Effective Patient-Provider Communication for Colorectal Cancer Screening

This March, the Association of Community Cancer Centers (ACCC) is recognizing National Colorectal Cancer Awareness Month by highlighting the importance of cancer screenings and early detection. In the United States, colorectal cancer is the fourth most common cancer—behind breast, prostate, and lung cancers—and the second leading cause of cancer mortality. 

If caught early (through regular screenings), colorectal cancer may be prevented or successfully treated. In fact, because of the recognition that early detection improves survival rates, the U.S. Preventive Services Task Force (USPSTF) recommends colorectal cancer screenings for all Americans, who are 45 years of age and over. 

There are several factors that affect screening prevalence, such as age, race, socio-economic status, insurance status, cost, accessibility to care, provider communication, awareness of colorectal cancer screening, perceived colonoscopy pain, rural living, and geographic access to screening facilities. Despite the increase in colorectal cancer screenings in recent years, disparities in screenings and care are still found among rural communities. 

To learn more about colorectal cancer and the importance of early screening, ACCCBuzz spoke with David Switzer, MD, FAAFP, medical director, Population Health and Family Physician at Valley Health in Winchester, Va.

ACCCBuzz: Why are younger people being diagnosed with colorectal cancer at a higher rate? 

Dr. Switzer: I suspect it is multi-factorial and not entirely known, but the USPSTF recommendation to start screening at age 45 certainly reflects the significance of that observed phenomenon.

ACCCBuzz: Has the risk colorectal cancer poses to younger Americans been effectively communicated? 

Dr. Switzer: Speaking from my experience, no. I don’t think it has—especially in rural areas. Even for people who have some awareness of cancer screening, I don’t think they understand that colorectal cancer screening is now recommended at age 45. 

ACCCBuzz: Compared to breast cancer, why is so little discussed about the importance of colorectal cancer screening? 

Dr. Switzer: Private entities have taken it upon themselves to aggressively distribute this message: Women above age 40 should consider breast cancer screening. There is hardly any female patient I encounter who is unaware of that. Colorectal cancer screening has certainly been around for many decades, but the cultural memory of it is not nearly as robust as it is with breast cancer screening. 

There is also not enough awareness in rural areas about the other stool-based screening modalities patients can access. They picture it to be unpleasant and invasive—something most patients don’t really rush to do. However, a colonoscopy is not the only way to screen, and that is a message that needs to be widely disseminated.

ACCCBuzz: What are examples of these stool-based screening modalities? 

Dr. Switzer: There are two types of stool-based testing that we often use. Both have been endorsed by the U.S. Preventive Services Task Force

• The first is FIT [fecal immunochemical testing]-DNA, commonly known as Cologuard^®, which is a stool test that checks for precancerous and cancerous DNA, as well as blood that cannot be seen with the naked eye. The patient receives the test in their home, collects a specimen, and sends it to the propriety lab for the test to be run. If that test is negative, then based on guideline recommendations, the patient can rescreen in three years. If the test is positive, you [patients] follow it up with a colonoscopy.
• Second is the fecal immunochemical testing [FIT], which is simply testing for blood you cannot see with the naked eye. This test is conducted annually, and, if the result is negative, patients are considered adequately screened for that year. Like Cologuard, a colonoscopy would follow a positive test [result]. Though annual, instead of every three years, generally speaking, the cost to the patient (if uninsured) or insurance carrier is the lowest of all screening options.

ACCCBuzz: Are patients apprehensive about screening for colorectal cancer due to the possibility of a positive result? 

Dr. Switzer: Yes, while I don’t know if this is particularly unique to rural areas, we see it a lot. With respect to colorectal cancer screening, if you have cancer found at screening, that is before symptoms start, the likelihood that it is an earlier stage, curable cancer is much higher. In addition, colorectal cancer screening not only finds cancer, but it also finds precancer. I think patients have a misperception about what that diagnosis really means and what the screening test really finds.

ACCCBuzz: Colorectal cancer is prevalent in the Appalachian Region, as well as parts of the South and Midwest. Why is that? 

Dr. Switzer: In rural areas, such as Appalachia, it is difficult to reach the resource that does the screening due to the transportation and financial difficulties these groups face. Geography is also a major factor; for most of my patients the closest colonoscopy if they need one is 30 [miles] to 40 miles away. I think the socio-economic factors are the primary factors. 

For more information on the association’s work in rural health and colorectal cancer, visit the ACCC website. 

The Appalachian Community Cancer Alliance is supported by Bristol Myers Squibb.