Presented by Alaska Native Tribal Health Consortium
After losing her grandfather to colon cancer, Tara Ferguson-Gould knew how quickly and unexpectedly the illness could take someone’s life. When she was 38, she got her first colon cancer screening, and in the decades since then, those screenings came back without major issues.
Last year, that changed. Doctors found a polyp in her large intestine that was likely precancerous. It was safely removed.
“If I hadn’t had colon cancer screening, where would I be right now? I’m not even 60,” Ferguson-Gould said. “I’m one of the people who could have died from cancer that could have been prevented.”
Alaska Native people have the highest rates of colon cancer in the world. But, there is hope: it is one of the few cancers that is preventable and can be caught through the same screening that Ferguson-Gould had. At-home screening tests are also available that are helping expand access to health care in remote parts of the state.
‘We were there until his very last breath’
Ferguson-Gould lives in Cold Bay, a community of roughly 60 people on the southern tip of the Alaska Peninsula.
She lost her grandfather, Emil Gundersen, to cancer. He lived in Sand Point, a community of roughly 800 people on Popof Island in the Shumagin Islands. Born in 1917, he served in World War II in the Aleutian Campaign.
Gundersen died in 2007. His last words to Ferguson-G were “You know I love you’s guys,” a phrase he said often.
‘’We were there until his very last breath,” Ferguson-Gould said.
‘It’s worth it’: How screening saves lives
Ferguson-Gould was a community health aide practitioner for a dozen years, and then worked as a quality improvement manager, providing training and technical assistance for Alaska community health centers.
She traveled across Alaska helping people access care through the Tribal health and Community Health Centers and, among other duties, provided education on the importance of cancer screenings.
At age 38, when she was first screened for colon cancer, health care providers discovered small tissue growths called polyps.
Polyps are common and most are harmless, but some, if not removed, can develop into malignant growths, said Dr. Stephen Vindigni, a gastroenterologist at Alaska Native Medical Center.
Colon cancer is detected through several types of screening tests, including at-home stool testing or colonoscopies. For a colonoscopy, patients are given a sedative and are asleep for the procedure, where a tiny fiber optic camera is placed in the colon. The doctor examines the inside of the colon and looks for polyps. Most polyps are small and able to be fully removed, Vindigni said. All removed polyps are sent to a lab to determine cancer risk.
The procedure is short, painless and most people can return to their day as normal, said Medical Director of the Surgery Clinic at ANMC, Mark Thorndike.
The clinic provides colonoscopies for people who receive care in the Tribal health system, performing roughly 2,000 annually for Alaska Native people who live across the state, Thorndike said.
By the time patients arrive at the clinic for a colonoscopy, “the worst part of the experience is over,” Thorndike said. That’s because the colonoscopy is painless and short-lived, while preparation requires a day of a liquid diet and laxatives to clean out the bowels, which can be uncomfortable.
Sedative medication has also improved over the decades, Thorndike said, and most people can continue their day as normal afterward.
“It’s worth it,” Ferguson-Gould said of the preparation process. “The day or a partial day of discomfort is well worth being able to catch something early. It could potentially save your life.”
At-home testing increases access to care
For patients living in remote communities, though, a colonoscopy may require a flight into Anchorage or one of the regional Tribal hospitals, which can be costly and time consuming, Vindigni said.
At-home screening tests can help. Tests such as the fecal immunochemical test (FIT) are available at many regional tribal health organizations and can be done in the privacy of a patient’s home. If results come back as abnormal, at that point, a colonoscopy is ordered by the health care provider.
“It saves a person a trip all the way to Anchorage,” Vindigni said of the test.
Colon cancer screening is recommended starting at age 45 for all Alaskans and at age 40 for Alaska Native people. Individual recommendations may be earlier depending on risk factors such as family history. All Alaskans are encouraged to discuss appropriate cancer screenings with their health care providers. If someone is experiencing symptoms, such as blood in stool, diarrhea, constipation for more than two days, abdominal pain, or unexplained weight loss, it’s important to seek an evaluation from a healthcare provider.
Given her own family history, Ferguson-Gould has gotten screenings every five years instead of the typical 10-year window. During her screening last year, doctors discovered a polyp which was larger, and in a different location, than previous polyps. Doctors removed it, and Ferguson-Gould has since had subsequent ones removed.
‘A major health disparity’
Colon cancer is the third most common cancer in the U.S., and roughly 1.5 million Americans are estimated to be living with the disease, Vindigni said.
But for Alaska Native people, rates are far higher. Alaska Native people have the highest rates in the world. The Alaska Native Tumor Registry at the ANTHC Alaska Native Epidemiology Center has health records reaching back more than 50 years that show steady high rates through the decades. There are about twice as many new cases of colon cancer as well as twice as many deaths due to colon cancer among Alaska Native people compared with other populations.
“This is definitely a major health disparity,” Vindigni said.
According to the most recent mortality report from the Alaska Native Tribal Health Consortium, cancer is the leading cause of death among Alaska Native people, with lung, colon and rectum, and breast cancer the most common. ANTHC has several active research projects underway related to colon cancer prevention.
Although older age and family history of colon cancer are most associated with the disease, there are a number of things people can do to help prevent colon cancer, including not using tobacco, drinking alcohol in moderation, and eating less processed meats and more fruits and veggies.
One on-going study through ANTHC and the University of Pittsburgh is seeking to find out the role fiber plays in preventing colon cancer in Alaska Native people. Fiber is thought to affect the bacteria living in the gut and large intestine and increase “good” bacteria that create certain helpful compounds, Vindigni said.
One of these compounds, butyrate, is a fatty acid believed to lower inflammation.
“Less inflammation means less cancer risk,” Vindigni said.
Researchers also know diets low in fiber are prone to more issues such as constipation, hemorrhoids and diverticular disease, he said, so fiber may be key to a healthy colon.
Healthy actions can prevent cancer
Colon cancer often doesn’t show symptoms until the cancer has been present in the body for some time, Vindigni said.
“Just because you feel well doesn’t mean you shouldn’t get tested,” Thorndike said.
That’s why screening is so important. And, unlike most other cancers, colon cancer is preventable.
“There are people walking around that potentially have something going on in their body right now,” Ferguson-Gould said. “How would you know if you haven’t had a screening?”
Using the knowledge and education she gained as a Community Health Aide, Ferguson-Gould started making positive changes in her life after getting screened for colon cancer decades ago. Her first major shift was quitting smoking. These days, she prioritizes rest. She realized social media was increasing her stress levels, so she made an active choice to step away.
Adapting to lifestyle changes is an ongoing process, and she’s always looking to maintain exercise, eat less processed foods, increase consumption of traditional and fresh foods, and, of course, continue getting screened.
“I can make a difference in my outcome,” she said. “I know that.”
Ferguson-Gould continues to spread the message of cancer screening, honoring the memory of her grandfather, who had eight children, 28 grandchildren, 37 great-grandchildren, and three
great-great-grandchildren at the time of his death.
“For him, it ended up taking his life, but it doesn’t have to take ours,” Ferguson-Gould said.
Learn more about colon cancer screening at ANTHC.
This story was sponsored by the Alaska Native Tribal Health Consortium, a statewide nonprofit Tribal health organization designed to meet the unique health needs of more than 175,000 Alaska Native and American Indian people living in Alaska.
This story was produced by the sponsored content department of the Anchorage Daily News in collaboration with ANTHC. The ADN newsroom was not involved in its production.