Research project seeks to increase screenings for colorectal cancer in Yukon-Kuskokwim region
Alaska Natives have the world’s highest documented rate of incidents and deaths from colorectal cancer, more than twice that of U.S. whites. Now a five-year project is examining better ways to ensure that Alaska Natives in rural areas can detect the early signs of those cancers and thus avoid bad outcomes.
It involves varying types of public-awareness campaigns, from occasional mailers to frequent telephone calls to personal meetings, in 32 communities in western Alaska’s highly rural Yukon-Kuskokwim Delta.
The project, a cooperative effort between the Alaska Native Tribal Health Consortium, the Yukon Kuskokwim Health Corp. and the Mayo Clinic, is promoting two types of cancer screening. Those are colonoscopies, which require uncomfortable and time-consuming clinical procedures, and the simpler “multi-target stool DNA test,” in which fecal samples can be taken at home and sent to labs for detection of signs of cancer.
In recent years there has been a push, in Alaska and elsewhere, for stool DNA testing as an easier and more convenient alternative to full colonoscopies. The company currently providing the technology nationally is Cologuard Exact Sciences, which is a participant in the Alaska project. If no abnormalities are detected in patients’ stool tests, those patients do not need colonoscopies.
The technology has plenty of benefits, but it has one significant drawback for rural Alaska users: It requires that stool samples reach the company’s laboratory in Madison, Wisconsin, within 72 hours.
“If you are sending samples from a small Alaska Native community, to get things to Madison within three days is practically impossible,” said Diana Redwood, an ANTHC epidemiologist working on the project. The deadline became even tougher to meet during the early period of the COVID-19 pandemic, when the major rural Alaska air carrier company, Ravn Air Group, went bankrupt and abruptly grounded its planes, she noted.
That is why the research project features a preprocessing lab in Anchorage, where the collected stool samples can be stabilized – frozen at minus-80 degrees – thus easing the need for ultra-quick shipment to the Lower 48, Redwood said.
The outreach project got underway in April of 2020 – right at the start of the COVID-19 pandemic that triggered a setback for cancer detection in general.
Screenings for many types of cancers lapsed, and that was especially the case for colorectal cancer screenings. A study of Veterans Administration facilities around the nation found there were 45% fewer of the procedures performed in 2020 than in 2018. Similar or even worse trends were recorded globally, according to a study by researchers in Iran.
The COVID-19 pandemic also created unforeseen complications for the Yukon-Kuskokwim colorectal cancer intervention project aside from the Ravn bankruptcy.
There were extra challenges in the search for lab space. Originally, Redwood said, the plan was to have the lab operations set up at the ANTHC campus, but all available space became needed for COVID-19 testing and, later, vaccination. Ultimately, space was secured at the State of Alaska Public Health Laboratory in Anchorage. It is the first such preprocessing lab ever established, Redwood said.
The pandemic also interfered with plans for in-person meetings, including an important focus group meetup. Instead, meetings have been conducted by teleconference, and the focus-group event was postponed, Redwood said.
If Cologuard works out in the Y-K, it would probably work in other areas, too.– Diana Redwood, Alaska Native Tribal Health Consortium epidemiologist
Nonetheless, she and her colleagues are hopeful that the project will result in more testing and early detection that, in the long term, will reduce colorectal cancer’s toll on Alaska Natives. She also hopes that this project, with its focus on the remote Yukon-Kuskokwim region, will help guide similar work elsewhere.
“If Cologuard works out in the Y-K, it would probably work in other areas, too,” she said.
Alaska Natives have had elevated rates of colorectal cancers for three decades at least, with a pattern that holds among all age groups, Redwood said. The reason for that has yet to be determined, she said: “The jury’s still out on what it is.”
One theory being explored concerns dietary fiber. A 2019 study compared gut bacteria of 32 Alaska Native volunteers and 21 volunteers from rural Africa, where the population has the world’s lowest rates of colorectal cancer. The traditional Alaska Native diet has a lot of fat and animal protein but little fiber, while the traditional rural African diet is high in plant fiber, the study noted.