The Centers for Disease Control and Prevention last week announced that colorectal cancer screening rates--after years of increases--seem to have stalled. In fact, millions of Americans between the ages of 50 and 75, it says, have never been screened.
This obviously concerns public health authorities since screening has been shown to reduce death rates.
The CDC has suggested there are a number of steps that can be taken to increase CRC testing rates. For example, state and local healthcare agencies should be developing record systems to track and notify those who need to be tested. And doctors, nurses and healthcare staff should be able to recommend different test options--and offer advice about each--and be prepared to match the patient with the test that's right for them, whether it's colonoscopy, sigmoidoscopy or a stool test.
But there are other steps that can be taken, as well.
Efforts should be made to reach out to groups that traditionally have shown a reluctance to undergo CRC screening. For example, in 2010, only 45.6 percent of eligible Arab-Americans over the age of 50 living in Michigan (home of one of the largest populations of Arab-Americans in the U.S.) underwent CRC screening, compared to 70 percent of the entire state's eligible population. A study in the August 2013 issue of the Journal of Community Health found that discomfort, unawareness about CRC screening, and the failure of primary care physicians to recommend testing were barriers to screening, and that providing better education to this population about the benefits and ease of screening could increase screening rates.
Discomfort in the form of colonoscopy preparation is another potential barrier to CRC screening. Patient surveys have shown that the need for bowel preparations are the most objectionable aspect of colonoscopy, making improvements in bowel preparation tolerability critical. Splitting the dose is becoming more common as a way to improve tolerability, patient compliance, and effectiveness of the procedure. Research published last year found that split-dose bowel preparations (SDP) improve polyp detection, and there have been calls for SDP to become the standard of care.
And then there's the question of virtual colonoscopy. In 2009, the Centers for Medicare and Medicaid Services decided Medicare wouldn't cover the procedure, but since then, the evidence suggests that the time has arrived for CMS to provide coverage. One can only assume that this will help increase screening rates, considering that studies, like this one published in the January 2013 issue of the Journal of the American College of Radiology, have shown that giving patients the option of undergoing virtual colonoscopy could improve colon cancer screening rates.