HealthMarch 26, 2024

The new era of colon cancer screening is defined by personalization

As colon cancer rates increase among younger populations, advancements in testing and digital education offer proactive opportunities for care management teams and providers to help members and patients.

Colorectal Cancer Awareness Month: Rising risk of colon cancer in younger populations

Healthcare professionals at Yale Medicine are reporting seeing patients as young as 18 with colorectal cancer (CRC). The face of colon cancer is changing — and administrators can work with clinicians to turn this change into an opportunity during Colorectal Cancer Awareness Month.

Rates of colon cancer are increasing among some unexpected populations, but at the same time, advancements in testing and patient communication mean that leadership can respond and take advantage of shifting dynamics. This step will require leveraging technology, exploring personalized cancer screening options, and helping providers understand the key role they play in turning the tide on this highly preventable disease.

Why colon cancer screening is key to improved outcomes

It’s likely that as many as 90% of colorectal cancers and deaths are preventable through a combination of screening and lifestyle modification. Colonoscopies alone are associated with an almost 70% decrease in new cases of colorectal cancer and as much as an 88% drop in deaths from the disease. Maintaining and improving these numbers requires healthcare professionals to take advantage of their role as key influencers in patient decision-making and improving rates of adherence to the screening step.

Studies from the UK (focused on screening by sigmoidoscopy) and the U.S. (colonoscopy) show that even infrequent or one-time screening can produce long-term benefits. Over time, screening rates have been trending in the right direction — the percentage of American adults who have never been screened dropped from 27.4% in 2012 to 21.6% in 2020.

Today, clinicians and care managers can discuss a much wider range of options and new perspectives on colon cancer prevention with their patients and health plan members. While colonoscopy is the gold standard of examination in many regions, studies have demonstrated that it might no longer stand out as the optimal method of screening. Other options or complements (for average-risk patients) include annual or biennial fecal occult blood tests in addition to conducting a flexible sigmoidoscopy every five years — a combination that has been found to be as effective, and in some cases, superior to colonoscopy once every 10 years.

Supporting a personalized approach to colon cancer screenings

Addressing colon cancer and screening options is a collaborative effort between healthcare professionals and patients or members – one where patient-specific paths of screening, evaluation, and testing feature personalized cancer screenings and conversations that align with individual patient needs.

Clinicians and care managers need the right tools and content to take full advantage of their position as trusted advisors in colon cancer prevention. Healthcare professionals should recommend colon cancer screening based on most recent evidence-based guidelines for both high- and average-risk patients. They will need support in addressing the most significant challenges to patient compliance, including stress reduction and facilitating increased patient comfort with bowel preparation and the inherent vulnerability of the procedure.

One of the most important physician considerations is individual patient expectations for receiving information — keeping in mind that patients want guidance from their care providers and can have preferences for care professionals being the primary decision-makers in their care choices.

Reducing no-shows through personalized communication

No-shows can be a difficult challenge for colorectal cancer screenings, particularly in gastrointestinal practices, where rates are higher than other specialties. This is frequently due to anxiety over the procedure and its preparation. But digital-first engagement programs can be used to support a personalized approach to care.

A recent study on digital navigation for bowel preparation found that text messages improved the quality of colorectal cancer screening by reducing no-show rates and improving preparation rates compared to usual care. A 2023 study additionally found that telephone should be added to electronic communication to reach groups with lower income levels and education. This can be an effective tactic in reducing CRC no-shows in certain groups. Predictors for no-shows of endoscopic gastrointestinal procedures include unpartnered status and having a non-commercial insurance provider.

Personalized paths feature new options in colon cancer screening and colonoscopy prep

Screening rates can also benefit from raised awareness of alternative options in screening and colonoscopy prep, including a new fecal immunochemical test (FIT), artificial intelligence (AI), and pills for bowel preparation.

FIT has become a popular option with patients but has struggled with issues around detecting advanced adenomas and advanced serrated polyps. An alternative, the antibody-based multitargetFIT (mtFIT), exhibits increased sensitivity that could position it as a viable option for certain patient groups. AI-assisted colonoscopies have also reduced the miss rate for colorectal neoplasia by 50%.

The emergence of broader options for patients is an opportunity for clinicians and care managers to have deeper discussions about colonoscopy prep — a hurdle that, if addressed, could support positive outcomes. In the past, patients had to drink almost a gallon of laxative fluids at once to prepare for the procedure. Today, patients and members have options that are not only more palatable, but that can be broken into smaller doses and stretched over two days. Many patients also prefer pill prep over traditional liquids.

Other options for improving screening rates could include increasing awareness of sedation-free colonoscopy. While sedation is the norm in the U.S., Singapore, and Hong Kong, in Finland only 6% of colonoscopies are performed with sedation. In Italy, 45% of patients did not have sedation or analgesia during their colonoscopy. China uses sedation in around 18% of procedures.

Leveraging Colorectal Cancer Awareness Month

Finding new methods of improving screening numbers is especially important considering rising risk in younger populations. The American Cancer Society reports that 20% of diagnoses in 2019 were in people under 55, a number that’s doubled since 1995.

Realizing the full benefit of early detection of colorectal cancer will require that physicians have access to a robust range of options in communication, preparation, and content around cancer prevention and awareness. Colorectal Cancer Awareness Month is an excellent time to start building out your patient engagement and partnership toolbox.

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