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Wednesday Mar 18, 2015

FP Recommendation Key to Boosting Colorectal Cancer Screening Rates

Each year, more than 130,000 U.S. adults are diagnosed with colorectal cancer, the nation's second-leading cause of cancer deaths. Despite those stark statistics, nearly one-third of adults ages 50 to 75 aren't getting screened as recommended.

In an American Cancer Society survey of unscreened patients, one of the leading reasons respondents gave for not being screened was that they had not received a screening recommendation from a physician. Family physicians are positioned to make a huge difference in closing this gap because we provide roughly 200 million office visits each year to a vast spectrum of patients.

A physician discusses care options with a patient. An American Cancer Society patient survey indicates that a physician recommendation can make a big difference in whether or not patients are screened for colorectal cancer.

So it was no surprise last year when the National Colorectal Cancer Roundtable (NCCRT) -- chaired by family physician Richard Wender, M.D. -- sought the AAFP's support for its 80% by 2018 initiative, which seeks to increase the percentage of adults ages 50 and older who get screened for colorectal cancer to 80 percent by 2018.

It's been estimated that achieving that goal would prevent more than 200,000 deaths(onlinelibrary.wiley.com) because colorectal cancer can be detected early -- when treatment is more likely to be successful -- and even prevented through the removal of precancerous polyps.

So where do we stand? The percentage of U.S. adults who have been screened increased from 56 percent in 2002 to 65 percent in 2010. And as the screening rate has risen in recent years, cancer incidence has dropped in this age group.

Still, much work remains to reach the initiative's goal. College graduates are screened at a rate of more than 80 percent, but disparities exist for many other populations. Patients with less education and income, the uninsured, underinsured and certain minority groups have dramatically lower screen rates and higher cancer rates.

So how do we reach these populations? I recently participated in an event hosted by the American Cancer Society and the NCCRT that looked at the progress made during the first year of the 80% by 2018 initiative. We heard from some of the more than 200 groups that have pledged to help boost the screening rate. Those groups range from individual physician practices to national physician organizations and also include payers, public health groups, national retailers and others. In some communities, family physicians, gastroenterologists, public health officials and others are working to identify unscreened patients and direct them to affordable care.

For example, John Allen, M.D., M.B.A., president of the American Gastroenterological Association, said during the event that a grant from Walgreens had helped physicians in Connecticut identify and screen more than 300 patients. Of those, 46 percent had precancerous polyps.

In Arizona, the state department of health is working with one payer to provide screening information to 200,000 patients, as well as providing related CME to physicians.

Earlier this month -- which happens to be Colorectal Cancer Awareness Month -- Mississippi announced a statewide program that aims to increase screening rates in that state to 70 percent by 2020. Although that goal is lower than the NCCRT's objective, it would be a giant leap for Mississippi, which has the nation's highest mortality rate -- and one of the lowest screening rates -- related to colorectal cancer.

What can we do in our own practices? We can make that all-important recommendation during visits with patients ages 50 to 75, and we can follow up with reminders through mail or email.

We also can be sensitive to what type of test patients are willing to do because although some may be hesitant to have a colonoscopy, they may agree to do a take-home test. Remember that a typical series of take-home stool tests does qualify as screening and should be done annually. However, a single, one-time, in-office stool test does NOT adequately screen for colorectal cancer.

In my federally qualified health center, we are helping eligible patients get coverage through the health insurance marketplace. Although screening is a covered preventive service, follow-up care could require a copay in some health plans.

Family physicians build relationships and trust over time. By making a recommendation and providing reminders, we can help achieve this important, life-saving goal.

Wanda Filer, M.D., M.B.A., is president-elect of the AAFP.

Posted at 02:21PM Mar 18, 2015 by Wanda Filer, M.D.

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