On March 4, 2016, to mark the eighth annual Dress in Blue Day, the University of Colorado Cancer Center set up a table in the lobby of the University of Colorado Hospital stocked with blue balloons, blue candy, and blue information packets to raise awareness for colorectal cancer. Over 100 people stopped by the table to chat with the CU doctors, researchers and other experts. One of these people was a woman in her mid-50s named Becky. Holding back tears Becky admitted that she has never been screened for the disease because she is afraid of what the test might find. Other reasons people gave for missing their recommended screenings included forgetting or putting off scheduling an appointment and feeling ashamed about talking with their doctor about that particular part of the body.
Colorectal cancer claims 50,000 lives each year, but the reality is that many of these deaths could be prevented. Screening for the disease often catches it early, when many good options for treatment still exist. Unlike many other cancers, screening can even prevent colorectal cancer from developing.
Enter the elephant in the room: Due to stigma, fear, and good old procrastination, people are dying of a preventable disease.
In fact, one in three adults between the ages of 50 and 75 – about 23 million people in the United States alone! – are not getting the recommended screening according to the National Colorectal Cancer Roundtable (NCCRT), a national coalition dedicated to reducing the incidence and mortality of colorectal cancer in the U.S.
“This is a huge public health issue because people are being diagnosed with colorectal cancer when they could have prevented it in the first place,” says Dennis Ahnen, MD, investigator at the CU Cancer Center and a steering committee member of NCCRT.
Evidence shows that screening impacts both the incidence and mortality rates of colorectal cancer, meaning that not only does screening catch early cancers in a treatable stage, but screening also discovers conditions that would lead to cancer down the road – with treatment, many of these patients will never develop cancer at all. While not everyone who should be screened completes the procedure, screening rates are up and, according to the American Cancer Society, this has been a major factor in the 30 percent decrease of colorectal cancer diagnosis and deaths in the last ten years among adults 50 and older.
“Screening for the disease works,” says Ahnen. The most well-known screening option is a colonoscopy. “This procedure is more effective than lung and breast cancer screening because it can actually prevent colorectal cancer by removing polyps.”
A colonoscopy procedure is just one of three different options that people can use to screen for the disease. In it, a flexible, lighted tube is used to look at the interior walls of the rectum and the entire colon. When physicians discover pre-cancerous polyps, they can remove the tissue before it has a chance to create the disease. The American Cancer Society recommends a colonoscopy once every ten years starting at age 50, or more often if you have a higher risk of developing the disease (ask your doctor). Other screening options include a high-sensitivity fecal occult blood test (FOBT) or fecal immunochemical test for blood (FIT), both which check for hidden blood in stool samples, or a sigmoidoscopy, in which physicians use a tube to look at the rectum walls and part of the colon. These tests are followed by a colonoscopy if a positive test occurs.
So, with these recommendations, the usefulness of screening, and the many options to accomplish it, why is there still an elephant in the room? Why are nearly 137 people a day losing their lives to a preventable disease? Again, the answer goes back to fear, stigma and procrastination.
“There are many reasons why this may be happening,” says Ahnen. “Lack of trust, lack of education, not having insurance, fear of the procedure, or fear of what might be found can stop people from scheduling their exam.”
In order to increase the national screening rate and combat the reasons people are not getting screened, the NCCRT has initiated the 80 Percent by 2018 Campaign. According to the NCCRT, “80% by 2018 is an initiative in which hundreds of organizations have committed to substantially reducing colorectal cancer as a major public health problem for those 50 and older. These organizations are working toward the shared goal of 80 percent of adults aged 50 and older being regularly screened for colorectal cancer by 2018.”
The initiative launched in the fall of 2014. CU Cancer Center member Holly Wolf, PhD, MSPH, was on the NCCRT steering committee at the time.
“Because of advancements in the science of treating the disease, we knew we had an opportunity to make a difference in colorectal cancer, but we had to make sure we were screening people to find it,” Wolf explains.
Wolf, along with other members of the NCCRT steering committee, helped to develop a new strategic plan to reach consumers, improve screening delivery systems, make sure that people know their rights to screening under the Affordable Healthcare Act, and celebrate people that pledged to the campaign. The result is a multi-step plan to help reach the 80 Percent national screening rate by 2018. Some steps include educating and engaging clinicians, insurers, employers, and the general public, making sure that colonoscopy is available to everyone, making sure everyone is offered a stool blood test option, recruiting as many partner organizations to join the effort as possible, and implementing intensive efforts to reach low socioeconomic populations.
“We are aware that it is a very ambitious goal to raise national screening rates by 35 percent in four years, but we believe that
it can be done. As screening rates rise, colorectal cancer rates are dropping and we hope this provides the incentive people need to go out and get it done,” Wolf says.
All over the United States hundreds of organizations including health care centers, hospitals, insurance companies, employers, and cancer coalitions have already signed the pledge created by the NCCRT stating that they are embracing the goal of 80 Percent by 2018. Leading the charge in Colorado is the Colorectal Cancer Task Force of the Cancer Coalition of Colorado.
To ensure that organizations can meet their goals, the NCCRT offers toolkits that provide groups with evidence based action steps to take immediately rather than losing a lot of time thinking and talking about what they can do.
“For example we are talking to insurance companies about stopping co-payments for screening and encouraging physicians to make screening a standard of care,” says Wolf.
Patient navigation will also play a huge role in meeting the 80 Percent by 2018 goal. Andrea (Andi) Dwyer, who was recently appointed to the advisory board of the NCCRT, and is a steering committee member of the NCCRT, helped create the national model of patient navigation, which is used by hospitals and health care centers all over the United States. Patient navigation includes not only helping patients and the best treatment, but following patients along the care continuum, from diagnosis to survivorship. Dwyer and Wolf led the nation in implementing a patient navigation program for colon cancer screening in Colorado a decade ago.
“It made sense for me to get involved with the campaign because I am very familiar with making sure people know about preventive screening and getting them to the best care,” Dwyer says.
Denver itself has gotten behind the 80 Percent by 2018 effort. The capitol building and the 100 foot tall spiral steel sculpture in the Denver Technological Center have agreed to turn blue in March, local health fairs are encouraging screening, radio ads in both English and Spanish are being aired all over the state, and don’t miss this year’s Undy 5000 fun run, presented by the Cancer Center and the Colon Cancer Alliance on June 25!
If Ahnen, Dwyer, Wolf and the hundreds of other doctors, researchers and organizations can address the elephant in the room and reach 80 percent screening by 2018, by 2030 the effort will have prevented 277,000 cases of colorectal cancer and saved 203,000 lives. But even more than these doctors, reaching the goal depends on you. What will you do? Will you let fear, stigma and procrastination prevent you from getting screened? Or will you take the elephant by the trunk and become part of the 80 percent that reduces your chance of becoming a colorectal cancer statistic?