Colon Cancer Screening Expands
While overall U.S. rates of colorectal cancer have been dropping since the 1980s, they are rising among adults under the age of 50. Now those younger adults will be able to get screened for colorectal cancer, which can diagnose the disease early or even prevent it from occurring.
In May 2021, the U.S. Protective Services Task Force (USPSTF) updated its guidelines to recommend colorectal cancer screening in adults ages 45 to 75 years old who have an average risk of developing the disease.
The task force is an independent group that makes evidence-based recommendations on who should undergo preventive measures such as cancer screenings.
While colon cancer is most often diagnosed between ages 65 and 74, nearly 11% of new cases now occur in adults younger than 50.
The new recommendations were proposed based on research stemming from the realization that “younger patients were being diagnosed with colorectal cancer, and when these patients were diagnosed, they were frequently already at advanced stages,” says Michael Goldberg, DO, Chair of Gastroenterology at Einstein Healthcare Network.
Most of these more advanced cancers were discovered because of symptoms, since adults under 50 were not eligible for screening unless they had a family history of the disease or fell under other high-risk criteria.
Symptoms include rectal bleeding, new-onset constipation, or a change in bowel habits.
The American Cancer Society had been recommending since 2018 that screening begin at age 45. However, the USPSTF is more influential because insurance companies usually cover screenings that it recommends.
There are several ways to screen for colorectal cancer. The most common methods are stool-based testing, colonoscopy and sigmoidoscopy. There are benefits and drawbacks to each, but colonoscopies are the most recommended method.
Stool-based testing uses a sample of stool to search for microscopic amounts of blood or DNA mutations. However, if a patient’s stool sample comes back positive, a colonoscopy is required to find out why.
Colonoscopy uses a camera attached to a tubelike instrument to look inside the colon. Very small polyps that could turn into cancer can be both identified and removed within the same procedure.
A sigmoidoscopy is similar but doesn’t cover the entire colon and, according to Dr. Goldberg, is not effective in detecting polyps and cancers on the right side of the colon.
Colonoscopy and sigmoidoscopy require following a restricted diet and using laxatives to cleanse the bowel before the procedure. Stool-based tests, on the other hand, don’t require bowel preparation or a procedure.
“Depending upon the presence of polyps or family history of colon cancer, [patients] can be anywhere from five to 10 years from having to get screened again after a colonoscopy,” says Dr. Goldberg. Stool-based tests must be done more often.
Although colorectal cancer is currently the third leading cause of cancer death, only 69% of those who qualified for screening received it in 2018.
Dr. Goldberg says there are several reasons behind low screening rates, including “lack of insurance and lack of recommendations from their primary care doctor for screening.” Some people also may not realize there are multiple screening options available.
Screening rates are even lower than average in low-income areas, while colorectal cancer rates are higher. This cancer is also more common among African Americans, who have higher death rates than other ethnicities.
In Pennsylvania, according to the Department of Health, death rates of colorectal cancer are higher than the national average.
Direct Access Program
Einstein Healthcare Network’s Direct Access Colonoscopy (DAC) program was created in 2019 to break down barriers to screening by reducing the number of steps a patient has to take to be tested.
With DAC, patients can schedule their colonoscopy over the phone without a preliminary office visit with a primary care doctor.
Within a year after the program began, the colon cancer screening rate for Einstein’s patient population increased from 54% to 64%, according to Dr. Goldberg.
Although screening colonoscopy procedures halted for several months when the pandemic hit, Einstein staff were able to reschedule more than 1,000 patients by the end of 2020.
Societal perceptions of colon cancer screening methods and procedures may also negatively impact screening rates.
Fear of having a procedure is one factor that may influence the decision to get screened. Dr. Goldberg says that “a simple face-to-face talk” with a doctor can help get past what people may have heard. Still, he says, it’s sometimes easier to persuade people to get a stool-based test rather than a colonoscopy.
Einstein has promoted screening in a variety of ways in the past, including community events such as an outreach screening event at Enon Tabernacle Baptist Church.
“There’s not just one thing to do,” continues Dr. Goldberg. “It’s a very individualized process and that’s why we have to hit from all these angles — from the primary care doctors, from the local community leader level, as well as from the GI physicians, surgeons and oncologists. Everyone needs to be discussing colon cancer screening.”