Colon cancer is the second leading cause of cancer related deaths for both men and women in the United States . If diagnosed after the disease has spread, the five-year survival rate is less than eight percent. However if it is caught early the five year survival rate can be as high as 90 percent. Screening is the best way to detect the cancer early and colonoscopies can even prevent the disease by removing pre-cancerous polyps.
On May 26 and 27 physicians, nurses, patient navigators, other medical providers and public health professionals from Colorado and neighboring states discussed the current state of colorectal cancer screening outreach plans and how to improve Colorado’s plan for the future.
Richard Wender, MD, chief cancer control officer of the American Cancer Society and steering committee member of the National Colorectal Cancer Roundtable (NCCRT) was the keynote speaker of the event. He addressed the nationwide goal of screening 80 percent of the eligible population by 2018.
“Dr. Wender was a very enthusiastic speaker and got the crowed pumped up,” says Sheryl Ogden, RN, BSN and program manager of the Colorado Colorectal Screening Program. “However he made it clear that there would be challenges along the way of reaching the goal of 80 percent by 2018.”
One of the biggest challenges of reaching the goal is that people who are insured are not getting screened although they are covered. Dr. Wender spoke of the ‘unworried well’: adults eligible for screening that do not recognize the importance of screening.
Patient navigators who attended the Summit remarked on the reluctance of many clients to even talk about colorectal cancer or screening because of the location of the cancer and the methods for screening. Doctor recommendations make a big difference in the number of people who choose to get screened.
“Another reason why people do not get screened is that their doctor doesn’t mention it,” says Ogden. “For some populations the simple recommendation for screening made a big difference.”
Individuals at an increased risk due to family history and even those at high risk due to a genetic syndrome are not getting screened as recommended. This may be due to the fact that funding for genetic testing and counseling for colorectal cancer lags behind other cancer types.
“If someone is found to have a genetic syndrome such as Lynch Disease it is easier to determine what course of action should be taken,” says Shannon Pretzel, program coordinator for the Colorectal Cancer Control Program at the University of Colorado Cancer Center. “However it becomes less clear for someone who does not have a genetic link but has a relative with the disease. Many times those people do not get screened at the correct time due to vague guidelines.”
Coverage also becomes a problem for some people, specifically if a polyp is found and removed during a screening.
“If a polyp is discovered during a ‘screening’ colonoscopy it may then be considered a diagnostic procedure for patients,” says Ogden. “This can become very expensive for patients who were expecting their screening exam to be covered, depending on what type of coverage they have. We advise people to check on their overage before their exam so there are no surprises, but the risk of out-of-pocket expense may deter some people from getting the exam.”
It is important to note that there are other screening options available for people who cannot or will not have endoscopic procedures.
“DNA sampling from stool (Cologard) and Fecal Immunochemical Test (FIT) are non-invasive tests that screen for colorectal cancer and can help people determine if they need to come in for more invasive testing,” says Ogden.
With 2018 quickly approaching it is clear that there is work to be done to reach the goal of 80 percent screening rates. Ogden and Pretzel feel that it can be done with increased messaging to the public.
“Talking about the importance of screening and being aware of family history is huge,” says Ogden. “However in order to do that we need to work on the stigma surrounding colon cancer and get people comfortable talking about it. Events such the Undy 5000 and Scope it Out are helping but there still is a long way to go.”