Colorectal cancer (CRC) is recognized as the second-deadliest cancer in the United States, yet screening rates remain insufficient due to various factors such as lack of awareness, patient apprehension, and barriers within the healthcare system. Many patients remain unaware of their risk since early-stage CRC is often asymptomatic, making regular screening essential for detection and prevention.
Nurse practitioners (NPs) and physician associates/assistants (PAs), as frontline healthcare providers, are in an advantageous position to address these challenges. Their role in patient education, initiating discussions about screenings during routine visits, and facilitating the screening process is crucial for increasing CRC screening rates.
**Why Early Detection is Important**
Symptoms of CRC usually manifest at an advanced stage, where treatment becomes limited. The five-year survival rate for late-stage CRC is just 14%, whereas early detection boosts it to over 90%. Although the recommended screening age was lowered from 50 to 45 in 2019, many remain uninformed of this change. High-profile individuals such as Katie Couric and James Van Der Beek have publicized their cancer experiences to enhance awareness, an essential move that health care providers must bolster at the patient level.
Research continues to uncover environmental risk factors, such as a potential link between microplastics and increased CRC rates. Early detection remains the best defense, and providers must consistently emphasize the importance of regular CRC screening and aid patients in understanding their risk factors.
Additionally, individuals with a family history of CRC often do not engage in family discussions about this health risk, leading to a gap in awareness. Providers need to incorporate family history assessments as a part of routine check-ups to identify at-risk patients who should ideally begin screening at age 40, or 10 years earlier than the age at which their relative was diagnosed. This proactive measure can catalyze important family discussions and promote life-saving early detection.
**The Role of NPs and PAs in Screening**
NPs and PAs, through regular patient interactions, are strategically placed to initiate screening conversations. A simple query such as, “When was your last colorectal cancer screening?” can effectively incorporate this topic into standard care. Educating patients on the importance of screening, despite the absence of symptoms, and diversifying their understanding of available options beyond colonoscopy can significantly reduce their apprehensions. Addressing concerns around bowel preparation by introducing low-volume options, alternative tests like FIT and Cologuard, and offering resources to manage costs can bolster adherence. Ensuring that stool-based tests are supplied with clear instructions during office visits increases completion rates. Additionally, scheduling colonoscopy appointments before the patient exits the office reduces patient drop-off.
**Navigating the Future of Screening**
Blood-based CRC screening is an emerging technology that shows promise but also has limitations. It relies on identifying circulating tumor DNA, often undetectable during early CRC stages. While future applications may see it supplementing stool tests or colonoscopies, it cannot replace these current methods due to its limited sensitivity and potential to provide false reassurance.
**A Collaborative Approach to Increasing Screening Rates**
Increasing CRC screening rates demands a coordinated effort across healthcare settings. Collaborations involving NPs, PAs, medical assistants, front desk staff, and GI specialists can ensure patients obtain the necessary screenings. Streamlining office workflows to provide kits and educational resources, along with real-time scheduling, can mitigate missed follow-ups. Coordination with GI specialists can alleviate extended wait times for colonoscopies, ensuring timely patient access.
Beyond clinical environments, peer collaboration within professional networks like The American Association of Nurse Practitioners, POCN, and the American Academy of Nurse Practitioners can enhance providers’ strategies through shared best practices, continuous education, and updated CRC screening knowledge.
**Saving Lives, One Conversation at a Time**
Regular, accessible, and patient-centered CRC screening is a vital aspect of patient care. By proactively addressing barriers to screening and simplifying the screening pathways, NPs and PAs are instrumental in enabling early detection of CRC cases. Building patient trust, integrating prevention in routine care, and prioritizing early detection efforts present an opportunity to empower and safeguard lives through informed health discussions.
*Elisabeth Evans is a nurse practitioner.*