Monday Mar 14, 2016
FPs Must Demystify Colorectal Cancer Screening
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.
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(onlinelibrary.wiley.com) 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(www.uspreventiveservicestaskforce.org) 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(www.pcori.org) (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(www.pcori.org) 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(www.pcori.org) 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(www.pcori.org).
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.
Wanda Filer, M.D., M.B.A., is president of the AAFP.
Posted at 12:12PM Mar 14, 2016 by Wanda Filer, M.D.