Awareness Is No Longer Enough: Fighting Colorectal Cancer

The Pulse | Friday, March 5, 2021

By Loralee Kelsey MSN, RN, CGRN

We have been fighting against colorectal cancer since I joined the profession as a nurse 30 years ago, and yet it still remains the second leading cause of cancer deaths in the United States, with an estimated 148,000 diagnoses and 53,000 deaths annually (ACS, 2020).

Colorectal cancer rates have been reported to be decreasing since the 1980s due to an increase in smoking cessation and screening rates (ACS, 2020). However, not everyone benefits equally from screening. SGNA encourages its members, partners and the health care community to work together to break down barriers and target populations with screening disparities.

SGNA is committed to eradicating colorectal cancer (SGNA, 2021) and collaborates with several colorectal non-profit organizations to that end. Collective efforts with like-minded organizations will help break down barriers and increase screening rates at the regional and national level. These organizations can be found on the SGNA advocacy page and includes the 80% in Every Community campaign through the National Colorectal Cancer Round Table (NCCRT).

The NCCRT was established in 1997 by the American Cancer Society (ACS) and the Centers for Disease Control and Prevention (CDC). Its mission is to reduce the incidence of mortality from colorectal cancer in the United States through “coordinated leadership, strategic planning and advocacy” (NCCRT, 2020). The 80% by 2018 campaign, joined by thousands of individuals and organizations, was extremely successful with an additional 5.1 million people screened from 2012-2016. The current campaign, 80% in Every Community, seeks to build on that effort by targeting disparities identified in screening populations, including younger people, low income communities, certain racial and ethnic communities, and rural and geographical locations.

Keeping an Eye on the Young Adult Population

While the incidence in colon cancer is decreasing in men and women combined, incidence in younger adults is on the rise (ACS, 2020). Between 2008 and 2017, death rates declined by 3% in individuals older than age 65, decreased by 0.6% in those age 50-64 years, but increased by 1.3% per year in younger people less than age 50. Death rates are higher in the younger population due to delays in diagnosis contributing to 26% having metastatic disease by the time of diagnosis (ACS, 2020).

The American Cancer Society recently changed their recommendation for colorectal screening to start at age 45 for all individuals (ACS, 2020), but governmental and gastroenterology societies are slower to adopt. Alarming symptoms in persons under the age of 50 should be taken seriously and testing completed. Timely diagnosis of younger adults is critical in diagnosing and treating colorectal cancer in its earlier stages.

Overcoming Barriers in Underserved Populations

Income also plays a role in the incidence of colorectal cancer in the United States. Underinsured and uninsured individuals are less likely to be screened for colorectal cancer. Fewer resources make it more difficult to address modifiable risk factors of diet, physical activity, alcohol use and smoking. Interventions such as navigational services for colonoscopy have been researched with mixed results but show significant promise. One study conducted by Rice, et al. in 2017 showed an increase of completed colonoscopies of 96.2% compared to 69.3% in the control group, with improvements noted in bowel prep quality, no show and cancellation rates.

Increasing screening rates in this underserved population will take a multifactor approach and will require removing structural barriers such as child care needs, transportation, extended service hours and measures to reduce out-of-pocket costs. These could all help improve screening rates in this population (CDC).

The incidence in colorectal cancer started declining in the 1980s for non-Hispanic whites (NHW) but remained stable for African Americans. Today, colorectal cancer rates range widely in various racial and ethnic communities. From 2012-2016, the incident rates for NHW were 39/100,000, compared to African Americans of 46/100,000 and 89/100,000 Alaska natives.

While the incident rates for African Americans are 20% higher than NHW, the death rate is 40% higher. This racial disparity is attributed to less screening in the African American population and lower survival rates per cancer stage (ACS, F&F, 2020). Efforts should focus on building trust within the community and providing screening options that fit within the populations’ capacity and preferences.

Rural communities have unique barriers and less access to health services, as well. People living in rural communities are more likely to pay for healthcare out-of-pocket and are less likely to complete colorectal screening than their urban counterparts. Barriers include transportation issues, fewer healthcare providers, lower literacy rates and poverty, to name a few (NCCRT, 2009). The CDC reports that rural Americans tend to have a higher rate of modifiable health risks, including obesity, smoking and high blood pressure, with fewer healthcare resources — all of which negatively impact health outcomes (2021). Plans to increase screening in rural communities should be flexible, inclusive and seek to address barriers of this population.

How We Can Take Action

March is Colorectal Cancer Awareness Month, but we are long past the need for awareness alone. Action is required to improve screening rates and address screening disparities within our communities. There are a number of ways SGNA members can participate in this effort:

Encourage your organization to take the pledge and join the 80% in Every Community initiative
Perform a needs assessment in your community
Work with your organization’s leadership, marketing and public relations departments to communicate the importance of colorectal screening
Share with primary care providers the screening disparities and screening tests available with the understanding that the best test is the one that the person is willing to do
Partner with public health departments, community leaders and faith-based organizations to address barriers and create a screening plan in your community
Join and/or volunteer for colorectal advocacy organizations
Spread the word through social media
Share your story with SGNA by emailing The Inside Tract at editor@sgna.org

Sharing your story with the SGNA membership about screening initiatives and successes will encourage others and stimulate ideas that can build into something great. It takes all of us to eliminate disparities and improve screening rates and we look forward to hearing your ideas for attaining the shared goal of 80% in Every Community.

References

American Cancer Society. (2020). Colorectal Cancer Facts & Figures 2020-2022. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2020-2022.pdf

American Cancer Society. (2020). Colorectal Cancer Burden Shifting to Younger Individuals. http://pressroom.cancer.org/CRCStats2020

Center for Disease Control and Prevention. (2021). Rural Communities. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/other-at-risk-populations/rural-communities.html

National Colorectal Cancer RoundTable. (2020). Post Summit Report: May 2009 Rural Health Summit. http://nccrt.org/wp-content/uploads/NCCRT-Rural-Health-Summit-Columbia_Summary-Report.FINAL_.pdf

Rice, K., Gressard, L., DeGroff, A., Gersten, J., Robie, J., Leadbetter, S., Glover-Kudon, R., & Butterly, L. (2017). Increasing Colonoscopy Screening in Disparate Populations:Results From an Evaluation of Patient Navigation in the New Hampshire Colorectal Cancer Screening Program. Cancer, 123, 3356-3366. https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/cncr.30761?purchase_referrer=links.govdelivery.com&purchase_site_license=LICENSE_DENIED_NO_CUSTOMER&r3_referer=wol&show_checkout=1&tracking_action=preview_click

Society of Gastroenterology Nurses and Associates. (2020). Colorectal cancer screening and awareness. https://www.sgna.org/Advocacy