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Dr. Rhonda Henry-Tillman, a UAMS surgical oncologist, addresses legislators while Paul Greene, Ph.D., a professor of health and behavior education at the Fay W. Boozman College of Health, listens.

Colorectal cancer will strike 1,690 Arkansans this year and kill 580 of them. One in 19 Americans will be diagnosed with the disease at some point in their lifetime. It’s the nation’s second deadliest cancer, and Arkansas has the highest age-adjusted annual death rate in the nation.

But many of those lives could be saved by redirecting the state’s existing resources to emphasize screening and early detection.

That was the message at a June 25 legislative briefing at the University of Arkansas for Medical Sciences. Presenters updated legislators serving on the Public Health, Welfare and Labor Committee regarding progress made by the Arkansas Colorectal Cancer Control and Research Program. The program was created by the Colorectal Cancer Act of 2005, which provided $1 million to fund a statewide study, create demonstration programs at 10 private practices across the state, and provide vouchers for underinsured and uninsured patients. The briefing was one of a series regarding cancer funded by the National Cancer Institute.

The study included a survey of more than 2,000 Arkansans that found that half above the age of 50 had been screened for the disease, a number the American Cancer Society would like to see increased to at least 75 percent. Screening rates varied widely across regions, with residents in Central Arkansas much more likely to have been screened than those in the southern part of the state.
Socioeconomic factors such as proximity to specialists, education and income levels, and racial background played a major part in determining if a person had been screened.

Still, according to Rhonda Henry-Tillman, M.D., F.A.C.S., a UAMS surgical oncologist who was one of the presenters at the briefing, no one is immune. “If you look at the mortality rates for colon cancer, men versus women, you know, it doesn’t discriminate,” she said. “Colorectal cancer affects men just as well as it affects women. … All of us here are at risk, and so it may not be affecting you right now, but with age come different issues, and if we’re not prepared to deal with this, those numbers are going to increase.”

Henry-Tillman and Paul Greene, Ph.D., a professor of health and behavior education at the Fay W. Boozman College of Health, told legislators that early detection is the key to survival. Unlike some cancers, colorectal cancer can be reliably discovered in its early stages and then cured. The five-year survival rate for cancers caught and removed in the first stage, when the tumor is localized in the colon and no additional treatment is necessary, is 93 percent.
However, when the cancer is left untreated until the fourth stage, when the cancer has spread throughout the body, the rate drops to only eight percent.
Meanwhile, annual treatment costs at that stage average $200,000, with drugs alone costing $161,000 in the first year.

The two told legislators that a demonstration program involving 10 primary care practices that was funded by the act met with great success. The program, which focused on educating physicians and the public about the need for screening, resulted in 467 referrals from September 2006 to December 2007. Of those, 351 were screened and 337 of them received a colonoscopy. Polyps were found in 107 of the cases, while another 59 patients were found to have adenomatous polyps, a precursor to cancer. Three cases of cancer were diagnosed and treated.

Presenters made the case that a statewide colorectal cancer program that removed some of the barriers to care could achieve a screening rate of 75 percent with current medical personnel and facilities. One idea was to provide “navigators” at the clinic level who help patients find the most convenient locations for specialists. “It’s not going to require a major overhaul in how we’re providing care,” Henry-Tillman said.

Glen Mays, Ph.D., M.P.H., associate professor and chair of health policy at the college, said the demonstration program had saved the state $207,000 in health care costs and extended life by a combined 20 additional years at a cost of $17,000 per life-year. He said Arkansas currently spends $50 million addressing colorectal cancer, most of that for treatment, but by increasing the screening rate to 80 percent and spending more on prevention, it could spend the same amount of money but save many more lives.

The Colorectal Cancer Act also mandated that insurance companies pay for screenings for Arkansans over 50 years of age and for others who are at high risk or who have colorectal cancer symptoms. Those provisions are permanent, but the money that funded the study and the demonstration program has been spent.

Sen.-elect Joyce Elliott of Little Rock, who was the lead sponsor in the House of Representatives and who attended the meeting, said in an interview that she’ll push for increased funding in the next legislative session that focuses on areas of the state, such as Southeast Arkansas, that need it most. “It is absolutely a priority that it’s restored, and I think, not so much just restored, but we need to be wide-eyed about looking to see what we need to do to make sure we address the disproportionality that we see in the results,” she said.



August 2008

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