How can we increase colon cancer screening rates?

This is what we know--colorectal cancer screening works.

Colon cancer is the third most common cancer for both men and women, and the second leading cancer-killer in the U.S. But screening asymptomatic people for colon cancer can be very successful in detecting colon cancer earlier enough to significantly decrease colon cancer mortality rates.

Despite this, screening rates remain problematic. According to the Centers for Disease Control and Prevention, about one in three adults ages 50 to 75, haven't been tested for colorectal cancer as recommended by the United States Preventive Services Task Force.

The numbers look even worse when we look at screening rates in certain minority or low-income communities.

Efforts are being made to get those rates up--some of which have been successful, others not so much.

In this week's issue of FierceMedicalImaging we report on study published in the Annals of Family Medicine that examines one effort that hasn't been too successful. A program in Ontario to increase cancer screening rates--including those for colorectal cancer--by providing financial incentives to primary care physicians has had little effect on those rates. 

While the researchers in that case found little evidence that provider financial incentives work, they did find evidence that other kinds of interventions are more successful, such as the use of patient or provider reminders.

A recent study published in JAMA Internal Medicine found exactly that. Northwestern University researchers determined that community health center patients who received follow-up in the form of outreach by mail, automated telephone or text message and phone calls were more than twice as likely to complete a colon cancer screening test.

One of the reasons for low screening rates is the sheer unpleasantness of ingesting the bowel preparation necessary for colonoscopies. Researchers have been working on ways to improve that process in order to both increase screening rates and help patients comply with that process once they've made the decision to get screened.

One possible solution could lie in the development of laxative-free computed tomographic colonography. In 2012 Michael Zalis, M.D, an associate professor of radiology at Harvard Medical School reported on the possibility of using a software program to electronically cleanse fecal matter from virtual colonoscopy images in the Annals of Internal Medicine. The idea, he said, was that with a more patient-friendly form of screening, more patients might participate.

Which, of course, brings us to the use of virtual colonoscopy, which has been shown to increase screening rates.

While the American Cancer Society has endorsed virtual colonoscopy as an appropriate screening modality for colorectal cancer, advocates still are waiting for Medicare to give its approval.

The United States Preventive Services Task Force is currently evaluating colorectal cancer screening tests, a process that could eventually lead to support and Medicare approval. Considering the number of Americans who are electing not to undergo colonoscopies, this process could be quickest way to get those screening rates up. - Mike (@FierceHealthIT)