that people are more likely to screen for colorectal cancer if providers explain their testing options. In addition to the traditional colonoscopy performed in a hospital setting, stool-based tests can be done in a patient’s home.

“Shared decision-making occurs when a patient and provider collaborate to make a health choice, taking into consideration scientific evidence and patient preferences,” Boatman said.

Staff from WV PICCS also increase awareness by taking their message on the road with the Strollin’ Colon, a large inflatable that people can walk through to learn about what a healthy colon looks like, what happens when a polyp appears and how the presence of cancer emerges.

“It’s a perfect way to have conversations about colon cancer and colon cancer screening and early detection,” Eason said. “People are intrigued and want to know more. It really is an icebreaker for starting the conversation that sometimes can be uncomfortable for people.”