Eleanor Richey, 60, has been bothered for years by the nagging feeling that she was overdue for a colonoscopy to check for colorectal cancer and precancerous growths.
Both of her parents had colon polyps, she said. And a friend of hers, who didn’t have a colonoscopy early enough, died about two years ago from colon cancer.
“I know at a certain age those polyps do develop,” said Richey, of Chicago’s South Shore neighborhood. But “how are you going to get a colonoscopy with no insurance?”
Uninsured for four years, Richey underwent her first colonoscopy last week free of charge.
Richey’s colonoscopy was a result of a statewide colorectal cancer screening initiative launched in June by the American Cancer Society and partnering hospitals. The goal is to increase Illinois’ screening rate to 75 percent from 61.7 percent, including guaranteeing that at least 9,000 uninsured and underinsured individuals are provided free access to colonoscopies as well as any necessary treatment identified during screening.
Although it is one of the only cancers that can be prevented through screening, colorectal cancer is the second-leading cause of cancer-related deaths in Illinois, according to the American Cancer Society.
Within the state, it’s estimated that 6,940 cases of colorectal cancer will be diagnosed and 2,510 people will die from the disease in 2012, according to the cancer society.
“It makes no sense that only (about) 60 percent of the eligible population is being screened,” said Dr. Karen Kim, a University of Chicago gastroenterologist who helped develop the screening initiative. “This is just unacceptable.”
The campaign, which aims to increase the overall number of individuals screened by about 80,000 a year, will run through December 2014. In 2015, the Affordable Care Act will provide funding for screening, said Adrienne White, vice president of health initiatives and advocacy for the Illinois division of the American Cancer Society.
“It was determined that there would be a large number of people who would unnecessarily die from colon cancer,” White said. “Our goal is to fill this gap between 2012 and 2015.”
The first part of the screening initiative involves a statewide media campaign encouraging everyone 50 and older to be screened, White said.
The second aspect of the initiative is a research component in which data will be collected on colorectal cancer screening compliance to identify barriers to screening for underserved populations, she said.
The final prong of the initiative, which will cost about $4 million, is a partnership with medical institutions to increase the number of colonoscopies performed across the state, White said.
Many institutions weren’t promoting colonoscopies because there was a fear that the uninsured would then want a service that the hospital couldn’t provide for them, White said.
To combat that mentality, the American Cancer Society is providing incentive grants to hospitals that agree to provide a specific number — at least 150 a year — of colonoscopies to uninsured patients, she said.
“It’s a grant to say, ‘Don’t hold back because you’re afraid uninsured might come through the door,'” White said.
The program will ensure that 9,000 uninsured and underinsured individuals have access to colonoscopies by the end of the initiative. About 20 percent, or 1,800, of those colonoscopies will likely result in the removal of polyps or potentially precancerous cells, White said. Cancer will probably be diagnosed in 30 to 48 of the individuals from that pool.
Hospitals that participate — on board are Northwestern Memorial Hospital, Rush University Medical Center, University of Chicago Medical Center, Southern Illinois Healthcare and Southern Illinois University School of Medicine — also are agreeing to cover the cost of treatment for any polyps or cancer detected through the colonoscopies, White said.
“If by chance we find something that requires further care … we would take responsibility to care for that patient all the way through the system,” said Dr. Daniel Derman, vice president of operations at Northwestern Memorial Hospital and president of Northwestern Memorial Physicians Group. “There’s nothing worse than finding someone diagnosed with a disease and not being able to treat them.”
That’s the reason why Northwestern Memorial Hospital has to be careful about how many uninsured cases it agrees to take on, Derman said. The hospital is not going to screen more people than it can commit to treat.
“We understand that there are going to be some downstream costs,” he said. “That’s our tangible commitment to the community.”
Depending on the stage of colorectal cancer when it’s found, the cost of treatment can run from $50,000 to multimillions, said Dr. Joshua Melson, gastroenterologist and assistant professor of medicine at Rush University Medical Center, where he serves as the point person for the cancer society’s initiative.
In addition, about a third of colonoscopies require some lab work, which can cost more than the screening procedure itself, Melson said. And the incentive grant will provide only about a fifth of what a hospital usually would receive from an insurance company for a colonoscopy.
“It’s a money-losing enterprise for us, but it seems like a good thing to do,” Melson said. “Whatever we can do to get more people screened, we thought was a good idea.”
The American Cancer Society needs 15 to 20 additional hospitals to join the initiative and hopes to have those contracts complete by the end of the year, White said.
Ambulatory providers, or primary care centers that cater to the uninsured, also are needed to play a large role in the campaign. These feeder facilities are the ones that recognize candidates eligible for free colonoscopies and refer them to participating hospitals.
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To help them, the American Cancer Society is placing health educators within the feeder facilities to make sure patients are informed about and fully prepared for their colonoscopies, White said.
Near North Health Service Corp., which oversees two primary care facilities referring patients to Northwestern Memorial Hospital, has identified at least 153 patients eligible for free colonoscopies, spokesman Matthew Smith said. Of them, 118 have agreed to go ahead with the procedure.
Carlton Little, 55, said signing up for the free colonoscopy was an easy decision.
Having the screening paid for is a great opportunity, the Niles resident said. The fact that the hospital is willing to pay for any necessary follow-up treatment makes the offer invaluable.
“It’s not the most pleasant thing to think of, but it’s better than colon cancer,” Little said.
About 85 percent of colorectal cancers start out as polyps and could be prevented if everyone followed screening guidelines, said Kim, an associate professor of medicine at the U. of C.
Colorectal cancer is one of few cancers that can be removed as a premalignant lesion through screening as opposed to early detection of the cancer itself, she said.
“We understand the biology of the disease and have technology to remove precancerous lesions,” Kim said. “It’s a beautiful system for preventing cancer.”
About 20 percent of the U.S. population age 50 and older — 15 percent of women and 25 percent of men — have polyps, Kim said.
Not every polyp is precancerous, she said. In fact, most never turn into cancer. Because no one knows which ones will, however, all potentially premalignant polyps that are found are removed.
It takes 10 to 15 years for a precancerous polyp to become cancer, Kim said. The average age a person develops colorectal cancer in the United States is 67.
The American Cancer Society recommends most of the general population should start being screened for colorectal cancer at 50 and have the test repeated once every 10 years. People with a family history of the disease might need to be screened earlier.
There are several types of colorectal cancer screening, but none of them are as highly regarded as the colonoscopy, Kim said. If any abnormalities are found through another screening method, the patient will then need to undergo a colonoscopy anyway.
Sometimes, cancer itself is removed during a colonoscopy if its focus is within a polyp, Kim said. In such a case, the doctor might not even know he or she has taken out cancer until lab tests on the polyp are done.
In other situations when cancer is diagnosed, surgery might be required to remove a segment of the colon, she said. Depending on the extent of the cancer, the patient may need chemotherapy or radiation therapy.
Ninety percent of patients diagnosed with early stage colorectal cancer survive at least five years, the amount of time a case is followed after cancer goes in remission, Kim said. Only 10 percent of patients with late-stage cancer survive five years.
Leon Williams, 62, said several friends that he grew up with didn’t undergo colorectal cancer screenings and ended up dying from the disease before their time.
Williams, who learned through the American Cancer Society that he was eligible for Medicaid and has his first colonoscopy scheduled for September, said it’s a terrible way to die. Men who were once incredibly strong are made thin and weak by the disease, he said.
Williams, a resident of Chicago’s Near North Side, said he is telling everyone that he is getting screened and hopes others will follow his example.
“If somebody isn’t ashamed to do it, the other guys say, ‘It must be OK,'” he said. “Anything you can do to help prevent medical problems, I think you should take advantage of it.”