Family Physicians Must Demystify Colorectal Cancer Screening
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Note: This post initially appeared on the Leader Voices Blog at the American Academy of Family Physicians.*
During the nearly two decades I worked as a health correspondent for our local NBC affiliate, my cameraman was a kind, funny man who seemed to know everyone in town. Phil not only was my colleague but also my friend.
PCORI has funded 51 patient-centered comparative clinical effectiveness research (CER) studies on cancer, several of which focus on colorectal cancer or include patients with colorectal cancer as well as other illnesses.
Because most colorectal cancer deaths can be prevented by screening and early treatment, much research addresses ways to increase screening rates. Among the PCORI-funded colorectal cancer projects, one is testing whether providing people with quantitative information on cancer risk and screening benefits increases screening; another is comparing ways of encouraging Hispanic adults to undergo screening; and a third is surveying colorectal cancer patients to improve patient-clinician communication.
For more information, see a list of our colorectal cancer projects and a list of our cancer projects.
Phil and I talked about the health segments we were working on, and he also frequently asked my opinion about health issues he and his family members were dealing with. He wanted my perspective on immunizations, medications and more.
Unfortunately, one health topic Phil never asked me about was colorectal cancer. I was heartbroken when I learned this wonderful man recently died a preventable death just a few weeks shy of his 61st birthday.
If Phil had asked me about colorectal cancer, I would have told him that his age and his race put him at increased risk, and screening would have been appropriate. Blacks have the highest incidence of colorectal cancer and the highest mortality rates of all racial groups.
Colorectal cancer is the second-leading cause of cancer deaths in the United States, yet nearly one-third of adults ages 50 to 75 aren't screened as recommended. Two years ago, the AAFP joined the National Colorectal Cancer Roundtable, which seeks to increase the percentage of adults ages 50 and older who are screened to 80 percent by 2018. It has been estimated that reaching that goal would avert roughly 280,000 new cancer cases and 200,000 cancer deaths within 20 years.
Family physicians can help by screening patients—or referring patients to screening when appropriate—and also by answering questions and demystifying the process.
It's worth noting that the U.S. Preventive Services Task Force issued a draft of updated screening recommendations in October. The Academy has offered feedback for the final recommendation, which is pending.
Others are doing research to learn how we can increase screening rates and close gaps in care. For example, the Patient-Centered Outcomes Research Institute (PCORI)—an independent nonprofit that seeks to improve the quality and relevance of evidence available to help patients, physicians and others make informed health decisions—is funding several projects related to colorectal cancer screening and treatment.
- Screening rates are substantially lower among Hispanics than non-Hispanic whites. A project at Thomas Jefferson University aims to improve screening rates among Hispanics by implementing an intervention that will identify the participant's preferred screening test and work with patients and their primary care providers to facilitate testing.
- A project at Indiana University will provide clinical evidence and patient input to guide decision-aid designers on how to present patients with comparative effectiveness information about screening methods.
- A North Carolina project aims to survey more than 1,000 colorectal cancer patients to develop measures for use in improving communications between physicians and patients.
Years ago, I lost an aunt to colorectal cancer in an era when screening was not yet widely accepted. She often was on my mind when I spent years lobbying in my state's capital for legislation that now requires insurers to cover screening.
Today, patients have more access to care and more options for potentially life-saving screening. It is up to us to ensure that they understand their risks and their choices.
*AAFP News, March 14, 2016. (c) American Academy of Family Physicians
The views expressed here are those of the author(s) and not necessarily those of PCORI.
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Comments
March 23, 2016, 1:43 AM
Comment by Geoffrey Goldsmith,
March 22, 2016, 10:32 PM
Comment by Dena Davis,
Perhaps if more professionals practiced evidence-based medicine and took cost into account, more consumers would be willing to have the procedure. Read Elizabeth Rosenthal's June 1, 2013 article in the New York Times, about the high cost of colonoscopies and the use of unnecessary anesthesiologists.
I was the PI on an NCI funded research project designed to improve the rate of colorectal cancer screening (CRCS) among patients aged 50-75 who are family physician patients. The project ended in 2014. I wrote a guide to FP residency programs on how to improve cancer screening in the model FP clinic using CRCS as an example. The team also created a highly rated patient education video that emphasized the importance of CRCS. We had outstanding results in improving CRCS in private practices and good but variable results in different FP residency clinics. I'd be glad to share our methodology and results. Dr. Goldsmith