Sentara adapts to the changing demographics of colorectal cancer

Feeling lightheaded and unable to breathe, Iris Lundy remembers leaning against walls to navigate Sentara Norfolk General Hospital where she worked as the system manager of the Accreditation and Regulatory Department in 2012. After several tests, multiple infusions, and transfusions, she learned she had stage 2 colon cancer at the age of 48. With surgery and follow up treatments, she has now been cancer free for 12 years. 

“When I was young and living paycheck to paycheck, my first thought, and still my first thought, is always my children,” said Lundy, vice president of health equity for Sentara Health. “Your mom can be sick and you can come home and say, ‘Oh, I’m sick. I don’t feel well.’ She jumps right up because that is what we do, that is that maternal instinct in us. I not only feel that for my children, I feel that for my community.”

In a full circle moment, Lundy, as a Black woman, experienced a health disparity first-hand and now leads the Health Equity team at Sentara, one of the largest integrated healthcare systems in Virginia.

“I think it makes me a better leader, mom, and friend,” said Lundy. “When I am working with others, and I see them going through anything, whether it’s cancer or anything, my first go-to is to figure out how do I help them process and get through whatever that is.”

Iris, her team, and colleagues work to identify existing barriers, be they financial, environmental, physical, or mental, which prevent people from living their best and healthiest lives. They urge community members to participate in clinical trials, screenings, and, most importantly, encourage them to be advocates for their personal health.

Addressing a health disparity

Black people are about 20% more likely to get colorectal cancer, and 40% more likely to die from the disease, than other populations, according to the American Cancer Society. The causes are multifactorial, with social drivers, such as lack of insurance, housing, and transportation, all being factors.

Sentara’s 2022 cancer data shows that Virginia Beach, Va., whose population is 59% white and 19% Black, has the highest volume of colon cancer diagnoses in Virginia and northeast North Carolina. However, Norfolk, Va., whose population is 39% white and 42% Black, has the highest percentage of late-stage diagnosis (at initial screening), that number being 32% compared to Virginia Beach’s 18%.

To address such health disparities, Sentara recently partnered with Polymedco to provide at-home fecal immunochemical test (FIT) kits, another way to screen for colorectal cancer at home. These fit kits will be provided at community events for free to eligible community members.

Understanding that transportation and money are barriers to those with limited resources, Sentara created a process to have the kits directly mailed to a Sentara location, with the postage already paid for. Sentara processes the kits in its own laboratories, decreasing the likelihood of specimens going missing.

“Last year we had a low yield on return of kits and a lack of kits,” said Lindsay Rushing, team coordinator for cancer clinical services at Sentara Norfolk General Hospital. “As long as we take a patient-centric approach and try to eliminate as many barriers as we possibly can on the kit return, we should be more successful than in the past.”

Sentara in attendance at a Regional Cancer Disparities Collective Roundtable in December 2023 with other area health systems.

Sentara Health Plans, the health insurance division of Sentara, will mail colorectal cancer screening tests to members at their homes free of charge. Sentara Population Health holds community health fairs in which FIT kits are available to members who have not had a screening within the last 12 months.

On the research front, Sentara is part of the Virginia CSRN Accrual, Enrollment and Screening Site (ACCESS) Hub. This is one of eight hubs nationwide which will conduct groundbreaking research for the Cancer Screening Research Network.

“Being part of the Virginia CSRN ACCESS Hub will allow important research to include all eligible patients, especially those historically underrepresented,” said John Sayles, M.D., colorectal surgeon with Sentara Surgery Specialists. “Sentara Health and the Sentara Brock Cancer Center are excited to be a large part of this cutting-edge research, aimed to accelerate medical breakthroughs in an equitable and inclusive manner.” 

Sentara is also a member of the Virginia Colorectal Cancer Roundtable and the Regional Cancer Disparities Collective. The main goal is to collaborate with other health systems to reduce disparities, and increase access and colon cancer awareness and screening.

Rise in colorectal cancer among younger adults

Colorectal cancer is expected to be the leading cause of cancer-related deaths by 2030 in 20–49-year-olds, according to JAMA Network.

“The data isn’t out there enough to know why that’s the case,” said Sayles. “Certainly, that’s the case in the last 10-15 years that it's getting more prevalent in younger people.”

Almost 1 out of 3 people diagnosed with colorectal cancer before age 50 have a family history or genetic predisposition. People who know they have a family history should begin colorectal cancer screening before age 45.

"Many people say, ‘I don’t have a family history, I’m young and healthy,” said Rushing. “Because of that they think they won’t get cancer, but that’s horribly inaccurate. Cancer doesn’t discriminate, it will pick anybody it can. It hits men, women, all races, young and old. It hits anybody.”

Colorectal cancer patients under the age of 50 are more likely to experience four symptoms — abdominal pain, rectal bleeding, diarrhea, and iron deficiency — in the three month to two-year period before diagnosis, according to research published May 4 in the Journal of the National Cancer Institute.

Dr. John Sayles at Audacy radio station recording a "Hampton Roads Perspective" radio segment for Colorectal Cancer Awareness Month.

“Don’t blow off those symptoms and say, ‘Oh I’m young, this has to be benign, nothing to worry about, it will go away,’” said Sayles. “Make sure you go to your physician, primary care provider, whoever it is, and get some advice. Get screened, get tested. It may not mean you automatically go for a colonoscopy, but certainly talk to a professional, a physical examination, getting laboratory, things like that.”

Throughout March, National Colorectal Awareness Month, Sentara will work to engage with a younger audience on social media by sharing videos and posts which draw a comparison between happy hour and getting a colonoscopy.

Happy hour is a time-honored tradition of the younger population, and with the trend of colorectal cancer hitting their demographic, an hour-long colonoscopy can officially become the new happy hour.

Early detection saves lives, so say yep to prep

Despite being the leading cancer killer for men under 50, and the second leading for women under 50, colorectal cancer is preventable, treatable, and beatable. If diagnosed at an early stage, patients have a 90% chance of survival.

New recommendations for colorectal cancer screenings state that people at average risk should start screening at age 45. But some people may need earlier screening, or screenings more often.

Hampton Roads is one of three "hot spots" in the nation for colorectal cancer mortality. Sentara is adopting the American Cancer Society's initiative to increase colorectal cancer screening with a goal of getting 80% of eligible patients screened starting at age 45. Currently 20% of eligible patients aged 45-49 have been screened. 

Sentara is also adopting another initiative, in alignment with the American Cancer Society, of lead-time messaging. They will target patients younger than 45, particularly in the 29-40-year-old age range, to educate them on the need for on-time colorectal cancer screening in the hopes that when they are recommended for a colorectal cancer screening at age 45, they will get it on-time, thus improving age 45-49 screening rates. 

“People with a higher risk of colorectal cancer, such as a family history, or inflammatory bowel disease, should ask their physician to determine the best age to start screening,” said Gregory Fitzharris, M.D., a colorectal surgeon with Sentara Surgery Specialists.

It’s commonly agreed that the preparation regimen for a colonoscopy is the worst part. To clear out your bowels so that a gastroenterologist can clearly see the lining of your colon, you need to take laxatives the day before a colonoscopy. This typically involves drinking a laxative liquid throughout the day and visiting the bathroom multiple times.

“There are newer options for colonoscopy prep, including a pill-only prep that some patients may prefer,” said Fitzharris. “So, ask your doctor about your options and cost. The prep is crucial to ensuring a successful colonoscopy.”

“Part of it is inconvenience; people don't want to go through prep,” said Rushing. “No one wants to go down there. There's a lot of stigma with that area. There's a lack of education. But colorectal cancer can be prevented with these screenings.”

“That’s the good thing about a colonoscopy, it’s not just a screening test, it’s therapeutic,” said Sayles. “You take out the polyps there before they become cancer and you’ve actually improved people from that standpoint.” 

Don’t wait to screen for colorectal cancer:

• Schedule your colonoscopy beginning at age 45 if you are at average risk.
• Remember that early colorectal cancer does not have signs or symptoms, so it is important to get screened.
• Early screening and diagnosis can prevent colorectal cancer.
• A polyp can take up to 10 years to develop into cancer. With colonoscopies, doctors can remove polyps before they turn into cancer.

Benjamin Franklin is famously quoted as saying, “An ounce of prevention is worth a pound of cure.” And that couldn’t be truer when it comes to colorectal cancer. Through screenings such as FIT kits and colonoscopies, colorectal cancer can be prevented.

Visit SentaraCancer.com to request an appointment or find more information on colorectal cancer recommendations. Services such as financial counseling and care coordination are available to help point you in the right direction, no matter where you are in your health journey.