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Colorectal Cancer Screening: A Menu for Success
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Colorectal cancer screening is a huge topic for gastroenterologists. It’s at the core of what we do; colonoscopies and colon cancer screenings are a pivotal aspect of our practice so it is incumbent upon members of our specialty to be up to speed on our options.
I firmly believe that colonoscopy remains the number one choice because one is not only diagnosing, but also treating and thereby actually reducing that patient’s cancer risk for the future. Still, we must have back-up options. Clearly having alternative screening opens up screening for patients who otherwise would not follow through.
We cannot become embattled in the how. We must focus on helping our patients. The goal is to reduce colon cancer related deaths. The best way to do that is — as our experts in the Cover Story say — to have a “menu” of colon cancer screenings and allow a patient to choose what is comfortable for him or her.
Many of us already have anecdotes of patients who said, “No way, no how am I ever going to have a colonoscopy.” But they still wanted to have colon cancer screening. These patients underwent Cologuard or FIT testing and the positive result from one of those tests was enough to change their minds and then pursue a colonoscopy. Significant findings on that exam give us a gratifying solution. By having another screening option on your “menu,” you were able to convince the patient to get screened, an advanced adenoma was removed, and a cancer may have been prevented.
It’s not difficult to stay on top of these screening technologies. In practice, if we keep up with a couple of these options, we can feel comfortable that we are covering the bases for our reluctant patients.
Additionally, in the Cover Story, Jonathan A. Leighton, MD, explains that CT colonography is available in many centers and that is a great adjunctive piece to have available for an colonoscopy. In some cases, you may be able to do the colonography that same day and save your patients another bowel preparation.
If you just describe these alternative non-invasive options that don’t have a vigorous prep, patients are quite receptive. It sells itself because the patient realizes the benefits.
It’s important to note that for FIT testing to really be effective, it needs to be done every year. It’s not just one and done. Cologuard offers intermittent testing that may work better for some patients.
As said by a couple of our experts, “The best test is the test that actually gets done.” We must tailor our options to our patients. Colonoscopy is the gold standard and should be our first choice, but do not give up if a patient declines that preferred method of screening.
Lastly, we also must educate the primary care providers who work with us to also offer these options. By definition, if a patient is reluctant to have a colonoscopy, they likely won’t be talking to us as gastroenterologists. Our job is to educate those primary care providers about these options and then they can discuss and convince the patients of these.
If you have the opportunity to further educate these providers via lectures or grand rounds, please take that chance for the health of your communities.
As always, please join us at Healio.com/GI and on Twitter at @HealioGastro and @EdwardLoftus2 for ongoing discussions of how you handle colorectal cancer screening in your practice.
Disclosure: Loftus reports consulting for Janssen, Takeda, AbbVie, UCB Pharma, Amgen, Pfizer, Celgene, Gilead, Eli Lilly, CVS Caremark, Celltrion Healthcare, and Napo Pharma; and research support from Janssen, Takeda, AbbVie, UCB Pharma, Amgen, Pfizer, Celgene, Gilead, Robarts Clinical Trials, MedImmune, Allergan, Genentech, and Seres Therapeutics.