By Elizabeth Egan

UNC Media Hub

In 2015, only 34 percent of patients at community health centers in Buncombe County, North Carolina, were up to date with their colorectal cancer screening. In only six years, that number rose to over 70 percent.

Much of this increase can be attributed to the work of the Western North Carolina Colorectal Cancer Screening Initiative — a nonprofit that aims to decrease the disparities in colon cancer screening for uninsured patients in the Western region of the state.

Community Health Centers provide health services to community members. Graphic by Ellen Cochran.

Originally started in Buncombe County, home of Asheville, the program has since expanded to five other western counties — Madison, Mitchell, Yancey, Henderson and McDowell — and has  screened more than 3,000 patients without health insurance.

Dr. Michael Newcomer, lead physician and one of the founders of the initiative, said colon cancer is one of the most common cancers in the United States — and also one of the most preventable. However, there are mountainous barriers to colon cancer screening for many patients to overcome — the one by far, being lack of health insurance. 

“So we know that the burden of colon cancer is shared unequally in our state,” he said. 

This is the wall that Newcomer and the cancer screening initiative is working to tear down — one stool test and colonoscopy at a time. 

Idea to initiative 

In 2015, Newcomer and his practice, Digestive Health Partners, based in Asheville, began to research screening rates for patients with colorectal cancer. What they found was that people closest to the federal poverty line had the lowest rates of screening.

Research shows people who do not have health insurance tend not to get screened for colorectal cancer and are more likely to develop late-stage colon cancer. 

Newcomer said that as the only gastrointestinal practice in Buncombe County and the largest in the Western region of the state, Digestive Health Partners felt a responsibility to find a solution for uninsured patients. 

As Digestive Health Partners began this quest to decrease the screening gap for uninsured patients, it found a natural partner in community health centers, Newcomer said. 

Community health centers, formally known as Federally Qualified Health Centers, receive part of their funding from the federal government in exchange for providing healthcare to those without the ability to pay. Around 90 percent of uninsured people in North Carolina are served by community health centers, Newcomer said. 

The program began by providing stool-based colorectal cancer testing to the Western North Carolina Community Health Services to distribute to its patients. In the event of a positive test, a patient would need a colonoscopy — which can range from $2,500 to $5,000 without insurance.

In short, “very expensive,” Newcomer said. 

Amy Barcomb, director of development for the Western Carolina Medical Society, said Newcomer approached the organization and asked how to provide free colonoscopies to all uninsured patients.

This map shows the rates of colorectal cancer in North Carolina. Graphic by Ellen Cochran.

The Western North Carolina Colorectal Cancer Screening Initiative is what the two groups decided on as the solution, she said. In 2019, the non-profit was officially formed — housed in the Western North Carolina Medical Society.

This allowed the initiative to raise money, expand its reach and, most importantly, screen more uninsured patients. 

“That’s just sort of a huge impact in the number of people screened, in a clinic in which half of the adult population is uninsured,” Newcomer said. 

‘Fatal yet treatable’

Colon cancer is the third most common cancer in the United States among both males and females, Newcomer said. In 2022, there were an estimated 151,030 new cases, with 52,580 deaths.

He said the nature of colon cancer makes it more treatable than other cancers, if caught in time. Colon cancer develops very slowly, taking many years for a precancerous polyp to turn into cancer. This gives providers a screening window, Newcomer said.

“Colon cancer is so very fatal, yet treatable if caught early,” Barcomb said.

The risk of not getting screened in the typical age range is that, if a cancer is found, it will be in an advanced stage, Newcomer said. He said at early stages of colon cancer, the cure rate is over 90 percent. However, if the cancer is at a late stage, the cure rate drops to about 14 percent.

“It’s not preventable in everyone, but it has a significant preventative component because of the slowness that it develops, and so not having screening is not giving people the opportunity to have their cancer either prevented or diagnosed,” he said. 

Dr. Lisa Gangarosa, a professor in the UNC School of Medicine’s Division of Gastroenterology and Hepatology, said the recommended age range for colon cancer screening is from ages 45 to 75. The screening recommendation was recently lowered from 50 to 45 due to an increase in colon cancer in younger populations.

Gangarosa added that a person would only start screening sooner if they had a first degree relative with colon cancer. In that case, the recommendation is generally to begin screening 10 years before the affected person developed their cancer. 

Dr. Ian Grimm, director of GI procedures in the School’s Division of Gastroenterology and Hepatology, said colon cancer’s screening ability makes it unique.

“That’s the belief, that we can intervene way before there’s any trouble,” he said. “If you look at lung cancer, breast cancer, prostate cancer, etc., there’s no pre-cancer that’s easy to find.”

‘Real impact’

Barcomb said in 2022, the Western North Carolina Colorectal Cancer Screening Initiative program performed 22 colonoscopies. Of those, 15 patients were found to have a precancerous growth that would likely have become cancerous within two years.

This chart shows the breakdown of the colorectal screening process for patients. Graphic by Ellen Cochran.

“It really is program that has a real impact, that you can see,” she said. 

Newcomer said if a patient needs to be treated for colon cancer, and they are eligible for Project Access then all their care is paid for. If they are not eligible for Project Access — which is about half the patients the initiative sees — the program will work with community health partners to try to secure supplemental insurance or find providers who will donate care. 

“To date, all the people that we have found cancers in have gotten their care provided with minimal to no cost,” he said. 

Newcomer said with the health system in the United States, there is not one organization that is responsible for screening the population, which is why the Western North Carolina Colorectal Cancer Screening Initiative has taken it upon itself to fill those gaps. 

While he has been satisfied and fulfilled by the results, it was not his original expectation.

“We didn’t think it was going to grow to the extent it has, but we learned from our mistakes early on, and we got momentum,” he said.

UNC Media Hub is a cohort of students from various concentrations within UNC-Chapel Hill’s Hussman School of Journalism and Media who collaborate to produce top-tier integrated media packages covering stories across North Carolina.

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