Review the ECLIPSE study published in New England Journal of Medicine.  See the data

Simple Ways to Make Colon Cancer Screening a Routine Step in Your Practice

Prevention is better than cure. It’s one of the tenets of medicine. When it comes to the early detection and treatment of cancer, screenings are one of our strongest allies. 

Colorectal cancer (CRC), also called colon cancer or rectal cancer, is the second-leading cause of cancer-related deaths.[1] For cancer types such as CRC that develop slowly and may go unnoticed by a mostly asymptomatic patient, screening helps identify any abnormalities in the cells. While the patient may feel fine, it’s still important to rule out the presence of colorectal cancer using a high sensitivity test. The earlier the cancer signal is detected, the better the prognosis for survival and recovery.

Campaigns such as Screen for Life by the Centers for Disease Control and Prevention (CDC) and 80% in Every Community by the National Colorectal Cancer Roundtable (NCCRT) focus on increasing CRC screening awareness and compliance among average-risk patients in every community. With the rate of CRC increasing among younger Americans, the CDC and U.S. Preventive Services Task Force (USPSTF) now recommend that both men and women begin screening tests at age 45 – with a goal of achieving CRC screening rates of 80% or higher.

And yet, more than 75% of adults who died from CRC were not up to date with screening. [2]

Why is CRC Screening So Important?

Early detection of CRC is critical. To date, low screening compliance has contributed to over half of CRC patients receiving a diagnosis after their disease has spread. Significantly fewer patients survive (14%) when they are diagnosed in a later stage, compared to 90% for the early stage (I-II).[1,3]

CRC is often treatable with the help of regular screening. [1,4,5] However, the challenge is compliance rates remain low despite current screening options being offered to patients. [6]

Who delivers this call to action of, “Get screened”?

Patients trust primary care providers, like you and me, to help them stay on top of their health. You play a leading role in advising patients and ensuring that wellness isn’t just about addressing current symptoms, but also prevention.

How Can We Improve CRC Screening Compliance in Patients?

It’s imperative for healthcare providers to know the screening guidelines, understand which CRC screening methods are available and how to describe them, and which patient types may be most receptive. Here are a few basic steps and guidelines to get you started in the right direction.

1. Identify Patients Who Need Screening

The USPSTF and American Cancer Society recommend that people who aren’t experiencing symptoms and have an average risk of colorectal cancer start getting screened at the age of 45 through 75 years of age. If the patient is over 75, you should determine their screening needs (if any) on a case-by-case basis. 

Determining the screening status of your patients involves asking them how and when they were last screened.

2. Develop a Screening Strategy

Spend some time discussing the importance of CRC screening with your team. Consider the following strategies which have worked well for myself and for my peers.

With your patients:

  • Have a conversation about screening with the patient as part of the initial vitals and preparation 
  • Combine vaccine or bloodwork visits with the opportunity to be screened for CRC using a new blood-based cancer screening method

For your practice:

  • Screen every eligible, unscreened patient at any visit, including during wellness visits
  • Designate specific days for screening and proactively invite patients to come in on those days
  • To reach your broader patient population, consider hosting a “screening day” in which patients learn about the screening methods, have their blood drawn immediately, receive a take-home stool-based test for future send out, or schedule a colonoscopy
  • Have the right people in place to run your CRC screening program. This will keep it efficient, productive and boost the patient experience. While this might vary depending on your office size, here are some points to consider:
    • Who in your practice has the best opportunity to talk with patients, raise screening awareness and educate (including you)?
  • Phlebotomist
  • Office manager
  • Medical assistant
  • Physician assistant
  • Nurse practitioner
  • Physician 

Once you have your team in place, they should work together to determine how they’ll connect with patients to encourage screening.

3. Ways to Screen for CRC

The most common ways to screen for CRC include:

  • Stool tests: every 1 to 3 years
    • Fecal Immunochemical Test (FIT) / Fecal Occult Blood Test (FOBT): usually done once per year 
    • Multi-target Stool DNA test (Cologuard): usually done once every 3 years
  • Colonoscopy: once every 10 years, or more frequently if patient is at high-risk

And, there’s a new approach to screening, which is blood-based. This offers patients an accurate, easy-to-complete method of detecting of CRC early with a simple blood draw. [4,5,7,9]

This is good news for patients who may find available methods, such as colonoscopy or stool-based tests, unpleasant, time-consuming, and difficult to complete. In fact, one study found that patients who initially refused a colonoscopy preferred screening with a blood test over a stool-based test — 83% vs 15%, respectively. [7,8]

In addition to choosing your screening methods, consider these points: 

  • Talk to your patients who remain unscreened about their fears and barriers, then review different screening options 
    • If their fear is around invasive tests, have you talked about stool-based or blood-based tests?
    • If they feel disgusted by idea of dealing with stool, have you discussed blood-based screening as a convenient, easy-to-complete way to get their screening done? 

Remember, the goal is to get the patient screened.

4. Run Your CRC Screening Process

What are you doing to effectively communicate with your patients? Do you have educational materials to explain why CRC screening is important? Consider placing brochures or posters in the waiting room or exam room to spark conversation. Pre-appointment emails can highlight topics to be discussed during the upcoming visit. Patients can then ask questions about screening during their in-office visits. 

Identify those patients who remain unscreened by asking them questions or looking at your Electronic Health Record system. During wellness visits, check for any previous CRC screening results, and discuss screening options.

The process doesn’t end with screening. Continue to think about how your clinic will share test results and manage follow-up appointments.

  • If an abnormal signal is detected, how would you follow-up with the patient? 
  • Consider what the referral process entails for further assessment and treatment.

For future screenings, you might find it effective to proactively schedule the next screening and provide reminders via text or email at various intervals, such as a week before or a day before.

Stay in touch with your patients by periodically emailing them with educational materials on how living a healthy lifestyle and keeping preventative health top-of-mind will benefit them both now and in the long run. This personal communication provides your patients with the confidence to take care of themselves and reach out to you when there is a need or a question.

5. Measure the Results of Your Program

The only way to know if your CRC screening program is working is to track and measure patient compliance. Determine how many blood tests, stool tests, and colonoscopies were actually completed by patients. This information can be especially insightful if you compare the results across different screening modalities and provide a test that your patients will actually complete.

Remember the purpose of these efforts: to detect and treat the presence of cancer before it can become life-threatening. When you diligently work with your patients to improve CRC screening compliance, together, you take a more preventative approach to healthcare and help fight the prevalence of colon cancer.

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