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Get the Facts on Colorectal Cancer and Recommended Screenings

check mark According to the Centers for Disease Control and Prevention (CDC), in the United States, colorectal cancer (CRC) is the third-most commonly diagnosed cancer and the second-most common cause of cancer death. In 2014, 51,651 people in the United States died from colorectal cancer, including 27,134 men and 24,517 women. 

Colorectal cancer kills about 170 Delawareans every year ( Colon Cancer Facts). The rate of deaths from colon cancer is 13.7 per 100,000 Delawareans ( Colorectal Cancer Rates by State). 

It is important to note that colon cancer deaths are, for the most part, preventable. A 2016 study titled Current noninvasive tests for colorectal cancer screening: An overview of colorectal cancer screening tests found that 60 to 70 percent of patients are found at middle- or late-stage CRC when they are diagnosed. The study found that approximately 60 percent of CRC deaths could be avoided and the average five-year survival rate could be increased from 46 percent to 73 percent if healthy people carry out a regular periodic screening each year. 

With increased awareness and knowledge of the variety of approved colorectal cancer screening tests, it is possible to decrease the number of deaths from colorectal cancer.

The United States Preventative Services Task Force (USPSTF) recommends screening for colorectal cancer starting at age 50 and continuing until age 75. It is possible to develop colon cancer at any age, though 90 percent of patients diagnosed with colon cancer are 50 and older ( You can prevent colon cancer by getting screened). Following the USPSTF recommendations regarding colorectal cancer screening will help to decrease cancer deaths by not only finding cancer in its early stages, but by preventing polyps from becoming cancerous.
Fecal Immunochemical Test Offers Patients an Alternative to Colonoscopies

patient visit The CDC's Colorectal Cancer Screening (CRCS) tests describes how the fecal immunochemical test (FIT) works. The fecal immunochemical test uses antibodies to detect blood in the stool. FIT is performed by collecting small amounts of stool in a tube or on a card. The sample is then sent to a lab, which analyzes the sample for the human hemoglobin protein.

Patients may be more inclined to have a CRCS if they are offered alternatives to a colonoscopy, such as the FIT. According to an article posted on the National Center for Biotechnology Information website,  Patient-Reported Barriers to Colorectal Cancer Screening , an open-ended questionnaire of why people do not have a CRCS revealed that  the most commonly reported barriers include: fear, unpleasant prep, lack of knowledge, and pain.  Offering a FIT test can eliminate three of the top four of these barriers to having a colonoscopy.

The provider's role in educating patients about not only the importance of having a CRCS, but also reviewing the screening options that are available, is pivotal to increasing screening rates.
Fecal Immunochemical Tests (FIT) vs.Guaiac-Based Fecal Occult Blood Test (gFOBT): What is the Difference?

question mark Both the FIT and gFOBT tests are similar in the way that the samples are collected, the length of time suggested between tests, and in that a lab is searching for occult blood in the stool. The major difference in these tests is the level of specificity in which CRC can be detected.  Current noninvasive tests for colorectal cancer screening: An overview of colorectal cancer screening tests explains why the FIT test is a better option for patients:

"...the gFOBT relies on peroxidase-like activity between heme and guaiac, which can be affected by many factors in daily diet without distinguishment between upper and lower gastrointestinal (GI) tract bleeding, while the FIT test targets the hemoglobin in the lower GI tract, as hemoglobin from upper GI tract will be degraded when it arrives at lower GI tract. This characteristic allows FIT test to specifically detect the bleeding from lower GI tract, and therefore detect the diseases with bleeding, such as adenoma, polyps, inflammatory diseases and CRC, etc . As the gFOBT test has many drawbacks in CRC screening, FIT is used more commonly in current CRC screening."

Due to high sensitivity, specificity, and low costs, FIT has replaced gFOBT and has become the major screening test for CRC. It is the cheapest method with high screening validity available.
infographic helps determine best crcs option for each patient

There are several factors that should be evaluated when selecting a CRCS option for a patient. The CDC has developed the Choosing the Right Test infographic to guide healthcare providers and patients in deciding which test is best for the patient, a FOBT/FIT or colonoscopy, based on specific  risk factors. The risk factors include family history of CRC or polyps, personal health of inflammatory bowel disease, and age. 

This resource also provides key facts and things to consider for both tests. 

Quality Insights encourages you to post this infographic on your website and patient portal. We also suggest printing it out and posting it in your exam rooms to serve as a tool to initiate a conversation about CRCS and to make it easily accessible to use it to determine which test is a better fit for the patient.
Find Out How Your Practice Can Increase CRCS Rates by Implementing a FluFIT Program

patient and daughter A research tested intervention program (RTIP), the FluFIT Program increases access to CRCS. The patient is offered a FIT when they come to the office for their annual flu vaccine. The program increases CRCS  rates by communicating and reminding patients of its importance.

Reasons why should you implement the FluFIT program?
  1. Annual colorectal cancer screening tests are underused
  2. Annual flu shot activities are an opportunity to reach many people who need colorectal cancer screening
  3. FIT kits can be given to patients by flu shot clinic staff
  4. FluFIT programs increase colorectal cancer screening rates
  5. FluFIT Programs can be a first step toward other innovative preventive health and screening interventions
Now is the Time to Plan for Next Flu Season
Quality insights can assist your practice in implementing a FluFIT campaign which would count as one of your two EDIs for the program. Please ontact Sarah Toborowski for additional information.
learn more about Screening for colon cancer

Dr. Edward Sobel, Quality Insights Medical Director, recently hosted an educational webinar to take a deeper dive into the importance of colon cancer screening. He shared some valuable colon cancer facts, discussed some disparities in the testing options that are currently available and the impact of colon cancer. Dr. Sobel also reviewed appropriate testing, as well as  tests that are NOT recommended. 

Webinar Highlights Processes to Ensure Colonoscopy Follow-Up After FIT

e-learning An important component of using a FIT as a CRCS test is to make sure that patients who have a positive result are scheduled to have a follow-up colonoscopy. 

The National Colorectal Cancer Round Table hosted a webinar, Processes to Ensure Colonoscopy Follow-up, to educate providers.  Click here to view the webinar.
Earn Free CME and Learn About Optimizing CRCS

CME An important component of using a FIT as a colorectal cancer screening test is to make sure that patients who have a positive result are scheduled to have a follow-up colonoscopy. 

The National Colorectal Cancer Round Table hosted a webinar, Processes to Ensure Colonoscopy Follow-up, to educate providers.  Click here to view the webinar.
contact information

For more details about the Cancer Quality Improvement Project , please contact Sarah Toborowski.

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Developed by Quality Insights on March 29, 2018. Publication number DEDPH-CRCS-032918