What keeps people from lifesaving colon cancer testing?

By Richard Wender, MD

We have made amazing progress in reducing colon cancer death rates. This progress is a direct result of increasing screening for colon cancer and pre-cancerous polyps. We are actually preventing thousands of cancers by finding and removing pre-cancerous polyps. The nation has embraced the goal of increasing national screening rates to 80% by the end of 2018 – an achievement that will substantially reduce the terrible toll that colon cancer exacts every year.  Everyone is at risk for colon cancer, whether or not someone in your family has ever had a colon polyp or colon cancer. For that reason, everyone has to start being screened for colon cancer at age 50, and people with inflammatory bowel disease or a family history of colon cancer or polyps have to start before they reach age 50. Colon cancer screening is one of the best opportunities to prevent cancer that we’ve ever discovered.

Despite this compelling reason to be screened, many people either have never had a colon cancer screening test or are not up-to-date with screening. Interestingly, nearly all of these unscreened people know that they should be screened, In fact, awareness about colon cancer screening recommendations approaches 100%. The American Cancer Society asked more than 2,000 adults, most of them unscreened, a series of questions about screening, and we now have a pretty clear idea about what’s stopping people from taking that lifesaving step:

  • Some people are concerned about the cost of the test
  • Others have heard that the test is difficult or painful, and they may be embarrassed to discuss colon cancer screening
  • Some people think screening is only for those who have symptoms
  • Others think that having no family history of colon cancer means that they are not at risk and don’t have to be screened

Finally, and perhaps most importantly, many people are concerned about the complexity and cost of having a colonoscopy, like the need to take time off from work, the need to have a ride home, and the potential for high out-of-pocket expenses, which all combine to discourage them from having a colonoscopy. [more]

The messages that work to help patients get tested

These research results don’t surprise me. I’ve heard every one of these explanations in my primary care practice. Every week, primary care clinicians come across patients who are reluctant to be screened, usually giving one of the reasons found in the American Cancer Society research.  Actually, through the years, I’ve learned a lot of approaches to convince reluctant patients, and more than 80% of my patients are up-to-date with screening. Consumer research done by the American Cancer Society suggests that the approaches I used to convince reluctant patients were on the right track.

Here are the two messages that resonated most strongly with consumers:

The first message gets right to the heart of individual risk. “Colon cancer is the second leading cause of cancer related death when men and women are combined.” Waiting for symptoms is a mistake; screening is intended for people without symptoms and is predominately aimed at finding and removing polyps. Remove the polyp – prevent the cancer. Colon and rectal cancers will kill 50,000 Americans this year. Everyone is at risk, and everyone needs to be screened starting at age 50, or even earlier for people with a family history or inflammatory bowel disease.

The other most convincing message for patients addresses the issue that colonoscopy is expensive, disruptive to daily routine, and difficult to go through. “There is an excellent way to be screened for colon cancer that can be done in the privacy of your own home. The test is cheap and easy to do, and if you do it every year, it works just as well as being screened with colonoscopy.” That test is a yearly fecal immunochemical test (FIT), and it looks for microscopic amounts of blood in the bowel movement (poop). The patient collects a small amount of stool on a brush or special stick and places it on a card or in a tube and then mails it in.  No change in diet is needed and the test is performed on only one or two bowel movements. If the test is positive, the patient must have a colonoscopy – and they should know that before they start. Patients also need to know that repeating the test every year is very important.

Health care professionals’ role in helping people get tested

 

Clinicians play a vital role in convincing reluctant patients to be screened. Patients are busy and face many other life priorities. Clinicians can give patients simple, clear messages: everyone is at risk, getting screened dramatically reduces the risk of developing and dying from colon cancer, and you have options for screening –  a colonoscopy every 10 years or a home stool blood test done every year (with colonoscopy needed only for people testing positive for blood in their stool).

The right messages go a long way to convincing patients to be screened, but messages alone aren’t enough to reach our 80% goal and save more lives. We need good systems of care: smooth handoffs of information and patients from primary care to specialists; innovative approaches to providing financial help for getting tested; affordable and tolerable preparation for colon cancer testing; and transportation to get that testing. Patient navigators to help get past barriers to testing and guide the process of screening have been proven to be particularly valuable in helping patients get through the entire process of screening, and it’s our goal for them to become part of the process every time.

Patients having trouble figuring out how to complete screening, whether it’s a stool test at home or a colonoscopy, should ask their primary care clinician for help. More and more innovative solutions are being provided in more and more practice settings.

Reaching our national 80% colon cancer screening rate can only be achieved one person at a time. Everyone has a personal obligation and opportunity to be screened for colon cancer. Everyone can find a test that is right for them.  Together, we can go a long way to eliminating colon cancer as a major health problem in America. Join the campaign. If you’ve never been screened for colon cancer or you’re due for your next test, get in to see your primary care clinician this week. The right test is waiting for you.

Dr. Wender is chief cancer control officer at the American Cancer Society and a primary care physician. 

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