MARCH is Colon Cancer Awareness Month and colon cancer is the third most commonly diagnosed cancer in both males and females in Jamaica and the third leading cause of cancer deaths locally.

According to the International Agency for Research on Cancer, Jamaica recorded 796 new cancer cases in 2020 which represented 11 per cent of new cancer cases.

The Ministry of Health has a goal to reduce cancer mortality by 25 per cent by 2025, and an integral part of this must be to reduce the prevalence of cancer by means of primary prevention.

This includes identifying risk factors that can be modified such as increasing physical activity, keeping a healthy weight, limiting alcohol consumption, and avoiding tobacco.

Screening is imperative given that 60 to 70 per cent of Jamaican colon cancer patients present with advanced metastatic disease. Screening can take the form of occult blood testing in stools or colonoscopy. For most Jamaicans, access to colonoscopy is prohibitive due to the absence of health insurance. Also, the service is also not readily available due to limited geographic distribution centres.

For that reason, Windsor Wellness Limited will be introducing to the Jamaican public occult blood testing using faecal immunochemical testing (FIT), which is both sensitive and specific for cancers and polyps and will allow for better use of endoscopic interventions. This screening modality is used globally in population screening programmes. The key benefits are that it requires no preparation, it is not invasive and the results are immediate.

Warning signs of colon cancer includes blood or mucus in the stool, change in bowel movements, loss of appetite, unintentional weight loss, unexplained anaemia or low blood count.

Charlie Balentine, managing partner at Pinnacle Labs, manufacturers of the FIT, told Your Health Your Wealth said he was happy to form the partnership with Windsor to remove colonoscopies as the primary screening tool for colon cancer, given barriers such as cost and cultural beliefs.

“Colonoscopies requires a three-day fast. It requires three samples, which means day one, day two, day three, and it’s very subjective. We came up with a brand new biomarker, so we took the biomarker of blood and we isolated a B positive protein in haemoglobin. If you think back to seventh grade science, 85 per cent of blood is haemoglobin, haemoglobin is the oxygen transport mechanism throughout your body. ‘Haem’ is the Latin word for iron and ‘globin’ is the Latin word for protein. We isolate that protein and use the cut off level of 15 nanograms per millilitre. Any time someone takes the test and gets a reading of more than 15 nanograms per millilitre, it elicits a positive result and a positive result means you need to be scoped,” Balentine said.

Further, he said when it comes to colon cancer in Jamaica, he has realised that majority of the population are “prisoners of hope”.

“‘We just hope we don’t get it’ and that’s not necessary any more because we certainly don’t have the infrastructure to screen everyone on the island with a colonoscopy. Even with that, we are only talking about the elite who would even think of something like that, much less have it done. So what can we do about that? The answer is a population-based screening test that is fast — results in five minutes. At the point of care in five minutes, I can have you screened for colon cancer with the second generation FIT ,” Balentine said.

He added: “After prostate cancer, colon cancer is the second most lethal cancer on the island. It kills more people than breast cancer, it kills more people than lung cancer but I drive all over this island all the time. I see billboards for prostate cancer, I see billboards for HIV, I see billboards for breast cancer. We don’t talk about colon cancer but this disease has no symptoms — none. If you have symptoms that’s incredibly problematic. The only way to eradicate the disease is early detection through screening.”

The FIT detects cancer with a 98 per cent sensitivity rate and a 96 per cent specificity rate and includes a tube filled with a sodium iodide buffer solution, which suspends the sample for a period of up to two weeks at room temperature and three weeks if frozen. It does not require dietary restrictions.

“Let’s say you’re 45 and at 45 you should screen for colorectal cancer. To do so, I need you to tale this tube home, unscrew it and after a spontaneously passed stool, use the wipe method to get a little sample of faecal matter — just enough to fill up the grooves on the test — and then cap it and bring it back to the collection site where you picked it up,” Baletine said.

“This idea of colonoscopy screening tests as the primary screening method is absurd in this day and age. We can do better, better is out there, available and incredibly inexpensive. The goal is to get these tubes in everyone’s hands. You can do more screening in one day with the FIT than you can do in one week with the colonoscopy.”

Going forward Balentine hopes that the test will become population-based and available in the public sector for every Jamaican. Also through US not-profit organisation Black Health, there will be a major public education campaign around colorectal cancer and screening using FIT as a preventative tool.

In the meantime, founder/CEO of Windsor Wellness Centre Dr Alfred Dawes said the FIT has the potential to cut colon cancer cancer rates in half.

“The test detects the presence of blood in the stool,which is a reliable indicator of polyps — the growth that can eventually turn into cancer. If you can find and remove half of the polyps in population, just through screening more, you pick up earlier colon cancers and can cut the rates in half. Seventy per cent of the colon cancers in Jamaica are detected at late stage, which is more difficult and more expensive to treat, with higher death rates than early colon cancer. The FIT will pick up earlier cancers that have a higher cure rate and are easier to treat, so we will move from diagnosing advanced cancers to earlier detection of colon cancers.”