Encouraging Cancer Screening Has Benefits
- A new study published in JAMA Network Open found by combining automated and personalized communications such as a mailed at-home colorectal cancer test kit, postcards, and phone calls from your doctor, people across all racial groups appear more likely to follow through with cancer screening.
- The study involved a diverse group of more than a million people and found screening rates were higher than the national average of 72% across all groups.
- The results could help close the racial gap, especially among Black Americans who have higher colorectal cancer diagnoses and death rates compared to other racial groups. Part of the reason for the disparity rests in limited access to quality healthcare, cancer screening, and socioeconomic factors.
- Despite the added comfort and ease of use of at-home colorectal screening test kits such as the fecal immunochemical test (FIT), SurvivorNet experts say colonoscopies are still the most effective way to screen for colon cancer.
A recent study may reveal the key to closing the gap among Black Americans facing colorectal cancer compared with other racial groups — and it includes better communication and access to at-home testing.
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A little more than a million people participated in the study, whose median age was 61, with 53% women and 46% men. Researchers found that incorporating automated and personalized communications was more effective at encouraging people to use the FIT colorectal screening test kit. Screening rates increased across all demographic groups.
Automated outreach involves sending a prescreening postcard, followed by a FIT test kit with a photo and signature from the recipient’s primary care physician. A return envelope is also included. Individuals who failed to return their completed FIT test kit received an automated phone call and an additional postcard reminding them to complete the FIT test kit.
Personalized outreach was also implemented in the study, which involved recipients who still had not returned their completed FIT test kit receiving a phone call and electronic messages from their primary care physician’s office reminding them to complete the FIT test kit and return it.
According to the study, making colorectal screening easier in the comfort of a person’s home, followed by a series of reminders across multiple communication channels, improved overall screening. During the study, the proportion of participants who were up to date with their screening ranged from 74% to 84% across racial groups, slightly higher than the national average.
The Centers for Disease Control and Prevention (CDC) notes that 72% of adults are up to date with colorectal screenings.
WATCH: Colon cancer is almost completely preventable with screening.
A small number of people tested positive for signs of cancer (3% to 4%), and the majority of these positive participants followed with a colonoscopy.
The study suggests that combining automated and personalized communications makes people more likely to follow through with colorectal cancer screening.
Most notably, an automated and personalized approach could help address the disparity in colorectal cancer deaths, which disproportionately impacts Black Americans.
This group has the highest mortality (deaths) related to colorectal cancer among major U.S. racial groups, according to research published in Advances in Cancer Research. Many factors are believed to contribute to this unsettling statistic, including socioeconomic status and lack of adequate health insurance. Other environmental factors such as poor diet and tobacco and alcohol use are also believed to be contributing factors impacting Black Americans facing colorectal cancer at higher rates.
Research published in the American Journal of Pathology found African Americans’ colorectal cancer incidence rate is “20 percent higher than whites” and also have a higher mortality rate.
African Americans are also diagnosed with colorectal cancer at earlier ages, and it tends to be more advanced upon discovery.
Expert Resources for Colon Cancer Screening
- Colon Cancer Screening Options And Genetics: Myth Busting With Dr. Heather Yeo
- Colon Cancer Screening is Extremely Important; Guidelines Now Say to Start at Age 45 if There Is No Family History
- Colorectal Cancer Screening: a New Study Questions the Effectiveness of Colonoscopies But Specialists Reinforce its Importance
“Black people are still more likely to get colorectal cancer at a young age than white people even though the gap is shrinking,” Dr. Nathan Ellis with the University of Arizona Cancer Center said.
Dr. Zuri Murrell, a colorectal cancer surgeon and Director of the Cedars-Sinai Colorectal Cancer Center, previously told SurvivorNet that he does outreach to communities of color, especially African American communities.
“What I found, especially with my African American patients, is that there’s not a lot of African American GI docs. There’s not a lot of African American colorectal surgeons,” Dr. Murrell said.
“When I go to churches, and I go to a lot of inner-city churches just to, to kind of communicate my message of being your own healthcare advocate, I tell the story, and I try to diminish some of the taboo nature of colon and rectal surgery, anal rectal surgery,” Dr. Murrell added.
Although At-Home Colorectal Cancer Screening Has Benefits, Colonoscopies Are More Effective
Last year, the American Association for Cancer Research published the results of a study designed to determine the effectiveness of FIT. While examining nearly 57,000 people, “10.2 percent had unsatisfactory” results that didn’t leave users with definitive screening results. The researchers determined that FIT results were inconclusive because of inadequate specimens, incomplete labeling, old specimens, and a broken or leaking container.
Although researchers determined that “one in ten” people returned a FIT that could not be processed for “patient-related reasons,” improved specimen collection and labeling could make these at-home screening tests more effective.
As more research on the effectiveness of at-home colorectal screening and measures to boost compliance continues, perhaps a happy medium can be reached to improve overall cancer screening.
Why Colonoscopy is Still Key
Most colon cancers can be prevented if people are regularly screened. SurvivorNet experts recommend getting a colonoscopy rather than relying on an at-home test for the most accurate results. The screening usually involves a colonoscopy, in which a long, thin tube attached to a camera is used to examine the colon and rectum. The advantage of colonoscopy is that your doctor can remove any polyps found during the test. If no polyps are discovered, the following screening won’t be needed for about ten years.
At-home stool tests are also available to screen for colon cancer. However, our experts warn that they are not as effective as colonoscopies. Even though the at-home colon cancer test Cologuard is 93% effective, that’s still 7% of people who will have their cancers missed.
WATCH: Preparing for a colonoscopy.
Colon cancers begin as polyps 95% of the time. A study published in 2014 in the New England Journal of Medicine found that the Cologuard test, for example, missed more than 30% of polyps that will soon become cancer and 57% of polyps that may become cancer. That’s a significant discrepancy. Especially since when polyps are found during a colonoscopy, doctors can essentially stop cancer from growing before it even starts.
“We know that colon cancers can be prevented when polyps are found early,” colorectal surgeon and colorectal oncologist Dr. Heather Yeo told SurvivorNet. “Lowering the screening age helps somewhat with this, but access to care is a real problem,” Yeo added.
Dr. Murrell previously explained the colonoscopy procedure to SurvivorNet.
“When we see a polyp, we actually physically take the polyp out through the colonoscope,” he explained.
“What does that mean? That means we basically put a wire through with a little bit of a flange at the end, and we pull the polyp out. Now, note there is no pain with that. Inside the colon, there are no pain fibers. So, there’s no pain,” Dr. Murrell added.
Many colon cancers can be caught on colonoscopy before they develop or when the polyps are small enough to be removed without surgery.
RELATED: Myth Busting: Let’s Talk About Colon Cancer Screening
When to Screen for Colon Cancer?
The American Gastrointestinal Association lowered the recommended initial age for a colorectal screening from 50 to 45.
The U.S. Preventive Services Task Force recommends guidelines that state colon cancer screenings should begin at 45 years old. This is in response to the increase we see in colon cancer diagnoses in younger adults. However, many insurance companies still do not cover the cost of screenings for those under 50. In the past, the disease had predominantly been found in adults 50 years or older, but for those predisposed to getting it at a younger age, these new guidelines could help catch it earlier.
The best and most complete way of screening is a colonoscopy every ten years.
If you have a close relative who has colon cancer, a rule of thumb is to get screened ten years before their age of diagnosis to make sure any growths or cancers are caught early. If you have several family members who had colon cancer or family members who got it at a young age (less than 50 years old), it may be necessary to undergo genetic screening. If you have a lot of polyps on your colonoscopy or if you have had colon cancer previously, you will need a colonoscopy every three to five years.
Understanding Colon Cancer
Colon or colorectal cancer affects your large intestine (colon) or the end of your intestine (rectum).
A colonoscopy helps screen for this kind of cancer. Depending on where the cancer is found along your colon, this cancer can take on different names, including anal or rectal cancer and bowel cancer.
The cancer starts when polyps grow in the colon or rectum. These polyps can sometimes change into cancer if you don’t have them removed. It takes up to 10 years for a colon polyp to become full-blown cancer, according to SurvivorNet experts.
Most colon cancers can be prevented if people are regularly screened.
WATCH: Why everyone should be screened for colon cancer.
“We know that colon cancers can be prevented when polyps are found early,” Dr. Yeo said.
Colon cancer symptoms and warning signs include:
- Change in bowel movement
- Bloody stool
- Diarrhea, constipation, or feeling the bowel does not empty completely
- Unexplained weight loss
- Constant abdominal pain or cramps
If you notice symptoms or changes in your body, it’s important to discuss them with your doctor promptly.
Questions to Ask Your Doctor
If you are facing a colon cancer diagnosis, here are some questions you may ask your doctor.
- What are my treatment options based on my diagnosis?
- If I’m worried about managing the costs of cancer care, who can help me?
- What support services are available to me? To my family?
- Could this treatment affect my sex life? If so, how and for how long?
- What are the risks and possible side effects of treatment?
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