The National Colorectal Cancer Roundtable (NCCRT) was established in 1997 by the American Cancer Society and the Centers for Disease Control and is dedicated to reducing the incidence of and mortality from colorectal cancer (CRC) in the United States (US). The coalition is made up of public, private, and voluntary organizations. The Society for Gastroenterology Nurses and Associates (SGNA) is a member organization alongside federal agencies, state health departments, advocacy organizations, health plans, and academic institutions (American Cancer Society, Inc, 2019).
As a member of SGNA's Healthcare Policy Committee, I was able to attend the NCCRT 2019 Annual Meeting. The NCCRT has launched their new national campaign, 80% in Every Community. Attendees received an update on the impact of the previous campaign, 80% by 2018, and an overview of the new campaign's strategic plan.
One of the most profound moments I experienced was during a session on the available colorectal cancer screening tests. As an endoscopy nurse, I have often always suggested colonoscopy as the gold standard screening exam. One of the presenters mentioned that the best screening exam is the one that gets done. As I listened to the menu of screening tests, I realized that colonoscopy may not appeal to everyone and offering multiple options that fit our patients' lifestyle is imperative.
Stool-based tests include the guaiac-based fecal occult blood test (gFOBT), fecal immunochemical test (FIT), and multitargeted stool DNA test (FIT DNA). These tests should be administered every year (gFOBT and FIT) or every 1-3 years (FIT DNA). Recommendations also note that stool samples for these tests obtained by digital rectal exam have a low sensitivity and should not be used for CRC screening. A positive stool-based test should be followed up with colonoscopy to complete the screening process. Direct visualization exams include colonoscopy, computed tomography colonography (CTC), and flexible sigmoidoscopy. These tests should be repeated at 10 years, 5 years, and 5 years, respectively, for negative results (American Cancer Society, Inc, 2018).
A review of the 80% by 2018 campaign revealed that it is one of the most effective screening campaigns in history. The percentage of US adults aged 50-75 years who are up to date with CRC screening rose from 65.2% in 2012 to 68.8% in 2018. That percentage increase of 3.6% equates to 9.3 million more people up to date with screening. The number of Medicare health plans whose covered lives screened is > 80% rose from 25 to 105 from 2012-2019. Kaiser Permanente Northern California was honored as a health plan partner. This plan has achieved screening rates over 80% since 2011 and has demonstrated a 52% reduction in CRC deaths. The Kentucky Cancer Consortium established a statewide screening program for their uninsured and increased their rates to 70%, moving Kentucky from being ranked 49 in the US to 17 (Wender, 2019).
The new campaign, 80% in Every Community, is a different challenge. The previous campaign was a national goal and permitted averaging rates across all groups. The new goal is about achieving very high CRC screening rates in every community despite barriers. The new campaign has six objectives: (1) increase screening in target groups, (2) increase the percentage of those starting screening at the appropriate age, (3) increase the percentage of adults who receive a recommendation to be screened by a healthcare provider, (4) increase access to quality colonoscopy, (5) increase follow-up colonoscopy after positive stool test or CTC, and (6) increase community engagement in implementation (Wender, 2019).
As gastroenterology nurses and associates, we have a wealth of experience, knowledge, and access to varied patient populations who meet CRC screening criteria. Obtaining accurate family histories of CRC and polyps can facilitate high risk individuals starting screening at the appropriate age. Early-onset CRC demands a deliberate effort to begin screening no later than 50 years old. While CRC incidence has dropped dramatically for those over 50 years old, incidence in the 20-49-year-old population has grown 51% since 1994, with rectal cancer having the greatest growth (Wender, 2019). To help facilitate access to colonoscopy after a positive stool-based test, encourage your gastroenterologists and facilities to partner with their local Federally Qualified Health Centers to remove this barrier. Partner with your hospital's Commission on Cancer program to perform a mailed FIT kit program as a screening event. Partner with non-profits like the American Cancer Society to educate primary care providers on the importance of recommending CRC screening. There are many more ways we can work with our community partners to reduce morbidity and mortality related to CRC.
I encourage our members and regional societies to review the resource center on the National Colorectal Cancer Roundtable website and set a goal in 2020 to name your community and work towards achieving an 80% CRC screening rate. I look forward to hearing about your progress and successes.
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