Doctors don’t suggest colorectal cancer screening to their patients

September 20, 2023

Source:  Annals of Internal Medicine, September 12, 2023 LINK

Colorectal cancer (CRC) is the second leading cause of cancer death in the US, and early detection can save lives. But in 2021 only 61% of those over 50 on commercial PPO plans were up to date with colorectal cancer screening. This isn’t just delayed colonoscopies due to the pandemic; the 2019 screening rate was even lower. A new study from the American Cancer Society shows one potential cause; only about a quarter of patients remember that their physician suggested colorectal cancer screening at their most recent preventive care office visit.

Research published this week in the Annals of Internal Medicine pooled data from the 2019 and 2021 National Health Interview Survey conducted by the federal government. Researchers limited their sample to those who were not up-to-date on screening and reported a preventive care visit in the previous year. They report on answers to the question “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?”

The results, pictured above, are sobering. Less than a third of every group remembered that their physician suggested colon cancer screening; this was worse for Black, Hispanic and Asian people, and those with low wages or born outside of the US.

I imagine that many of these patients’ medical records would suggest that their physician suggested appropriate CRC screening, but if the patient doesn’t recall, the screening is less likely to happen!

Implications for Employers:

-        Programs by employers and insurance carriers to encourage CRC screening can help bridge this gap.

-        Providers who are in alternative payment model contracts are often subject to quality goals that can include improved cancer screening. They generally “solve” this problem not by getting physicians to change their office visits, but by setting up a structure where office staff set up appointments or give out screening material to eligible patients.

-        Colonoscopy requires a colon prep that many find uncomfortable. Stool testing is almost as effective at finding cancer and much less expensive if a screening program uses FIT tests (fecal immunochemical test) instead of Cologuard, a genetic test of stool for cancer, which has a high rate of false positives.

-        CRC is most common as people get older; current recommendations are to begin screening at age 45, but the largest benefit is in members from ages 50-75.

-        Employers can ask about potential clinical performance guarantees as part of their RFP process.

Tomorrow: National estimates of gender affirming surgery

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