Preventing poor outcomes: Early cancer detection is vital, doctors say, but barriers — both financial and mental — often get in the way

Andrew Maciejewski
Summit Daily
Kathy Jones intertwines her fingers while sitting at a table with her husband, Tony, on Sept. 8, 2022. The Joneses debated whether to get a preventative cancer screening for Kathy, at first, due to their anxiety, but their decision to ultimately get one is attributed to her positive outcome.
Liz Copan/For the Summit Daily News

Editor’s note: This is the second article in a four-part series titled “Peaks, Valleys of High Country cancer,” which publishes every Friday. Part 1 was published Sept. 2.

Kathy Jones says a simple suggestion by a physician’s assistant saved her life. 

He didn’t think anything was wrong with her health, but knowing she had a history of smoking, he encouraged her to get a CT scan just to make sure something wasn’t awry. 

She and her husband, Tony, initially debated whether to take his advice. Tony worried about a false positive. She worried about what the scan might reveal. 

“I was honestly terrified,” Kathy said as she reflected on her emotions as she prepared to get her first screening. “I was absolutely terrified.”

The anxiety nearly stopped her from getting the scan, but despite the emotions she felt as she headed into the exam, she took the assistant’s advice. 

They found a mass in her right lung, but the scan wasn’t all bad news.

Since Kathy went in before symptoms began, they caught her lung cancer very early, Stage 1, before it was able to metastasize and spread to other parts of her body. 

One surgery later — no chemotherapy, no radiation — and everything changed. 

“After the surgery, the doctor — the pulmonologist — used the term ‘cured,’” Tony recalled. 

“It all goes back to that preventative scan,” Tony continued. “Had that not occurred — here we are five years later — who knows what would have happened.”

Kathy Jones looks at her husband, Tony, as they talk while sitting at a table in their backyard on Sept. 8, 2022. Kathy says she overcame her Stage 1 lung cancer diagnosis thanks to a preventative scan she sought out despite feeling anxiety about what it might find.
Liz Copan/For the Summit Daily News

Normalizing the anxiety

Erin Perejda, a licensed clinical social worker who offers counseling and behavioral health support to cancer patients at Vail Health, said the roller coaster of emotions the Joneses felt is common. 

“We need to normalize it,” Perejda said. “It’s OK to be fearful about going in for these scans and these procedures. … I think it’s really common. They are not alone in that fear.”

The Longevity Project

Peaks, valleys of High Country cancer

Doctors say a mountain lifestyle has its benefits, but living at elevation also comes with risks and challenges.

Since fear and anxiety are common whenever the word “cancer” pops up at a doctor’s office, Perejda said it’s important that people surround themselves with supportive people who can help encourage them to overcome those emotions so that they don’t become chronic or debilitating. 

Feelings of anxiety and fear often cause people to enter a fight-or-flight response, where people either take action or ignore the root causes, according to Australia’s Centre for Clinical Interventions.

Sarah Roberts, another cancer-care focused social worker from Vail Health, said it’s important for people experiencing a choice similar to the Joneses to remind themselves that “the earlier the detection, the better the outcome.”

Taking control

When fear or anxiety stop people from seeking preventative care, the outcomes are often much different from Kathy Jones’ experience. 

Dr. Symon Stanley, who practices dentistry in Breckenridge, said he has caught tumors in at least two patients in the past year that have ended up being thyroid cancer and has referred people to oncologists after finding cancerous plaques in their mouths — all through routine exams that are done when visiting a trained dentist. 

While there are common signs of cancer that you can look up on the internet, he said relying on those indications should not be the only way people approach diagnosing cancers. 

“I think something that people often get surprised about is that cancer doesn’t typically hurt until it’s in the very late stages,” he said.

When cancer is growing in the body, Stanley said you’re not exactly going to notice it.

The topic of prevention is close to his heart since he watched a close friend receive a diagnosis late into her cancer’s progression. 

“(She) had symptoms for three or four years before she went in to see a doctor,” Stanley said. “It turns out she had Stage 4 colon cancer.”

The treatments ultimately proved unsuccessful for his friend, but statistics show that when colorectal cancer is caught in its early stages, the outcomes are better. 

According to the Centers for Disease Control and Prevention, roughly 90% of adults who are diagnosed with colorectal cancer at an early stage are expected to live equal to those without the cancer, compared to only 14% of those diagnosed with late-stage cancer.

Even if symptoms are what prompt cancer screenings, immediate action can have a dramatic effect on outcomes. 

U.S. cancer death rates have steadily declined over the past 20 years. Advancements in the field make outcomes for patients who seek preventative care better, according to the Centers for Disease Control and Prevention.
Andrew Maciejewski/Summit Daily News

From 2001 to 2020, cancer death rates decreased by 27%, according to the CDC. Advancements in cancer treatment allow for less invasive interventions and more targeted approaches that help patients reach remission. 

When approaching any screening for cancer, licensed professional counselor Kristi Grems said it’s important for people to remember that they have control and that every case of cancer is unique. 

“Remembering and reminding yourself that you are your own person and your friends’ and families’ stories with cancer are not yours” is important, she said, while adding that their negative outcomes are not necessarily going to become yours.

Grems often cautions her clients against Googling things about the test and outcomes since it can put people into a negative head space, which isn’t helpful when approaching cancer care and prevention. 

“As humans, we don’t like the unknown,” she said. “We like to know what to expect. We don’t like to not have control.”

Making the choice to trust the doctors is a form of control, Grems said. 

“Folks are cooking up stories and ideas of what’s going to happen and what’s this going to mean for their lives, so I’m a really big fan of teaching people to stay present with a lot of different grounding tools like taking deep breaths,” said Roberts, who provides counseling for Vail Health.

Grounding techniques are used as a tool in psychology to help people take action. The idea is to lead the person’s thoughts away from ruminating on things that happened in the past or might happen in the future since people can only control what is happening in the present. Plus, worrying about the past and future often elevates stress, which can negatively affect the body. 

Seeking professional help from a primary care physician is often the best way to approach cancer, according to everyone interviewed for this article.

“The thing about control, too, is to make a plan with their physician to understand what the test is going to entail, what they can expect,” Perejda said as she expanded on making sure patients know the process of how results are interpreted and how the results will be relayed. “Knowing all of that puts some power back in the patient’s hand and can help.”

Since there is a strong focus on making cancer care plans that are individualized to each patient, Vail Health nurse navigator Lindy Owens reiterated that statistics and other people’s outcomes do not correlate to any one person’s success. She said people should always be optimistic. 

“There’s no reason to believe that it’s not going to be a positive outcome. That helps a lot,” she said. “That’s not to say they walk through the door and they don’t have anxiety when they get here, but I think that makes it better.”

Perejda said one thing people can take away from Kathy’s story is that her relationship with her husband likely played a large role in her successful outcome. 

“You can’t underestimate the importance of your loved ones and the care that they have for you,” Perejda explained. “If you’re having anxiety and you’re thinking about it and haven’t even seen a primary care doctor or haven’t even seen someone for testing … open up and start the conversation with the person that they love, and they might just find that that is the person who loves them and encourages them to get the care that just might save their life.”

Keeping up with care

Though doctors used the word “cured” when they told Kathy her cancerous tumor was successfully removed, she goes to the doctor’s office regularly. For a three-year span after her surgery, doctors scanned her lungs twice a year to make sure the cancer hadn’t returned. 

Kathy had quit smoking years before she got her first lung screening. She has always loved to hike and be active, and Tony said she has made a strong effort to continue to hike and bike despite having part of her lung removed. 

While doctors have said the active, healthy lifestyle of most Summit County residents improves the local cancer diagnosis rate, cancer still has a presence in the community. 

Dr. David Biggs, Centura Health’s Summit County-based oncologist and hematologist, said the regular checkups that Kathy is undergoing have become a “relatively standard screening” procedure for people with a history of smoking and can help with early detection. 

The routine checkups have served Kathy well, but in April, a doctor found another unknown mass in her lung, so he asked her to get another specialized scan to see if the cancer had returned. 

“It was just like my heart dropped. I was like, ‘Oh no. Did this come back again?” Kathy said. “When they looked at it, they thought it was the cancer that had come back, but — come to find out — it was the scar tissue where they had taken part of the lung out.”

She said her successful outcome with preventative scans makes going to the doctor a bit less nerve wracking, but she still feels uneasy as the appointment date gets closer on her calendar.

“When I go in now, I’m still scared because I don’t want it coming back,” Kathy said. “Sometimes I feel that it might come back; you know what I mean?”

Cancer death rates in the U.S. begin to increase significantly after the age of 40, which is when most routine preventative screening schedules begin.
Andrew Maciejewski/Summit Daily News

Biggs said screening “definitely saves lives,” adding that certain populations are often more prone to certain cancers than others. Family history, or genetic makeup, can play a role in when it’s best to seek preventative care, and age factors into the equation as well, he said. 

That doesn’t mean everyone needs an oncologist, but he said everyone should keep good medical records and ensure they are getting regular checkups at the doctor and dentist. 

“Other than encouraging patients to be aware of when cancer screenings apply to them, based on age and family history, having a regular primary care provider to confide in — that’s probably the most important thing,” Biggs said.

According to the CDC, the incidence and mortality rates of cancer rise consistently as people age, but Biggs said as long as a doctor is aware of a family’s history with cancer, a trained physician will ensure people seek the screenings they need based on their lifestyles and inherent risks.

Cancer at elevation

More than 9,000 feet above sea level, Summit County poses unique challenges and risks. The environment, the socioeconomic demographics and lifestyle all play a part in how people should approach cancer prevention.  

With peaks and valleys all around, Biggs said people in Summit should be aware of their increased risk of melanoma, more commonly known as skin cancer. 

The percentage of Coloradans who do not have health insurance has decreased over the past 10 years, but the percentage of insured Coloradans who sought preventative care within a 12-month span has steadily hovered around 30%, according to 2021 Colorado Health Access Survey results.
Andrew Maciejewski/Summit Daily News

While other major cancers have regular intervals for seeking preventative care, often starting after age 30, Biggs said prevention for skin cancer typically begins at a younger age. But he clarified that doctors help make the decisions for care based on sunscreen use, the amount of time spent outdoors, genetics and other factors. 

Even though the average age for skin cancer diagnosis is 65, Biggs said he has seen cases in Summit County where the cancer began to form earlier than that. 

“I’ve had patients in their 30s with melanoma, where — unfortunately — it had already spread to other parts of the body,” Biggs said. “That definitely happens, and so for young people, at least seeing some kind of primary care provider and being aware that if you have skin lesions, getting them checked out is very important.”

Biggs said health insurance also poses a unique challenge in tourist towns like those in Summit County. 

Centura Health, Vail Health and the Summit Community Care Clinic all offer programs for people who might be experiencing financial stress, and Biggs said the state and other organizations offer financial assistance or free exams to ensure people get preventative care. 

Summit County also has “a large undocumented population of people who are here who aren’t citizens … and are inhibited to access screenings just because they don’t have insurance and their fear of exposing their undocumented status,” Biggs said. 

Lung cancer is the most deadly cancer in the U.S., according to the Centers for Disease Control and Prevention, but early detection can lead to positive outcomes as evidenced by Kathy Jones’ story.
Andrew Maciejewski/Summit Daily News

Tony Jones said he hopes barriers in those people’s lives don’t prevent them from seeking preventative care. 

“You would hope that people would have the resources available, and one of those resources is just knowledge to know that there are options,” he said. 

Even though lung cancer is the leading cause of death in the U.S. out of all cancer types, Kathy overcame her anxieties and fears to become a positive force on the statistics. She says it all comes back to being mindful of the powers that preventative care provides.

No matter what challenges people face, Kathy hopes her story will encourage others to face their anxiety, emotions or other challenges to get the care they need. 

“Kathy is a textbook example of getting it done early while it is treatable,” Tony said. “So if you let that fear — if you hold it off until there’s some pain or some indication that makes you feel that you need to do something — by that time, more often than not, it’s not too late, but it’s late in the game, and it could be a lot worse.”

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