The Colon Cancer Foundation had the opportunity to speak with Dr. Shahnaz Sultan, MD, MHSC, AGAF, about her research team’s findings that pandemic-related pre-procedure COVID-19 testing caused higher rates of endoscopy cancellations among patients from marginalized populations. A Professor of Medicine in the Division of Gastroenterology, Hepatology, and Nutrition and the Program Director for the Gastroenterology Fellowship Training Program at the University of Minnesota, Dr. Sultan’s research interests are focused on reducing colorectal cancer morbidity and mortality by improving adherence and quality of colonoscopy.
Q: What is the main takeaway you want people to understand from your research?
One of the most important things we want to emphasize is that colorectal cancer [CRC] is a very preventable cancer and there is a lot of high-quality evidence that shows that screening for CRC actually leads to a reduction in associated mortality. We really need to think about CRC screening along a continuum—whether you are doing stool-based testing or you’re getting a colonoscopy, it’s a multi-step process, and at every step, we need to be cognizant about reducing barriers and helping patients complete their CRC screening tests. Adding another step that patients have to complete prior to colonoscopy, such as pre-procedure SARS-CoV2 testing, in addition to completing their bowel prep, following dietary guidelines, finding transportation, and coming in to get a colonoscopy, really makes it that much more challenging. Pre-procedure testing serves as one more step and one more possible barrier in terms of getting people up-to-date with their screening.
Q: As you were conducting your research, were there any findings that surprised you?
Our objective here was to understand the impact of pre-procedure COVID-19 testing—we wanted to see the magnitude of the impact and who was specifically affected by this additional requirement. When we looked at the canceled outpatient endoscopy procedures in our cohort from March 2021 to September 2021, we were surprised that the overall cancellation rate was so high in terms of getting people to complete their colonoscopy. Among the 574 cancellations, a little under 10% were due to pre-procedure COVID-19 testing requirements, and a good proportion of the remainder, about 51%, were patient-initiated cancellations. There were a lot of additional factors that were potentially holding people back from CRC screening. Additionally, we were surprised that pre-procedure testing was disproportionately affecting certain populations. Persons who self-identified as Black, American Indian, Alaskan Native, or Hispanic were more likely to have testing-related cancellations.
Dr. Shahnaz Sultan
Q: Of the patients who canceled their colonoscopy, do we know if they went for an alternate form of testing for colorectal cancer, such as stool-based testing?
That’s an interesting question! We do not have that health data within our health system, but you bring up a good point. During the pandemic, a lot of other health systems were shifting gears from colonoscopy to stool-based testing and using programmatic efforts to directly reach out to patients to make sure they were getting some form of CRC screening.
Q: Healthcare challenges, such as the COVID-19 pandemic, have demonstrated to significantly disrupt CRC screening procedures and participation, especially for medically underserved communities. What steps can be taken or what policies can be implemented in the future to support CRC screening participation and prevent significant disruptions to CRC screening?
There is a lot of ongoing research to understand different barriers we can address or different interventions we can take to improve screening at the population level. We really need a multifaceted or multi-pronged approach to screening. We really need to think about interventions that not only focus on patients, but we also need to target providers, health systems, and community leaders, and think about national and federal policy decisions. I think there are a lot of opportunities to decrease barriers at different levels in terms of getting people to be more up-to-date with screening at a population level.
In terms of policy, one of the things that we have been able to fix recently is this loophole that existed in the past where if a test was done for screening purposes, but polyps were removed, then it was no longer counted as a screening test, and that incurred copayments and additional burdens on patients. I think that has been a real coup for us in the gastroenterology community and overall in terms of helping to support the care of our patients. Also, I think there are a lot of opportunities at the national level to support programmatic efforts to improve screening for populations that are underinsured or don’t have access to care, and I think we need to do more outreach and find ways to include health educators and patient navigators. We need to make sure we are educating patients about the importance of screening and helping address financial or logistical barriers that might serve as additional challenges for patients to overcome.
Continued on Page 2.
Setting it Straight: The Colonoscopy Controversy
A new study published in the New England Journal of Medicine has sparked controversy—this 10-year study involving nearly 85,000 participants in Europe highlighted that colonoscopies cut the risk of colorectal cancer (CRC) only by about a fifth, far below estimates from earlier scientific studies, and didn’t substantially reduce deaths, raising the possibility that the invasive procedure is not worth it. Doctors in the U.S. are now concerned that the study’s results could cause doubt about the effectiveness of a colonoscopy, which is a recommended CRC screening approach for those 45 and older, to be conducted once in ten years. Despite the confusion about the effectiveness of colonoscopies, national news articles and gastroenterologists in the U.S. have rebuked these conclusions.
A major limitation that experts found with the study was that only 42% of the people who were invited to get a colonoscopy actually had one. However, researchers still reported the outcomes for the entire cohort, regardless of whether or not they underwent a colonoscopy. The study found that of those who were invited to have a colonoscopy—whether they got it or not—there was an 18% reduction in developing the disease and no statistically significant reduction in the likelihood of CRC death. Many don’t believe that this is representative of what happens in the U.S., where colonoscopy is more widely accepted as a standard screening protocol compared to European countries, and was a serious shortcoming of the study. In fact, when the individuals who did not get a colonoscopy were removed from the study, the risk of developing CRC among those who did get a colonoscopy reduced by an estimated 31% and the risk of death reduced by about 50%.
As Robin Mendelsohn, MD, co-director of the Center for Young Onset Colorectal and Gastrointestinal Cancers at the Memorial Sloan Kettering Cancer Center, argues “in order for a colonoscopy to be effective, you have to have it done”.
Andrew Albert, MD, a member of the Colon Cancer Foundation (CCF)’s Interdisciplinary Medical Advisory Council (IMAC), said, “While the NordICC trial demonstrates the need for challenging the status quo related to colonoscopy, this remains an effective screening tool, particularly for individuals at average risk who may be on the fence about going in for screening. Misinformation is dangerous, especially in healthcare. If we miss catching colorectal cancer at an early stage—which is what a colonoscopy is very good at—it can have a big impact on survival. We need to remember that CRC is preventable, and treatable when caught early.”
IMAC member Matthew A. Weissman, MD, MBA, FAAP, told CCF, “I hope that the findings of this study, which have been taken out of context by many, will not discourage folks from getting screened for colon cancer by colonoscopy or other appropriate methods, which is extremely important in early detection (and prevention) of this deadly disease.”
In an accompanying editorial in the same issue, experts point to the need for a longer follow-up time for the impact of screening colonoscopy to be realized. They also point out that the skill of the endoscopist conducting the procedure has a significant impact on the detection rate—29% of endoscopists in the trial had an adenoma detection rate below the recommended 25%.
Consequent to this study, the American Society for Gastrointestinal Endoscopy (ASGE) issued a public statement that colonoscopy remains the best and most proven way to detect and prevent CRC incidence and death. The American Cancer Society also weighed in on the study, pointing to the high number of participants who didn’t undergo the procedure. Adam Lessne, MD, a gastroenterologist at Gastro Health in Florida told VeryWell Health that “when you take away the limitations, it’s proven again that colonoscopies do save lives and they do reduce the risk of death.”
The bottom line is that a screening test of any kind—stool-based or colonoscopy—is better than none, and CRC is preventable with regular screening. For detailed information on various CRC screening methods and current screening guidelines, visit this page on the Colon Cancer Foundation’s website.
Kitty Chiu is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.
Medicaid Expansion May Have Improved Diagnosis of Early-Stage CRC
Health insurance coverage is an important determinant of access to health care. Most people in the U.S. receive health insurance through their employers and many others qualify for government insurance programs like Medicare (generally for those >65 years) or Medicaid (for low-income families/individuals). The 2010 Affordable Care Act mandated preventive screening coverage for those who are enrolled in Medicaid and provided support to participating states. A cross-sectional cohort study has now revealed that after Medicaid expansion in 2014, the proportion of patients diagnosed and treated at Commission on Cancer–accredited facilities increased within expansion states and decreased in non-expansion states.
This study evaluated whether the proportion of patients diagnosed with early-stage colorectal cancer (CRC) changed over time within states that expanded Medicaid, compared with non-expansion states. The authors queried the multicenter registry data from the National Cancer Database (2006-2016) and identified a total of 10,289 patients in expansion states and 15,173 patients in non-expansion states. They found:
Similarly, a study published in the Journal of American Surgeons also found that Medicaid expansion has had a notable impact on the diagnoses of early-stage CRC compared to non-expansion states.
Improved insurance coverage following Medicaid expansion may have facilitated access to screenings and earlier diagnoses.
For more information on insurance coverage for CRC screening, please visit: Insurance Coverage for Colorectal Cancer Screening.
Kitty Chiu is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.
Distance, Region, and Insurance Coverage Associated With Increased Risk of Advanced Colon Cancer
Early-stage colon cancer is treatable and has a very promising survival rate. However, less than 40% of new colon cancer diagnoses are early-stage disease. Now, a new study has identified an association of distance, region, and insurance coverage with advanced colon cancer at initial diagnosis. Utilizing the Nation Cancer Database, patients 18 years or older diagnosed with colon cancer as a primary diagnosis between 2010 and 2017 were compared in terms of distance to their medical facility, region of residence, and insurance coverage.
The study found that patients at an increased risk of advanced pathologic disease:
Sahar Alam is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.
Lessons Learnt: COVID-19 Pandemic Impacted FIT Testing in the Early Days
Globally, the COVID-19 pandemic has led to sharp declines in cancer screening rates. Screening tests were halted as national lockdowns began as healthcare centers needed to prioritize COVID-19 patients. A retrospective cohort study revealed that during the early days of the pandemic in 2020, fewer fecal immunochemical test (FIT) screenings and colonoscopies resulted in fewer patients being diagnosed with colorectal cancer (CRC) and advanced adenomas than in 2019. In April 2020, colonoscopy volumes were significantly lower than in April 2019, with a 26.9% decrease in colonoscopy volume. Overall, there was an 8.7% reduction in CRC cases diagnosed by colonoscopy in 2020. This has fueled concerns of a potential negative impact on cancer prevention and care.
The study mentioned above analyzed the effect of the COVID-19 pandemic on CRC screening and diagnostic testing among 18-89 year-olds enrolled in the Kaiser Permanente Northern California health plan in 2019 and 2020. Researchers measured changes in the number of mailed, completed, and positive FITs; colonoscopies; and cases of colorectal neoplasia detected by colonoscopy. Findings show that when the pandemic-related stay-at-home orders were issued in March 2020, there was a dramatic decline in FIT mailings. Similarly, in South Australia, retrospective analysis on surveillance colonoscopy in patients at high risk for CRC revealed that there was a 51.1% decrease in surveillance colonoscopy procedures from April–June 2019 compared to April–June 2020, the period where the region faced the most difficulty due to COVID-19.
The reduction in CRC screenings during the pandemic suggests that patients may have been reluctant or unable to undergo screening. Furthermore, challenges with pre-pandemic CRC screening were amplified during the pandemic. For instance, stress levels in the general population increased and those who may have skipped screening due to work obligations were more likely to miss setting up a colonoscopy during the pandemic. Fear of contracting COVID-19 may have been another barrier. Another issue that was evident during the pandemic was healthcare inequities that disproportionately impacted medically-underserved communities.
Given the massive delays in traditional methods of screening, healthcare centers had to develop alternative approaches to ensure continued screening after the initial wave of COVID-19, such as the increased adoption of telehealth services. For CRC screening, the use of FIT was arguably the best alternative to colonoscopy procedures during the COVID-19 pandemic. This remote option gives patients a lot of flexibility with their screening, as they are able to take the test safely in the comfort of their own homes.
These findings may help inform the development of strategies for CRC screening and diagnostic testing during future national emergencies.
Kitty Chiu is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.
Ryan Reynolds Documents a “Potentially Life-Saving” Colonoscopy After Losing a Bet
A friendly bet resulted in a potentially life-saving procedure for actors Ryan Reynolds and Rob McElhenney. Reynolds bet McElhenney that if he learned to speak Welsh, Reynolds would let a camera crew document him as he underwent a colonoscopy. In partnership with Lead from Behind, Reynolds documented and shared his experience on YouTube.
Both Reynolds and McElhenney turned 45-years-old this year. In May 2021, the US Preventive Services Task Force (USPSTF) revised the colorectal cancer (CRC) screening age for average-risk adults to 45 years instead of 50. Reynolds noted in his video description, “I made a bet. I lost. But it still paid off.” Reynolds’ colonoscopy, conducted by Jonathan LaPook, MD, a gastroenterologist with NYU Langone’s Colon Cancer Screening and Prevention Program, resulted in the detection and removal of an “extremely subtle polyp” on the right side of his colon. McElhenney also decided to undergo a colonoscopy, which resulted in the identification of three polyps. Dr. LaPook emphasized, “This [colonoscopy] saves lives. Pure and simple.”
Importance of Colorectal Cancer Screening
Colorectal cancer (CRC) is the third most diagnosed cancer and over 5 million people worldwide currently live with CRC. According to the American Cancer Society, the lifetime risk of developing CRC is 1 in 23 for men and 1 in 25 for women, and recent research indicates an increased incidence of CRC among individuals younger than 50 years of age. There will be an estimated 106,180 new colon cancer cases and 44,850 new rectal cancer cases in the United States in 2022. While CRC screening rates have significantly improved over the past 20 years, only 65%-70% of age-eligible individuals achieve screening nationally. Screening is a significantly effective and preventive method to detect CRC before it advances to an incurable stage.
When to Schedule a Colonoscopy
The American Cancer Society and USPSTF recommend screening should begin at 45 years for average-risk adults. Individuals who are at a higher risk of developing CRC may need to be screened earlier.
What to Expect During a Colonoscopy
A colonoscopy detects swollen, abnormal tissues, polyps, or cancer in the large intestine (colon) and rectum. Before a colonoscopy, patients are required to empty their colon by following a specific diet recommended by their doctor, taking a prescribed laxative, and adjusting any daily medications as instructed by their doctor. On the day of the procedure, a long, flexible tube (colonoscope) is inserted into the patient’s rectum under anesthesia. A tiny camera at the tip of the tube allows the doctor to view the colon. If polyps and abnormal tissues are detected, they can be removed during the colonoscopy itself, just like in Reynolds’ and McElhenney’s procedures. According to the American Society for Gastrointestinal Endoscopy, more than 40% of adults over the age of 50 years have precancerous polyps in the colon.
What Are Colorectal Cancer Symptoms?
CRC may not cause symptoms immediately. Screening is the most effective method to detect and remove polyps before they advance into malignant disease. Speak to your doctor if you are 45 or older, have a family history of CRC, or notice any abnormal symptoms.
Remember: CRC survival is 90% if detected at an early stage when the cancer is localized and has not spread to other sites or organs.
Sahar Alam is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.
Study Finds Risk-Stratified Colorectal Cancer Screening Is Feasible and Cost-Effective
Colorectal cancer (CRC) is the third most common cancer diagnosis and the second most common cause of cancer death globally. The American Cancer Society estimates that there will be 106,180 new colon cancer cases and 44,850 new rectal cancer cases in the United States in 2022. Early detection and consistent screening reduce CRC incidence and mortality. A recent randomized controlled trial that analyzed the feasibility, adherence, yield, and related costs of various screening modalities found that a risk-adapted approach is feasible and cost-favorable for population-based screening.
Current guidelines recommend standardized screening plans for specific age groups, with colonoscopy recommended every 10 years and a fecal immunochemical test (FIT) between 1-3 years. Implementation of risk-stratified screening can potentially allow for more frequent screening and earlier detection of CRC at a population level. This would especially be beneficial for individuals who are at higher risk of CRC. Additionally, risk-stratified screening can help health practitioners detect and introduce plans for CRC treatment at earlier stages.
The National Health Service Breast Screening Programme (NHSBSP) recently investigated the potential benefits, costs, and effectiveness of risk-stratified breast cancer screening with BC-Predict, a platform that collects self-reported risk factor information for breast cancer, analyzes the self-reported information, and invites high-risk or moderate-risk women to a conversation about prevention and early detection options. BC-Predict was found to have the potential to reduce breast cancer mortality due to early screening. It also reduced screening in women who are at lower risk, minimizing the number of false positive test results in lower-risk women. The results from this analysis are pertinent to risk-stratified screening for CRC and support the implementation of a risk-adapted approach in CRC screening.
What Did the Study Find?
More than 19,000 participants in the TARGET-C trial conducted in six cities in China were placed into one of the screening arms in a 1:2:2 ratio:
The detection rate of advanced colorectal neoplasia, CRC, and advanced precancerous lesions were the main outcomes that were monitored. The follow-up to trace the rate of advanced colorectal neoplasia for all participants was conducted over a 3-year study period.
Over three screening rounds, the participation rates for colonoscopy, FIT, and risk-adapted screening arms were 42.4%, 99.3%, and 89.2%, respectively. The costs to the for detecting one advanced neoplasm, presented as both Chinese Yuan (CNY) and US dollar, using a package payment format were:
These findings underscore the value of a risk-adapted approach for CRC screening for feasibility and cost-effectiveness, as well as for allowing for more frequent screening and earlier detection of CRC for individuals with a high or moderate risk for CRC.
Sahar Alam is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.
Ultra-Processed Foods a Risk Factor for Colorectal Cancer
Diet has been recognized as an important modifiable risk factor for colorectal cancer (CRC). In particular, diets consisting of high fats and carbohydrates, such as red and processed meats, are considered high-risk. Now, a large-scale cohort study among U.S. residents has revealed that high consumption of ultra-processed foods might increase CRC risk in men—the third most diagnosed cancer in the U.S..
For the past two decades, researchers have witnessed a significant increase in the consumption of ultra-processed foods, industrial ready-to-eat or ready-to-heat products high in refined sugars, refined starch, and trans fats. Ultra-processed foods currently contribute to 57% of the total daily calories consumed by American adults. A growing pool of evidence suggests that ultra-processed foods increase CRC risk by altering the composition and diversity of gut microbiota and increasing the risk of obesity. Some examples of these foods include bread and rolls, breakfast bars and cereals, hotdogs and other processed meats, packaged sweet snacks and desserts, jams and jellies, and condiments, among other things.
The above-mentioned study analyzed responses from over 200,000 participants—159,907 women from the Nurses’ Health Study (1986-2015) and 46,341 men from the Health Professionals Follow-up Study (1986-2014)—across three large prospective studies in the U.S. that assessed dietary intake. The follow-up period was between 24-28 years. At the time of study enrollment, none of the participants had any cancer diagnoses. Information on dietary intake, demographic characteristics, lifestyle factors, and medical conditions of the participants was obtained through food frequency questionnaires every four years.
Of the 206,000 participants who were followed for more than 25 years, the research team documented 1,294 cases of CRC among men and 1,922 cases among women. The study findings indicated that those who consumed the highest amount of ultra-processed foods had a 29% higher risk of CRC compared to those with the lowest consumption. However, this was not observed among women. Among women, the risk of CRC was positively associated with higher consumption of ready-to-eat or ready-to-heat mixed dishes. In contrast, higher consumption of yogurt and dairy-based desserts was linked to a reduced risk of CRC among women.
These findings support the importance of limiting certain types of ultra-processed foods for better health outcomes. Here are some additional resources on diet and lifestyle and how they can influence your colon health and overall wellness:
Kitty Chiu is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.
Image credit: Tim Toomey on Unsplash
ASCO 2022: Access, Education, and Adherence Important for Colorectal Cancer Screening
A series of abstracts presented at the 2022 Annual Meeting of the American Society of Clinical Oncology identified ways to improve access to colorectal cancer (CRC) screening, including for minority and underserved populations; compared different screening modalities for efficiency; and highlighted ways to improve the impact of screening programs at health centers. The infographic below provides a snapshot of these research findings.
Abstracts presented at the 2022 Annual Meeting of the American Society of Clinical Oncology.
Details on the studies and their findings can be found below:
Juhi Patel was a Colon Cancer Prevention Intern with the Colon Cancer Foundation.
New NCCN Guidelines Recommend Genetic Testing for All CRC Patients
Colorectal cancer (CRC) is the third most diagnosed cancer and over 5 million people worldwide currently live with CRC. According to the American Cancer Society, the lifetime risk of developing CRC is 1 in 23 for men and 1 in 25 for women, and recent research indicates an increased incidence of CRC among individuals younger than 50 years of age.
Recent research has revealed that a significant number of CRC patients with heritable genetic mutations remain undiagnosed under past genetic testing guidelines, which limited testing to specific age groups and forms of cancer. Now, the National Comprehensive Cancer Network (NCCN) has announced new guidelines that recommend germline multigene panel testing for all individuals with CRC ages <50, as well as consideration for germline multigene panel testing for those with evidence of mismatch repair deficiency in their tumor or a family history of CRC.
Robert Nussbaum, M.D., co-authored a letter to the NCCN to formally request universal germline testing for CRC patients to be added to the guidelines. He states, “As the medical community’s understanding of genetic links to cancer evolves, genetic testing guidelines must evolve with it.” Increased accessibility to multipanel genetic testing can extend the representation of medically underserved populations and reduce the exacerbation of existing disparities. Expanding guidelines for genetic testing for CRC can also help family members determine their risk for CRC, increase surveillance for early detection, discover curative treatments, and promote awareness of CRC for those at increased risk.
Universal Versus Guideline-Directed Targeted Testing for Hereditary Cancer
Genetic factors play a significant role in the risk of developing many forms of cancer. Identification of germline predisposition can notably determine and direct a more effective plan of care, treatment, risk-reducing interventions, cancer screening, and germline testing. A multicenter cohort study among 2,984 cancer patients compared universal genetic testing with guideline-directed targeted genetic testing based on clinical guidelines to examine the prevalence of pathogenic germline variants (PGVs) in cancer patients. One in eight patients had a pathogenic germline variant, but 48% of those cases would not have been identified with a guideline-based approach. This underscores the limitations of clinical and guideline-based risk assessment for genetic testing. The multigene panel was more efficient at identifying heritable variants compared to guideline-directed targeted genetic testing.
Importantly, identifying PGVs in cancer patients can encourage their relatives to take earlier action for risk assessment and cancer prevention. However, financial barriers and lack of insurance coverage can limit patient participation in genetic screening. This study points to the effectiveness of multigene panel testing and its implications for cancer prevention and treatment.
Sahar Alam is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.
Dr. Shahnaz Sultan: Pre-Endoscopy COVID-19 Testing Led to Disparities
The Colon Cancer Foundation had the opportunity to speak with Dr. Shahnaz Sultan, MD, MHSC, AGAF, about her research team’s findings that pandemic-related pre-procedure COVID-19 testing caused higher rates of endoscopy cancellations among patients from marginalized populations. A Professor of Medicine in the Division of Gastroenterology, Hepatology, and Nutrition and the Program Director for the Gastroenterology Fellowship Training Program at the University of Minnesota, Dr. Sultan’s research interests are focused on reducing colorectal cancer morbidity and mortality by improving adherence and quality of colonoscopy.
Q: What is the main takeaway you want people to understand from your research?
One of the most important things we want to emphasize is that colorectal cancer [CRC] is a very preventable cancer and there is a lot of high-quality evidence that shows that screening for CRC actually leads to a reduction in associated mortality. We really need to think about CRC screening along a continuum—whether you are doing stool-based testing or you’re getting a colonoscopy, it’s a multi-step process, and at every step, we need to be cognizant about reducing barriers and helping patients complete their CRC screening tests. Adding another step that patients have to complete prior to colonoscopy, such as pre-procedure SARS-CoV2 testing, in addition to completing their bowel prep, following dietary guidelines, finding transportation, and coming in to get a colonoscopy, really makes it that much more challenging. Pre-procedure testing serves as one more step and one more possible barrier in terms of getting people up-to-date with their screening.
Q: As you were conducting your research, were there any findings that surprised you?
Our objective here was to understand the impact of pre-procedure COVID-19 testing—we wanted to see the magnitude of the impact and who was specifically affected by this additional requirement. When we looked at the canceled outpatient endoscopy procedures in our cohort from March 2021 to September 2021, we were surprised that the overall cancellation rate was so high in terms of getting people to complete their colonoscopy. Among the 574 cancellations, a little under 10% were due to pre-procedure COVID-19 testing requirements, and a good proportion of the remainder, about 51%, were patient-initiated cancellations. There were a lot of additional factors that were potentially holding people back from CRC screening. Additionally, we were surprised that pre-procedure testing was disproportionately affecting certain populations. Persons who self-identified as Black, American Indian, Alaskan Native, or Hispanic were more likely to have testing-related cancellations.
Dr. Shahnaz Sultan
Q: Of the patients who canceled their colonoscopy, do we know if they went for an alternate form of testing for colorectal cancer, such as stool-based testing?
That’s an interesting question! We do not have that health data within our health system, but you bring up a good point. During the pandemic, a lot of other health systems were shifting gears from colonoscopy to stool-based testing and using programmatic efforts to directly reach out to patients to make sure they were getting some form of CRC screening.
Q: Healthcare challenges, such as the COVID-19 pandemic, have demonstrated to significantly disrupt CRC screening procedures and participation, especially for medically underserved communities. What steps can be taken or what policies can be implemented in the future to support CRC screening participation and prevent significant disruptions to CRC screening?
There is a lot of ongoing research to understand different barriers we can address or different interventions we can take to improve screening at the population level. We really need a multifaceted or multi-pronged approach to screening. We really need to think about interventions that not only focus on patients, but we also need to target providers, health systems, and community leaders, and think about national and federal policy decisions. I think there are a lot of opportunities to decrease barriers at different levels in terms of getting people to be more up-to-date with screening at a population level.
In terms of policy, one of the things that we have been able to fix recently is this loophole that existed in the past where if a test was done for screening purposes, but polyps were removed, then it was no longer counted as a screening test, and that incurred copayments and additional burdens on patients. I think that has been a real coup for us in the gastroenterology community and overall in terms of helping to support the care of our patients. Also, I think there are a lot of opportunities at the national level to support programmatic efforts to improve screening for populations that are underinsured or don’t have access to care, and I think we need to do more outreach and find ways to include health educators and patient navigators. We need to make sure we are educating patients about the importance of screening and helping address financial or logistical barriers that might serve as additional challenges for patients to overcome.
Continued on Page 2.