Five questions with family practice physician Dr. Megan Mendez Miller

Dr. Megan Mendez Miller is interested in removing barriers to colorectal cancer screening in central Pennsylvania. Miller, a Penn State Health family doctor, is partnering with community health organizations for a program to increase screening. Penn State Clinical and Translational Science Institute invested through its pilot grant program to research how effective the program might be for use in other communities.

March is Colorectal Cancer Awareness Month. According to the Centers for Disease Control and Prevention (CDC), colorectal cancer is the third leading cause of cancer-related deaths in the United States. In 2017, the latest year for which data are available, 141,425 new colorectal cancer cases were reported in the United States. For every 100,000 people, 37 new colorectal cancer cases were reported, and 14 people died of this cancer. Pennsylvania is above the national average with 39 new cases per 100,000 people, making it 19th out of the 50 states and Washington, D.C.

Finding colorectal cancer early through screening is essential for treatment. According to the CDC, people between 50 and 75 years old should be screened for colorectal cancer. About 90 percent of new colorectal cancer cases are in people 50 and older. However, some groups recommend screening begin at 45. Doctors may recommend screening earlier than age 50 when taking into consideration factors such as family history. You should decide when to be screened with guidance from a health care provider.

Learn more about colorectal cancer in this Ask Us Anything feature by Penn State Health.

A full interview with Dr. Mendez Miller about her colorectal cancer screening project is available in episode 3 of Penn State Clinical and Translational Science Institute’s Engage Podcast. Each episode educates listeners about the research process and how Penn State is improving our neighbors’ and communities’ health.

Why are you interested in colorectal cancer screening?

Mendez Miller: As a family doctor, I have a strong interest in preventative health. I would much rather prevent than treat a disease. Not all cancers are easily screened or prevented. We often find many cancers at later stages, but colorectal cancer is one of the cancers that, as long as we have appropriate screenings, is much more preventable than other types of cancers.

What is your prevention project?

Mendez Miller: I feel it is our duty as an academic health institution to reach out and partner with our local federally qualified health centers, as well as privately funded and state- and grant-funded free clinics in the area. There are organizations that serve many of our patients who are most at need and provide services in our local communities.

Our project provides colorectal cancer screening by an annual fecal immunochemical test (FIT), a stool-based test that patients can perform in the comfort of their own homes. They send those results to a local lab. The science behind the FIT test is very good. If patients have a positive FIT test, it doesn’t mean that they have colorectal cancer. It means they should have a colonoscopy to determine if there is a benign or a precancerous polyp, and have that addressed before colorectal cancer develops.

Learn more about federally qualified health centers in Engage Podcast episode 3.

How is your project benefiting from a Penn State Clinical and Translational Science Institute pilot grant?

Mendez Miller: This is, in essence, a feasibility or a pilot study in which we want to take this approach towards this partnership with our local communities and our academic health institution and prove that this is a sustainable project moving forward. We want to show that it’s not just sustainable here in central Pennsylvania, but also duplicatable in other areas of the country in communities surrounding academic health institutions.

The research end is to show that this project improves colorectal cancer screening through FIT and with a diagnostic colonoscopy when there’s a positive FIT.

A pilot grant allows researchers to gather preliminary data to learn if larger studies will be effective. Penn State Clinical and Translational Science Institute invests in novel research ideas through its Bridges to Translation Pilot Grant Program. With pilot grant data, researchers can apply for larger grants because they can show that their work has potential for new knowledge. Since its inception, Bridges to Translation invested $3.5 million into novel research projects, which led to nearly $41 million in external grant funding.

What are some barriers to people getting screened for colorectal cancer?

Mendez Miller: In studies and published research, one of the primary barriers published on colorectal cancer screening from federally qualified health centers is transportation. The primary thing we attacked right from the beginning was the cost of transportation and the means of transportation for patients.

There’s a lot of other things that have come up. For example, before an endoscopy procedure, a patient now needs to have a COVID swab test. So that’s another ride that’s needed.

Patients cannot afford or don’t understand how to do a colonoscopy prep. Maybe they have a FIT kit, and they don’t understand what to do with it, even though there are instructions. There are literacy problems. We often assume in our society that by handing someone a piece of paper that explains something that people will be able to understand that. So even for people who speak English as their primary language, illiteracy rates are high in our communities and under-recognized. When you bring in someone where English is their second language, certainly written communication is really challenging. And often, you need someone to come alongside you and walk you through that process.

What kind of collaborations are you open to for this project?

Mendez Miller: I’m working very closely with the GI department on this. The brainchild of this project was Dr. Tom McGarrity and the GI department. But Dr. McGarrity needed partners, so we have been working to take this further. My department chair and family medicine doctor, Dr. Mack Ruffin, is a well-established researcher with colorectal cancer. He’s also a senior principal investigator on the grant, along with Penn State Cancer Institute’s Dr. Gene Lengerich. The Clinical and Translational Science Institute project allowed me to reach out and solidify those partnerships. I don’t think I would have had the time or the courage to reach out and build those partnerships had it not been for the institute’s grant. It allowed the opportunity for me to formalize more of the research end of things.

So, as far as future partnerships that I’d be open to, there’s potential in public health sciences. Thankfully, we haven’t had any cancer identified yet in the program, but it will happen. There’s potential for further collaboration with the Cancer Institute and with colorectal surgery and maybe surgical oncology. Cancer survivorship is a specialty. There might be some potential there. We’re on the other end of things, but I know there are many partners at Penn State University Park, as well as here at the College of Medicine, who are in cancer survivorship.

About Penn State Clinical and Translational Science Institute

Penn State Clinical and Translational Science Institute provides tools, services and training to make health research more efficient at Penn State. It is an advocate for translational science at the University and is a bridge between basic scientists and clinical researchers. The institute encourages collaboration to discover new treatments, medical procedures and ways to diagnose disease. Learn more at ctsi.psu.edu.

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