- Researchers say mailing people reminders as well as home test kits can improve colon cancer screening rates.
- Colon cancer is treatable in its early stages, but it becomes more deadly in later stages.
- Experts say socioeconomic conditions as well as health insurance status can discourage people from getting screened.
Discovering colon cancer in its early stages significantly improves treatment and survival rates, according to experts.
But about one-third of eligible people in the United States are past due for screenings.
A new study published in the journal Cancer concludes that mailing colon cancer screening kits with reminders is a cost-effective way to increase the likelihood of screening for the second leading cause of cancer death in the United States behind only lung/bronchus cancer.
The study examined the number of screenings over a one-year period and compared rates between those who were sent only a reminder and those who were sent a reminder plus a fecal immunochemical test (FIT) kit.
The FIT kit checks for hidden blood in the stool, which can be an early sign of cancer.
Those who were sent the kit had greater screening rates (23 percent) compared to those who received only reminders (16 percent).
What experts have to say
Dr. Durado Brooks, MPH, the vice president of cancer control interventions at the American Cancer Society, says a large number of studies show that mailing FIT kits is an effective approach to increasing colorectal screening rates.
“This particular approach coming out, a reminder alone and encouraging people to get screened, versus a reminder plus including the FIT kit, is a wrinkle that they added trying to demonstrate that sending the kit instead of making people do extra work by telling them, ‘You should get this done,’ … is a more effective way to get people screened,” Brooks told Healthline.
“People tend to choose the path of least resistance, even when it comes to healthcare,” added Dr. Laura Porter, the medical affairs senior consultant at the Colorectal Cancer Alliance.
Porter explains that since colorectal cancer often begins to develop with few, if any, symptoms, we often hear about athletes, vegetarians, and people in the prime of their lives who are diagnosed with the late-stage version of the disease.
“Encouraging colorectal cancer screening tests, and possibly catching it early, is certainly a more frugal strategy than waiting until a patient has full-blown symptoms and finding a later-stage disease, which is more difficult and costly to treat,” she told Healthline.
Reasons people delay screenings
The American Cancer Society now recommends that screening for colon cancer begin at age 45.
However, as with any other preventive healthcare test, the age at which you should begin screenings depends upon several factors.
If you are in a higher risk group, for example, or have a family history of colorectal cancer, then screenings should begin earlier.
But beyond choosing the path of least resistance, there are several societal and socioeconomic factors preventing people from getting regular screenings.
“There is this perception for a lot of individuals that the only test available is colonoscopy,” said Brooks. “Obviously, the study shows that’s not true.”
This is where the FIT kits can make a difference.
“There are a number of different stool tests, actually, and other tests that are effective, but many people think colonoscopy is the only test and they think, ‘I don’t want that test,’ or, ‘I don’t really have access to that test,’ and therefore they go unscreened,” said Brooks.
“Colorectal cancer is associated with a strong stigma about what it means and how it develops,” added Porter. “These beliefs are unfounded, but they still compel people to ignore their colon health until it’s too late.”
“It’s a number of different kinds of challenges,” notes Brooks. “For certain groups, we’ve actually done a pretty good job. … For people who are college-educated, rates are approaching 80 percent. For the Medicare population rates are near 80 percent.”
“When you start looking at other groups, then you see fall-off. Some of it is simply age-related. People in their 50s for instance are significantly less likely to be up-to-date with screening than older individuals,” he said.
“There are lower screening rates, for instance, in some minority populations,” he added. “African Americans have done better in recent years, although their rates still lag in a lot of states behind the white population.”
“Many African Americans are disadvantaged in the United States across so many facets of life and colorectal cancer screening is one of those important healthcare issues that is often lost among other pressing concerns,” added Porter.
“There’s very much an economic and education breakdown, so people who have lower education and people who have lower income are significantly less likely to be screened,” said Brooks. “And then insurance is a huge barrier.”
Brooks explains that screening rates for people without insurance are about half that for the overall insured population.
“So simply providing insurance doesn’t fix that, but if you take away insurance, rates will plummet,” he said. “Which means our current situation nationally is a huge concern for those of us in the colorectal cancer community.”
Brooks said he saw an estimate last week that more than 5 million people in the United States have lost their employer insurance over the past few months due to the economic conditions under COVID-19.
“So, a lot of people are going to be very challenged to be screened,” he said. “Now, part of the issue is also because primary care clinicians, quite frankly, aren’t doing everything they can to really educate their patients about the importance of screening.”
“The fact that screening is associated not just with finding cancer early, but preventing cancer, is something a lot of people don’t know,” said Brooks.
Mailed FIT kits provide some hope in this situation.
“A FIT test, as a first line of defense against this disease, is neither difficult nor expensive, especially when it’s being mailed directly to you for free,” said Porter.
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