COMMENTARY

Colorectal Cancer Screening: Give Your Patients Options

Djenaba A. Joseph, MD, MPH

Disclosures

August 10, 2015

Editorial Collaboration

Medscape &

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Hello. I am Dr Djenaba Joseph. It is my pleasure to join you as part of the CDC Expert Commentary Series on Medscape.

Colorectal cancer is the second leading cause of cancer-related death in the United States and the third most common cancer. It's an equal-opportunity cancer, affecting men and women of all races and ethnicities. In 2011, the most recent year for which we have data, more than 135,000 people in this country were diagnosed with colorectal cancer, and more than 51,000 died from it.[1]

The evidence is strong that in adults aged 50-75, routine screening for colorectal cancer reduces mortality. For people whose colorectal cancers are found and treated at an early stage, more than 90% will live more than 5 years. In the United States, colorectal cancer screening rates have increased significantly in the past decade, but we still have a long way to go.

A new report from the CDC[2] shows that there was no increase in colorectal cancer screening from 2010 to 2013, which was both unexpected and disappointing. The report was based on data from the 2013 National Health Interview Survey. It showed that just 58.2% of adults reported being up-to-date with colorectal cancer screening. Other studies show that up to 65% of adults have been screened appropriately.

Of this there is no doubt: We are falling short of the Healthy People 2020 target of 70.5% of adults being up-to-date with colorectal cancer screening. The US Preventive Services Task Force recommends colonoscopy, at-home high-sensitivity fecal occult blood or fecal immunochemical tests (FIT), and flexible sigmoidoscopy as effective screening tests to prevent or find colorectal cancer early.

Most often, patients are only offered colonoscopy as a screening test option. But studies have shown that many people would prefer a different test option, such as FIT, if it were offered to them. The best screening test is the one that actually gets done.

How can you help ensure that all of your patients are screened? First, recommend colorectal cancer screening to all of your eligible patients. Your recommendation has consistently been shown to be the most important factor in determining whether someone is screened.

If you are age 50 or older, you might share your personal screening story with patients to reassure and convince them. You can also emphasize the cancer prevention angle.

Second, patients need to know that they have options for screening tests. If you offer one test and the patient declines, don't stop there. Ask questions to see whether you can figure out why the patient is declining. Maybe there are aspects of that particular test that he or she does not like. See if that patient would consider an alternative testing method.

Third, make it easy for yourself, too. Develop a screening policy for your office. Involve other office staff in the screening process. Try to identify patients who are due for screening before they even come to the office, and be ready to offer them screening when they arrive. Send patients reminders to complete their screening test if you don't receive any test results in a predetermined amount of time.

How can we help you get your patients screened? There are some great tools to help you with this process.

The National Colorectal Cancer Roundtable has a primary care clinician toolkit that will walk you through, step-by-step, how to do some of the things I just mentioned, from establishing an office policy to involving your office staff.

CDC's Screen for Life campaign has a variety of patient reminders and other free patient education resources you can use.

CDC also offers a free CME course to primary care providers and clinicians who perform colonoscopy. It includes guidance and tools on optimal ways to implement colorectal cancer screening.

Please urge your patients to be screened for colorectal cancer. Give them screening test options. We have a real opportunity to do more to prevent colorectal cancer and save lives. Thank you.

Djenaba A. Joseph, MD, MPH , is board certified in internal medicine and is a Commander in the Commissioned Corps of the US Public Health Service. She joined the Centers for Disease Control and Prevention as an Epidemic Intelligence Service Officer in the Division of Cancer Prevention and Control (DCPC) from 2005 to 2007. She remained in DCPC as a medical officer and is currently the medical director of CDC's Colorectal Cancer Control Program (CRCCP).

Dr Joseph completed her undergraduate education at the University of Michigan, and earned her medical degree from the University of Michigan Medical School and a master's in Public Health from the University of Michigan School of Public Health. She completed her residency in general internal medicine at St. Joseph's Mercy Hospital in Ann Arbor, Michigan. Dr Joseph then went on to practice as a hospitalist in St. Louis, Missouri, before returning to Michigan to practice general internal medicine and teach internal medicine residents at a community hospital outside Detroit.

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