Increasing cancer screenings in the United States has always posed a significant challenge, especially when the guidelines are constantly changing. However, the COVID-19 pandemic has only exacerbated the problem, further decreasing screening rates and accentuating existing racial disparities in relation to cancer screenings, according to Rose Wolfe, BSN, RN, OCN, ONN-CG, HTP, certified oncology nurse navigator in the Work Stride: Managing Cancer at Work program at Johns Hopkins Medicine.
Keeping up with changes to the screening guidelines for different types of cancers can be a considerable challenge, but staying abreast of these changes is an important first step for navigators in helping to get cancer screening rates back on track.
“We each have our disciplines that we navigate, so we don’t always keep up with all of the guidelines and changes that are happening in different malignancies,” said Ms Wolfe. “But because of the COVID pandemic, we’re going to see a lot of important changes coming forward in the months and years ahead.”
At the 2021 AONN+ 12th Annual Navigation & Survivorship Conference, Ms Wolfe discussed updates to the colorectal screening guidelines as an example and walked attendees through some of the most pertinent changes in screening for that particular malignancy.
Changes to the Guidelines in Colorectal Cancer
According to the American Cancer Society (ACS), colorectal cancer is the third most common cancer diagnosed in both men and women, as well as the third leading cause of cancer-related death.
“But we know that because so many people miss colorectal cancer screenings, these numbers might not be as accurate or telling as we thought,” she noted.
The incidence of colorectal cancer is actually declining annually in adults aged 55 years and older. But at the same time, the incidence is increasing in adults younger than 55. Colorectal cancer rates actually rose 2.2% per year from 2011 to 2016 in people under the age of 50 years, and importantly, younger people who are diagnosed with cancer face an increased risk of developing other cancers later in life.
Between 2008 and 2017, death rates also increased by 1.3% in patients with colorectal cancer under the age of 50, while it declined 3% per year for patients 65 years and older.
“Researchers are trying to figure out why this is; there are a lot of ideas and hypotheses, but we don’t have an answer yet,” she said. “But we do know that people are being diagnosed with colorectal cancer earlier, hence the necessary changes in the screening guidelines.”
Based on these findings, the ACS commissioned a “modeling” study using existing data, and concluded that earlier screening (at 45 years) had a better “benefit-risk” ratio than screening at age 50.
The recommendations now state that men and women at average risk for colorectal cancer should be screened beginning at age 45. For men and women at increased risk of developing colorectal cancer (due to factors like family history or genetics), screening should begin at a younger age and on a more frequent basis.
Addressing COVID and Other Barriers
“We know that there’s already a backlog of screenings due to COVID,” said Ms Wolfe. “And by changing the guidelines, we’re adding approximately 21 million people to the screening pool. So we as navigators have to be very creative about how we’re going to get people screened.”
According to Ms Wolfe, because there is still so much hesitancy in the general public around getting colonoscopies, other forms of testing for colon cancer will have to be encouraged.
“As nurses, I know we want everyone to have a colonoscopy because that’s the gold standard,” she acknowledged. “But stool-based tests were used successfully during COVID.”
Colonoscopy screening can actually prevent colorectal cancer through the detection and removal of precancerous growths, or polyps. It can also detect colorectal cancer at an early stage when treatment is usually less extensive and more successful. But if patients are not actually getting colonoscopies, doing nothing as an alternative is not the answer. Navigators should be encouraging other types of tests, like stool testing (gFOBT [guaiac-based fecal occult blood test], FIT [fecal immunochemical test], or FIT-DNA [stool DNA test CT colonography]), CT colonography, or flexible sigmoidoscopy.
But bear in mind, she added, that if patients receive a positive result with any of these testing platforms, they will have to move forward with a confirmatory colonoscopy.