NIH Panel Concerned about Barriers to Colon Cancer Screenings

A National Institutes of Health (NIH) State of the Science panel recommended Thursday that healthcare needs to identify better ways to stop colorectal cancer. The panel noted that while guidelines have supported the value of getting screened for colorectal cancer, the disease still remains the second leading cause of cancer related deaths in the United States.

"We recognize that some may find colorectal cancer screening tests to be unpleasant and time consuming. However, we also know that recommended screening strategies reduce colorectal cancer deaths," said Donald Steinwachs, MD, the panel chair, and professor and director of the Health Services Research and Development Center at Johns Hopkins University in Baltimore. "We need to find ways to encourage more people to get these important tests."

Overall, rates of screening for colorectal cancer have been consistently lower than for other types of cancer—particularly breast and cervical cancer. Although the screening rates among adults 50 or older have increased from 20% to 30% in 1997 to nearly 55% in 2008, the rates are still too low, the panel said.

The panel, meeting at the NIH campus in Bethesda, MD, found that the most critical factor associated with screenings were having insurance coverage and access to a regular healthcare provider. The recommendations highlighted the need to remove out of pocket costs for screening tests.

A number of interventions, though, have been found to improve colorectal screening rates, Steinwachs said at a briefing on the recommendations. These interventions include the use of patient reminders, one-on-one communications with patients and providers, and facilitated follow-ups with patient navigators.

Also, keeping in mind the variety of tests available, the panel said that providers should consider an individual's personal preferences to help reluctant patients determine which tests they'd prefer. This means looking at factors such as invasiveness, frequency, and required preparation combined attributes. For example, an individual may choose a more invasive test that requires less frequent follow up, or a less invasive test that requires more frequent follow up.

Differences were detected as well in screening rates across racial and ethnic groups, socioeconomic status, and geographic location. Compared with non Hispanic whites, Hispanics are less likely to be screened.

The panel also noted that if efforts to increase messages are successful, the demand for colorectal cancer screening services will rise. "Available capacity" involves not only facilities and appropriately trained providers, but also support for informed decision-making.

The conference was sponsored by the NIH's Office of Medical Applications of Research and the National Cancer Institute along with other NIH and Department of Health and Human Services components. The 13-member conference panel included experts in the fields of cancer surveillance, health services research, community based research, informed decision making, access to care, healthcare policy, health communication, health economics, health disparities, and epidemiology.