Colorectal cancer ranks among the top five sites of cancer incidence and death for both men and women, according to the American Cancer Society’s annual cancer statistics report. As with most cancers, early detection of colorectal cancer averts death at a much higher rate than treatment.
Colorectal cancer screening and the removal of precancerous polyps contributed to 79% of the 940,000 colorectal cancer deaths averted between 1975 and 2020, according to research from the National Institutes of Health’s National Cancer Institute.
Despite this proven effectiveness, a Feb. 26 report from the Colorectal Cancer Alliance found that 69% of Americans would rather file their taxes than get a colonoscopy, even when recommended to do so by their physician.
Becker’s asked four experts from cancer centers across the U.S. how hospital and health system leaders can support colonoscopy adherence at their organizations to promote early detection and decrease future care costs.
Editor’s note: Responses have been lightly edited for clarity and length.
Andrea Dwyer. Program Director of the Colorado Cancer Screening Program at the University of Colorado Cancer Center (Aurora): For nearly 20 years, the Colorado Cancer Screening Program at the University of Colorado Cancer Center has worked to overcome barriers to colorectal cancer screening — focusing on rural, medically underserved communities — and primary care networks across Colorado. Major challenges include a lack of awareness about screening for average-risk individuals and the stigma surrounding discussions of colon and rectal health.
Health systems can address these barriers by implementing evidence-based strategies such as patient navigation programs, which guide individuals through the screening process and address concerns about preparation, fear and logistics like transportation.
Partnering with primary care teams and communities to expand fecal immunochemical test and fecal occult blood test programs can further increase participation by providing accessible, noninvasive options.
At the system level, electronic health record prompts, provider reminders and standing orders help ensure eligible patients are identified and screened. Performance feedback for providers, widely used by CCSP, has also been shown to improve screening rates.
Additionally, CCSP and advocacy groups have worked to expand insurance coverage and reduce financial barriers, while offering multiple screening options to increase screening rates and the best options for patients.
Public awareness campaigns and peer testimonials help normalize discussions about colorectal health, reducing stigma — similar to breast cancer screening initiatives.
By combining education, system-level interventions and policy changes, health systems can boost screening rates and improve early detection, ultimately reducing cancer incidence.
Stephenie Kennedy-Rea, EdD. Associate Center Director of the WVU Cancer Institute and Chair in the Department of Cancer Prevention and Control at the West Virginia University School of Medicine (Morgantown): Research shows that offering patients choices for their colorectal cancer screening screening, and covering the pros and cons of each screening test, increases the likelihood of a completed screening.
If the patient is considered at high risk for colorectal cancer and hesitant about colonoscopy, then listening to their concerns and helping mediate barriers such as cost, transportation, time off work, fear, etc., can lead to successful completion of the test. Working with a patient navigator can also assist this patient population.
For patients with high anxiety or multiple concerns, decreasing the wait time between the conversation with their provider and the scheduled colonoscopy is helpful. Messaging around colorectal cancer screening is key to moving patients to action.
Christopher Lieu, MD. Associate Director of Clinical Research and Co-Director of Gastrointestinal Medical Oncology at the University of Colorado Cancer Center (Aurora): One of the biggest barriers that hospitals will have to address is the insurance coverage for colonoscopies, as insurance status seems to be one of the biggest barriers to screening.
In addition to that, I think there is a general fear about the procedure, and a lot of that stems from the unknown. Given that, hospitals and health systems can really put a lot of information out about the procedure, what it entails and why in the end, it’s a very straightforward test.
Sometimes having celebrities talk about it can be helpful too, much like Katie Couric.
Van Morris, MD. Section Chief of Colorectal Cancer at The University of Texas MD Anderson Cancer Center (Houston): While no one looks forward to a colonoscopy procedure, night-before preps have gotten easier on patients in recent years and patients are able to be discharged the same day of the procedure. Putting one day aside from work or life every 10 years to get a colonoscopy can mean the difference between life and death.
