ASHLAND — It’s embarrassing to talk about poop.
But, according to experts, it’s important — especially in the context of colorectal cancer.
“It’s not a proper thing to talk about, almost like it’s rude to have a discussion over this topic. But it’s one that definitely needs to be talked about,” said Jenny Keesee of the Ashland County Cancer Association, “because things hidden go unchecked.”
Keesee joined four other medical professionals Tuesday night on a panel aimed at answering questions around a central theme: why is colorectal cancer in Ashland County so bad?
The event, sponsored by the Ashland County Health Department’s Health and Wellness Target Action Group (TAG), drew a small crowd of around 20 people to University Hospitals Samaritan on Main Street.
Jenna Gerwig, the chairwoman of the TAG and the health department’s director of nursing, said the turnout wasn’t great — but it wasn’t for a lack of trying.
“I contacted basically everyone I knew and emailed them all too,” she said following the event, which lasted a little more than an hour.
Gerwig said she even drove to more remote parts of the county to hang fliers.
Understanding the problem
Ashland County recorded 340 new cancer cases from 2016 to 2020. Colon and rectum cancer made up 10.5% of those diagnoses. That’s behind breast, prostate and lung and bronchus cancer diagnoses.
But colon and rectum cancer accounted for 13.5% of all cancer deaths within the same time period, behind only lung and bronchus cancer.
The grimmest data point, however, is perhaps the fact that colon and rectum cancer incidence and mortality rates surpass state and national trends.
In other words, more people are getting it and more people are dying from it in Ashland County compared to other areas of Ohio and the U.S.
Patients are also getting younger.
One in five cases of colorectal cancers diagnosed today occurs in people younger than age 55. In 1995, that rate sat at one in 10, according to a study published by the American Cancer Society.
That’s why, in 2021, the U.S. Preventative Services Task Force issued new recommendations stating the age for colorectal cancer screening should be 45 instead of 50.
Why Ashland?
Panelists discussed the million-dollar question: why are more people in Ashland County coming down with colorectal cancer? What’s causing this?
The short answer? They don’t know.
Factors such as genes and family history contribute to colorectal cancer incidence. So do lifestyle choices such as smoking cigarettes, drinking alcohol and eating lots of red meat and processed meats.
When it comes to narrowing it down for Ashland, however, experts don’t know.
Yet experts on Tuesday seemed to agree that screening rates need to improve.
Data from the Ohio Department of Health reveals only 48% of Ashland County’s residents who are between the ages of 50 and 75 have screened for colorectal cancer. That’s roughly 22 percentage points behind the rates of both Ohio and the U.S.
“Colorectal cancer is the most preventable cancer, given what we know about how polyps take 10 to 15 years to turn into a cancer — yet it’s the least prevented cancer,” said Liza Hillel, a medical science liaison with Exact Sciences, the company behind Cologuard, a type of take-home test for colorectal cancer screening.
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. If left untreated, however, they can develop into cancer.
The thinking is that if more people screen and catch colorectal cancer early, the mortality rate will decrease.
But here’s the confusing part: nearly 79% of people older than 45 in Ashland County have reported getting screened.
Between June and September of 2024, an Ashland County Health Department 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.”
The survey did ask for their age. Most respondents, 133, were above the age of 65.
Are environmental factors to blame?
Vickie Taylor, the director of Ashland County Health Department, said Tuesday she’s not convinced that so many people in the county are screening.
“I’m not sure those numbers are as accurate as we’d like to think,” she said. “Because if you’re getting tested, you’re going to catch it early and you shouldn’t have death rates that high.”
But because mortality rates are high, Taylor said the next step is looking into environmental factors that might be at play. She said she’s received data from ODH that will hopefully provide a clearer picture.
“We know we’ve had some industries in this area, particularly in the past, that have probably done something to either our soils or waters. We don’t know that to be fact but that’s the next area of research,” she said.
She said the data could point to “high-pocket” areas within the county. If it does, the next step would be to approach ODH for an environmental study.
“Maybe that will help us with some more information,” Taylor said.
Raising awareness
Tuesday’s event aligned with March’s designation as National Colorectal Cancer Awareness Month.
One of the health department’s TAG’s goals is to raise awareness in order to break the stigma around talking about colorectal issues.
“They talk about ‘break the stigma’ when you talk about mental health, but we need to break the stigma of colorectal cancer as well, and get to talking about it,” said Elisa Bryant, a business project manager for oncology services at OhioHealth.
Nancy Wasen, 75, of Ashland, shared an abbreviated version of her story with those in attendance Tuesday. Her cancer survival story began in 2010, when she was diagnosed with Stage Four base of the tongue cancer.
She smoked for the majority of her life, but in the tumor, doctors found human papillomavirus. When she kicked that one, another cancer arose. This time, in 2023 in the form of colorectal cancer. Doctors told her the cancer had developed from HPV.
Wasen said she went through radiation and chemotherapy, avoiding the need for surgery.
“Knowledge is power,” she said, encouraging people to reach out to her if they face a diagnosis of colorectal cancer.
“If they don’t want to have a colonoscopy, call me,” Wasen said. “I can tell them what I went through. It was tough. It was very tough.”
She said a little discomfort with a colonoscopy is better than going through the tolls of cancer diagnosis and treatment.
And yes, it’s all tough.
“But don’t give up,” she said.
More info (determining risk)
Average Risk
People with average risk include those who don’t have the following:
-A personal history of colorectal cancer or polyps
-A family history of colorectal cancer
-A personal history of inflammatory bowel disease
-Unexplained anemia
-A personal diagnosis or family history of known genetic disorders
-A history of radiation to the abdomen
Moderate Risk
Moderate risk factors include:
-Being older than 50
-Family history of colorectal cancer before age 50, or two first-degree relatives diagnosed at any age
-Genetic predispositions
-Smoking, drinking more than two alcoholic drinks per day
-Limited exercise
-Having ulcerative colitis or Crohn’s disease or familial adenomatous polypsis (FAP)
When should I screen, then?
In 2021, the U.S. Preventative Services Task Force issued new recommendations stating the age for colorectal cancer screening should be 45. This includes people in the average risk pool.
But, if you have genetic abnormalities or fall into the moderate risk pool, Dr. Tavallaee said you should begin screening at age 40.
And if you have someone in your immediate family — mom, dad, brothers or sisters — diagnosed with colorectal cancer, subtract 10 from the person’s age when diagnosed. That’s the age you should begin screening. (So if your dad gets diagnosed at age 35, you should screen at 25.)
