March 26, 2021 - Podcast

Episode 108—Colorectal cancer, and farming

Colorectal cancer is the third most common cancer and second most lethal cancer in the United States. Research scientists at Regenstrief Institute and IU School of Medicine hope to increase the uptake of patient screenings for colorectal cancer. The researchers developed and tested one of the first U.S.-based models to predict personal risk for advanced precancerous polyps and colon cancer (together, known as “advanced neoplasia”) in average risk individuals. Dr. Thomas Imperiale, leader of the study, says the model helps to estimate an individual’s risk. This estimate may be used to guide doctor-patient discussions about screening options, with the potential to increase patient acceptance of screening by giving them a choice based on their individual risk. Imperiale says personalized risk-based tailoring of colorectal cancer screening is done to a limited extent based on family history but could be done to a greater extent based on other factors. Eight out of 10 individuals who fall within the range for recommended colorectal cancer screening are considered to be at average risk of the disease. The new predictive model for average risk individuals considers age, sex, lifestyle, diet, smoking history and eight other factors. Through the study, researchers evaluated 4,500 individuals ages 50 to 80 who had not had a previous colonoscopy and identified sizeable lower risk and higher risk groups among the average risk individuals. About a quarter of average risk individuals in the study had a 2 percent risk, for advanced neoplasia, which is considered low risk. Approximately 60 percent were found to be medium risk, reflective of truer “average risk.” About 10 percent were deemed high risk for which a screening colonoscopy is appropriate. Imperiale says the importance of colorectal cancer screening cannot be overstated, particularly during the COVID-19 pandemic when people may be less willing to consider screening colonoscopies. Having an accurate risk assessment tool to guide the discussion of suitable options is part of personalized medicine and the informed consent process, and could improve the uptake and efficiency of colorectal cancer screening. It also has the added benefits of enabling us to prioritize those who are in greatest need of colonoscopy while conserving potentially scarce resources — from masks and other personal protective equipment to the costs of anesthesia.

In other news, 70,000 new farms are started in the U.S. every year. While new farmers help to bring prosperity to rural communities and make outsized contributions to sustainable agriculture, they also face significant obstacles when trying to obtain land. A project by IU researchers will study ways that the government can encourage new farm ownership among young and beginning farmers, farmers of color, and women. IU researchers will partner with American Farmland Trust to communicate directly with farmers and to establish a community of practice and national advisory team. Research scientist Julia Valliant says often, retiring farmland owners prefer to transfer their land to a beginning farmer to help them get started in agriculture. But lots of barriers get in their way. This study will aim to diversify access to opportunity in agriculture by helping owners transfer their land to young and beginning farmers and farmers from historically excluded groups. The market for available farmland is tight and existing agricultural plots are often consolidated into larger farms or sold for development. Most new farmers do not inherit land and instead struggle to raise enough capital to compete. These problems are compounded for farmers of color and women. Although people of color make up more than a quarter of the U.S. population and provide more than 60% of farm labor, they make up only 3% of agricultural landowners. And women, who make up half of the U.S. population, make up less than a quarter of agricultural landowners. While federal and state governments have tried to help beginning farmers overcome obstacles through financial incentives, little research has been done to evaluate their effectiveness, Valliant says. This project, she says, aims to help revitalize rural communities by helping a new generation of farmers enter the field – one that is more representational of the communities they serve.