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A Public Health Success Story: The Non-Physicians Behind the Decrease in Colon Cancer Rates

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Earlier this month, the American Cancer Society gave us some amazing news: The incidence of colon cancer -- the second-leading cause of cancer death in the United States -- has dropped by approximately 30 percent over the past decade in men and women age 50 or older.

This astounding phenomenon is attributed largely to an increase in colon cancer screening, which allows for the detection and removal of potentially pre-cancerous growths, called polyps. This makes colon cancer one of the few malignancies for which screening is available not only for the early detection but also the prevention of cancer.

According to Dr. Richard Wender, American Cancer Society chief cancer control officer, the dramatic decrease in new cases of colon cancer, "is one of the great public health success stories of the decade."

As a gastroenterologist who has been on the front line of colon cancer screening for over 20 years, I cannot tell you how rewarding it is to see this tremendous collective effort begin to yield success -- success that can be measured in lives saved.

However, while physicians recommend and provide colon cancer screening, we alone cannot take the credit for this success story. Colon cancer screening tests have long been available and colonoscopy specifically has been a recommended screening test since 1997. Yet, historically, colon cancer screening has been terribly underutilized and, prior to 2000, it seemed many Americans were uncomfortable even talking about the colon let alone undergoing colon cancer screening.

That's why this public health victory belongs not to the health care profession alone, but also to the cancer survivors, family members, and advocates who worked diligently to increase awareness, knowledge, and ultimately screening among their family, friends, colleagues, and the public.

Among the most public of these family members and advocates has been Katie Couric. In 1997, Katie was a co-anchor on NBC's "Today" show, and her seemingly-healthy husband, Jay Monahan, was a lawyer and legal commentator on MSNBC. They had two little girls and their whole lives ahead of them. That year, I had the sad task of giving Jay and Katie the news I had given to far too many others. Jay had advanced colon cancer. Treatment options were more limited then, and Jay's valiant battle with colon cancer ended just nine months later. He was 42.

At Jay's wake, Katie approached me and several other physicians and pleaded with us to do something about colon cancer. She didn't want other families to suffer the loss hers had endured. We explained to Katie that we thought she could do more than we could to fight this disease. We had the screening tests available to help find this cancer early and perhaps even prevent it, but people either didn't know about or were not willing to undergo the testing.

Within two months' time, producers from the "Today" show were in my office and the offices of other physicians, planning a series on colon cancer that would air in 1998. Two years later, in March 2000, Katie did what Americans didn't want to -- and she did it on television. She underwent a colonoscopy on the "Today" show, in an effort to demystify this disease and encourage others to get screened. It worked. University of Michigan researchers reported a nearly 19 percent sustained increase in colonoscopies nationwide after the broadcast aired, a trend they dubbed the "Couric Effect." I know I personally had more than one patient who responded "Katie Couric" to the question, "Who referred you for your colonoscopy?"

Katie went on to co-found the Entertainment Industry Foundation's National Colorectal Cancer Research Alliance in 2000, The Jay Monahan Center for Gastrointestinal Health in 2004, and Stand Up To Cancer in 2008. In addition to using her public platform to raise awareness and research funds, she spent many more hours recounting Jay's experience to anyone who would listen -- physicians, other health professionals, medical students, and others. Her effort has been a sustained one, both on and off camera, for over 15 years.

Thanks to the work of Katie and many others, colon cancer screening rates have been increasing since 2000. The American Cancer Society attributes this trend to an increase in colonoscopy testing, which nearly tripled from 19 percent in 2000 to 55 percent in 2010. As of 2010, our overall colon cancer screening rate in the United States was 59 percent.

This positive trend and related fall in incidence rates represent great progress -- and the leadership and work of many, including the American Cancer Society, Centers for Disease Control and Prevention, National Colorectal Cancer Roundtable, professional societies, colon cancer advocacy groups like the Colon Cancer Alliance and Fight Colorectal Cancer, city and state health departments, and most of all the survivors, family members, and friends who helped relay the importance of this potentially lifesaving screening.

I personally would like to thank my patients and their families who have helped make their loved ones and others aware of the importance of colon cancer screening. And I would like to thank Katie for her courage and steadfast commitment to a cause she wishes she hadn't been in a position to take on. I hope that Katie and others who have worked to move the screening needle forward will take comfort and pride in knowing that, because of their efforts, countless lives have been saved.

So thank you, Katie. Thank you to all of the survivors, family members, advocates, and those who have themselves chosen to be screened. And please continue to lend your support, for there is more work to be done. Our collective goal now, as just announced by the National Colorectal Cancer Roundtable, is to get 80 percent of men and women age 50 and older screened by 2018 ("80 percent by 2018") -- and we need everyone reading this to help make this goal a reality.

Sources:

-- Colorectal Cancer Facts & Figures, 2014-2016. American Cancer Society. http://www.cancer.org/research/cancerfactsstatistics/colorectal-cancer-facts-figures

-- Cram and colleagues. The impact of a celebrity promotional campaign on the use of colon cancer screening: the Katie Couric effect. Arch Intern Med. 2003 Jul 14;163(13):1601-1605.

-- For more information on colon cancer screening & prevention: www.NYULMC.org/colonscreening or http://patients.gi.org/

-- For more information on the 80 percent by 2018 campaign: http://nccrt.org/wp-content/uploads/80-by-2018-FACT-SHEET.pdf

 
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