Developments over just the past few years have created significant opportunities and challenges around colorectal cancer detection and prevention. Colon Cancer Awareness Month provides an opportunity for GI physicians to engage in meaningful discussions with patients and referral sources about colorectal cancer screening guidelines. Recommendations and best practices can also be discussed—the kinds of discussions that can save lives, says Amiee Mingus, Vice President of Clinical Operations at PE GI Solutions.
Colorectal cancer is the third-leading cause of cancer death for both men and women, according to research published in CA: A Cancer Journal for Clinicians. As the American Cancer Society (ACS) notes, when colorectal cancer is found at an early stage before it has spread, the 5-year relative survival rate is about 90%. Unfortunately, only about 4 out of 10 colorectal cancers are discovered at this early stage. Additionally, about 1 in 3 people in the United States who should get tested for colorectal cancer have never been screened.
“Colorectal cancer is largely preventable,” says Mingus. “You can’t say that about every cancer. It’s imperative that we do all we can to help get patients the screening they need that can lead to early identification and treatment of colorectal cancer.”
45 Is the New 50 for Screening Guidelines
One of the most noteworthy developments concerning colorectal cancer screening guidelines in quite some time occurred in May 2021. The U.S. Preventive Services Task Force (USPSTF) issued new recommendations for colorectal cancer stating that people at average risk should start screening at age 45 instead of the traditional 50. The recommendations came about three years after the ACS issued a similar guideline.
These recommendations come at a time when colorectal cancer is rising rapidly among young adults. Data reported in CA, which tracked the incidence of colorectal cancer from 2011 to 2016, revealed an up to 2% per year increase in colorectal cancer among people under 50 and a decline in the colon cancer survival rate among younger adults.
“It’s very important for people to recognize that colorectal cancer is not an ‘old person’s disease,’” Mingus says. “The fact that the age was lowered by ACS and USPSTF is an indication to younger adults that they need to be paying attention. Colorectal cancer is showing up a lot more in the younger population, but management is possible if you do something about it before it becomes a problem.”
The Affordable Care Act requires most insurers to cover the costs of colorectal cancer screening. This is as per the recommendations of USPSTF. Unfortunately, Mingus says, many patients and physicians do not know about the new recommendations and expanded coverage. To help build awareness, she says GI physicians can reach out to their referral sources and provide the current information.
“Primary care providers need to make sure their patients are aware of USPSTF’s recommendations and the reasoning behind them. Undergoing a screening at this earlier age can have such a significant impact,” Mingus says. “These providers should also be reminding patients that they do not need to wait until 45 to have a screening. People who are at a higher risk of colorectal cancer or those who have symptoms associated with colorectal cancer may benefit from undergoing a colonoscopy sooner.”
Colonoscopy as the “Gold Standard”
When communicating with referral sources, GI physicians should consider broaching another topic: alternatives to colonoscopy that are now available, including at-home screening products. While these products can serve a purpose, they have some significant shortcomings that physicians and patients should understand.
“These tests often have a difficult time detecting a precancerous polyp and cannot be used to treat a precancerous polyp,” Mingus says. “If something is detected by the test, a patient is going to need to undergo a colonoscopy anyway. In addition, if a patient uses one of the alternatives and the test determines the patient should undergo a colonoscopy, an insurance company isn’t likely to consider that colonoscopy a screening procedure any longer. This means the patient may be subjected to their deductible and copay.”
It makes clinical and financial sense, Mingus says, to steer patients toward colonoscopies over the alternatives, especially for those whose procedure will be covered by insurance. “Colonoscopy is the ‘gold standard’ because it’s the only way you can detect and treat in one procedure,” she says. “If someone is absolutely against undergoing a colonoscopy, the alternatives are better than nothing. We want everyone to get screened one way or the other. But providers have a responsibility to let their patients know about the risks and failure rates of the alternatives to colonoscopy.”
Catching Up From COVID
While outreach by GI physicians to referral sources will help ensure new patients undergo the colonoscopies they need for early detection of colorectal cancer under the new screening guidelines, another type of outreach is also essential. “We’ve seen some delays with screenings due to COVID-19,” Mingus says. “GI physicians need to make sure no patients who had their screening postponed over the past two years have fallen through the cracks.”
Colorectal screening delays are expected to contribute to delays in diagnoses, stage progression for those with undiagnosed cancer and increased colorectal cancer mortality. “When the statistics related to screenings that have been put off because of COVID-19 are published, we can unfortunately expect to see a bump up in colon cancer,” Mingus says.
A study out of Spain that compared data from the first year of the pandemic with data from the previous year found that there was a more than 40% decline in colon cancer diagnoses and 27% fewer colonoscopies were performed. The researchers noted that although the study concerned
1.3 million people in Spain, other countries heavily affected by the coronavirus that had colon cancer screenings stopped and postponed were likely to see a similar impact.
“Patients must understand that it’s still very important to take care of their health in ways that go beyond the pandemic,” Mingus says. “Just as they have protected themselves from COVID-19 by wearing masks, distancing and getting vaccines, patients should protect themselves by receiving preventive services like colonoscopies.”