"Do I Really Need to Get Screened for Colorectal Cancer?" and Other Common Patient Questions
When patients get a recommendation for a colorectal cancer screening, it's not unusual for them to question whether it's really necessary to do so. They may not be familiar with the reasons for the recommendation and why getting screened early is so important, even for those without a strong family history of colon or rectal cancer. Patients may also have concerns about what's involved and how much it will cost.
Following are some strategies to addressing frequent patient questions about colorectal cancer, based on commonly raised concerns and the latest guidelines:
Answering Patient Questions About Colon Cancer and Rectal Cancer
When? After an initial conversation about the risk of colorectal cancer, patients may ask when they need to go for their first screening.
The U.S. Preventive Services Task Force (USPSTF) recommends that adults undergo their first colorectal cancer screening at age 50. The USPSTF says they should get regular screenings until they're 75, and how often they need to repeat the screening will depend on the type of screening test, their age, and their medical history.
While about 90% of new cases of colorectal cancer occur in people who are age 50 or older, the American Cancer Society (ACS) now recommends that screenings should start even before you turn 50. The latest 2021 ACG guidelines lowered the recommendation for a first colorectal cancer screening to age 45, because rates of colorectal cancer are on the rise for people under 50. How? Patients may also ask about colorectal cancer testing options. Several kinds of screening tests are available, including:
- Stool tests
- Flexible sigmoidoscopy
- Colonoscopy
Each test has upsides and downsides, and it's helpful to discuss these with your patients—in addition to their risk profile—to help determine the best next step.
How much? Another thing patients may consider is their insurance coverage. Many plans, including Medicare, do pay for part of colorectal cancer screenings for people once they hit their 50th birthday. Patients can check-in with their health plan to investigate coverage and to find out if they need pre-authorization for a colon cancer screening test and whether they have out of pocket expenses to consider.
People at Increased Colorectal Cancer Risk May Need Earlier Screening
There are of course exceptions to the general guidelines for colorectal cancer screening. The following conditions may warrant an earlier-than-usual initiation of screening, even beginning in childhood:
- Family history of colorectal cancer or colorectal polyps
- Family history of conditions that may predispose patients to developing colorectal cancer, such as familial adenomatous polyposis (FAP) or Lynch syndrome
- Personal history of colorectal polyps
- Personal history of inflammatory bowel disease, such as ulcerative colitis or Crohn's disease
- Personal history of radiation to the abdomen or pelvis for previous cancer treatments
The Importance of Not Delaying Screening for Rectal and Colon Cancer
"But what about the coronavirus pandemic?" your patients may ask. Indeed, fear of COVID-19 has led many people to postpone routine care, including screenings and preventive care. While such caution is understandable, there are also significant risks to putting off important preventative care like colon cancer screenings. Patients may need to hear from their trusted healthcare provider how important it is not to delay these screenings, especially if they're overdue. One talking point that may convince patients to schedule a colorectal cancer screening (or to do an at-home test): Five-year survival rates for cancers that are detected early are about 90%. Once colorectal cancer starts spreading, however, five-year survival rates are much lower — only 14% (for colon cancer) or 16% (for rectal cancer) after the cancer spreads to distant organs or lymph nodes. To reassure patients about potential COVID-19 exposure, it can be helpful to talk to them about the preventive measures that your facility is taking to protect them, and to mention you're happy to discuss any concerns. Patients may also be more comfortable with appointments first thing in the morning, before a lot of other patients have visited the facility.
Regular screening can find colorectal cancer early; when it hasn’t spread and is significantly more easy to treat. As a provider, it is critical for you to encourage your patients to have these conversations early on and actively address any questions they might have.