Are Doctors Recommending Enough Colorectal Cancer Screenings?

A recent investigation has raised the alarm over an apparent absence of screening recommendations for people who are overdue for colorectal cancer tests. The study, which looked at a cohort of over 5,000 adults who were due for colorectal cancer screening, found that less than 30% of patients received a recommendation for screening during their wellness visit, with this rate dropping to less than 15% among those who did not have a regular source of care and those who were uninsured (1^✔ ✔Trusted Source
Receipt of Clinician Recommendation for Colorectal Cancer Screening Among Underscreened U.S. Adults

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“Although clinicians overwhelmingly report that they recommend [colorectal cancer] screening to average-risk patients, limited data exist on the consistency with which they do so, and the low patient-reported prevalence in this study is alarming,” wrote investigators.

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Prevalence of Colorectal Cancer

colorectal cancer accounts for 7.8% of all new cancer cases in the United States, making it the fourth most frequent type of cancer after breast cancer, prostate cancer, and lung and bronchus cancer (2^✔ ✔Trusted Source
Cancer Stat Facts: Colorectal Cancer

Go to source). The US Preventive Services Task Force advises colorectal cancer screening for persons aged 45-75, and adults aged 76-85 should talk to their doctor about it (3^✔ ✔Trusted Source
Colorectal Cancer: Screening

Go to source). Colorectal cancer screening tests can help prevent the disease or discover it early before it spreads to other parts of the body (4^✔ ✔Trusted Source
U.S. Cancer Statistics Colorectal Cancer Stat Bite

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Jordan Baeker Bispo, Ph.D., MPH, chief scientist of cancer disparity research for the American Cancer Society, and colleagues undertook the current study to determine the prevalence of clinician recommendations for colorectal screening among underscreened adults. To accomplish this, the researchers designed their study utilizing data from 61,479 patients who completed the 2019 and 2021 National Health Interview Surveys. Patients had to be age-eligible for screening, assessed for guideline-concordant screening, not up to date with screening recommendations, and have had a wellness visit in the previous year to be eligible for the study.

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Colorectal Cancer Screening

The researchers assessed whether participants had received a physician referral for colorectal cancer screening by asking, "In the past 12 months, did a doctor or other health professional recommend that you be tested to look for problems in your colon or rectum?" Only responders who did not report guideline-concordant colorectal cancer screening were asked to complete the survey. The proportion of reporting a clinician's suggestion for screening was calculated using age, survey year, gender, race/ethnicity, education, poverty status, nativity, urban or rural domicile, comorbidity burden, insurance, and usual source of treatment. Unadjusted and adjusted prevalence ratios were estimated using logistic regression models.

The study comprised 5022 patients who were both eligible and late for colorectal cancer screening. 1425 (26.8%) of these participants reported having a clinician recommendation for colorectal cancer screening. Prevalence was lowest among patients who did not have a typical source of care (9.7%) and were uninsured (12.6%), while estimates were similar in a sensitivity analysis that excluded respondents who did not have insurance or a usual source of care.

Non-Hispanic Asian (adjusted prevalence ratio [aPR], 0.53 [95% CI, 0.37-0.75]), non-Hispanic Black (aPR, 0.76 [95% CI, 0.63-0.92]), and Hispanic (aPR, 0.82 [95% CI, 0.67-1.01] adults were less likely than non-Hispanic White adults to report a clinician recommendation for colorectal cancer screening. Furthermore, receiving a clinician recommendation was less likely for those with less than a high school education (aPR, 0.76 [95% CI, 0.61-0.95]) compared to those with a college diploma, as well as for uninsured adults (aPR, 0.51 [95% CI, 0.38-0.68]) compared to those with private insurance.

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Loopholes in Colorectal Cancer Screening

“The findings highlight a major communication gap about [colorectal cancer] prevention in the clinical setting. At the systems level, investing in clinician training, automated point-of-care prompts, educational tools for shared decision-making with diverse patient populations, and community outreach may improve patient–clinician communication about [colorectal cancer] screening and advance progress toward national screening goals,” concluded investigators.

References:

1. Receipt of Clinician Recommendation for Colorectal Cancer Screening Among Underscreened U.S. Adults - (https://pubmed.ncbi.nlm.nih.gov/37696035/)
2. Cancer Stat Facts: Colorectal Cancer - (https://seer.cancer.gov/statfacts/html/colorect.html)
3. Colorectal Cancer: Screening - (https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening)
4. U.S. Cancer Statistics Colorectal Cancer Stat Bite - (https://www.cdc.gov/cancer/uscs/about/stat-bites/stat-bite-colorectal.htm)

Source-Medindia