ASHLAND — Ashland County health officials are seeking grant money to increase at-home colorectal cancer screening kits — despite a survey that indicates nearly eight in 10 residents have already been screened.
Colorectal cancer rates — both in incidence and mortality — are high in Ashland County, state data shows.
The prevailing theory among local health officials to explain the phenomenon revolves around suspected low screening rates. When found early, colorectal cancer is less lethal.
In fact, state health data show that only 48.1% of Ashland County residents between the ages of 50 and 75 years met screening guidelines. Ohio’s rate is 70.2% and the nation’s is 70.8%.
“We wondered if low screening rates could be contributing to our high colorectal cancer incidence rates in Ashland County,” said Jenna Gerwig, the health department’s director of nursing and chair of the agency’s Target Action Group dedicated to learning more about the local problem.
The survey
To test the theory, the health department circulated a survey that asked residents aged 45 and older if they'd ever had a colorectal cancer screen, either by stool sample or colonoscopy.
Officials followed the U.S. Preventative Services Task Force new recommendations that set the new age for regular colorectal cancer screening at 45.
Between June and September of 2024, the survey garnered 288 responses from people aged 45 and older, a segment of county's population that amounts to 24,019 people, according to census figures.
The survey's margin of error is 6%, according to calculations based upon a 95% confidence level. Most industry experts agree an acceptable margin of error falls between 4% and 8%.
Of those who responded, 78.8% reported having been screened for colorectal cancer. The survey did not ask respondents to report their ethnicity, gender or geographic information, in order to "encourage participation."
But it did ask for their age. Most respondents, 133, were above the age of 65.
The health department said the insight from the survey indicates “a potential gap in reaching the areas of our community with the greatest needs.”
When asked to clarify, Gerwig said the survey possibly didn’t reach the intended people affected by the issue.
“Did we hear from ages 45+ who do not have a primary care provider or who have not been to a PCP in years? Did we hear from ages 45+ who do not have health insurance, or who have a high deductible? Did health literacy affect our target audience’s ability to complete the survey?
"Essentially, did those who have the greatest barriers to seeking and obtaining healthcare in Ashland County participate in this survey?” she said.
Barriers to screening
Respondents who hadn't been screened said the big barriers to getting screened were cost and procedure prep. Others included "time," the procedure itself and transportation.
How to test
Colorectal cancer, depsite its high incidence and mortality rates, has a 90% survival rate, Dr. Mehrdad Tavallaee, an internist at University Hospitals, has said. The key is early detection through colonoscopies and other types of screens.
The golden standard for screening, Tavallaee said, is the colonoscopy.
"It's a little invasive," he said. "But we make sure you're very comfortable." The scope requires a clean bowel, which is the hardest part of the whole thing, the doctor said.
He said doctors provide colonoscopy patients with a liquid and laxatives the day before the scope.
"The cleaner the bowel, the better visualization field we have, so we can detect tiny polyps," he said.
What's a polyp?
A colon polyp is a small clump of cells that forms on the lining of the colon. Most of them are harmless, according to the Mayo Clinic. But it's those polyps that can, if not removed, develop into cancer, Tavallaee said.
Other screenings include Cologuard, a fecal immunochemical test (FIT) kit that is delivered to your house that screens stool for abnormal cells found in cancer and polyps.
Another screen, a sigmoidoscopy, examines the rectum and sigmoid colon, or the lower part of the colon. A colonoscopy examines the entire colon.
What's next?
Increasing screening rates is still the answer, health officials have said.
The health department sought a grant from Exact Sciences, a Wisconsin-based molecular diagnostics company, in 2024 to obtain colorectal cancer screening kits that could be disseminated for free to people in need.
The application failed.
Gerwig, during a Jan. 24 TAG meeting, said the department was unaware Exact Sciences requires grant applicants to be submitted by nonprofits. So the department’s partner agencies (Catholic Charities, Third Street Family Health Services, among others) will work to reapply in mid-February, she said.
The agency's TAG is also organizing a panel discussion for the community to address high incidence and mortality rates and promote the importance of screening.
Officials hope to host the panel in March.
read more about colorectal cancer in Ashland County
Why is colorectal cancer so bad in Ashland County?
ASHLAND — Something wasn’t right. Jeff Rose suffered from stomach cramps and other abdominal pains off-and-on through most of his 40s. Symptoms would last three or four days and then vanish, causing a medical mystery that persisted for the better half of a decade. Doctors first assumed it was his appendix; so they removed it.…
