Innovative colorectal cancer screening methods for remote areas

Colorectal cancer is the second-leading cause of cancer-related death in the United States, despite the fact that more than half of these deaths are avoidable with regular screenings. In fact, with screening, patients can prevent colon cancer from ever forming or catch it early enough to have a five-year survival rate of more than 90 percent. Unfortunately, even though it is the most preventable cancer, colon cancer is the least prevented, with the majority of cases diagnosed at late stage when treatment is difficult and survival rates a mere 12 percent.

National CRC screening guidelines call for men and women at average risk for the disease to begin screening at age 50. Nevertheless, one third of those in the recommended age group (an estimated 23 million Americans 50 and over) do not get screened. The reasons why patients avoid screening vary from embarrassment and cultural beliefs to fear of complications, radiation exposure and the preparation involved.

Recent data also shows a higher level of screening avoidance among patients living in geographic locations without easy access to conventional screening approaches, such as colonoscopy. In fact, current trends reveal that patients living in rural areas have a greater lack of compliance and, subsequently, higher CRC rates. In addition, the large communities of patients residing in remote or rural geographic locations are often left out of lifesaving CRC prevention efforts. As a result, remote areas, such as western central Appalachia and eastern Kentucky, have the highest colon cancer death rates and have become known as CRC "hot spots."

Research also indicates that patients residing in remote Alaskan tribal villages have among the world's highest rates of CRC. A recent study, published in Mayo Clinic Proceedings, focused on CRC screening among Alaska Native people and the data was striking. Nationally, CRC screening rates hover at about 58 percent and colonoscopy compliance rates among all patients are about 38 percent. Among the Alaska Native population, however, the screening rate was as low as 23 percent. It's no surprise, then, that the CRC rate among this population is more than twice that of U.S. Caucasian.

The fact is that geography can be a significant barrier to screening—for people in rural locations, it can be even more challenging to complete screening tests as they may have to drive hours just to see a doctor and then take another lengthy journey to have their colonoscopy. There is a clear need for accurate, noninvasive, at-home testing options to reach patients who are the hardest to reach with conventional screening options.

The Mayo study looked at 661 average risk Alaskan Native people who underwent CRC screening with both Cologuard, the FDA-approved fecal stool DNA test, and fecal immunochemical testing, a stool-based tool that only looks for occult blood, prior to pre-scheduled screening or surveillance colonoscopy. In the study, Cologuard detected 100 percent of colorectal cancers, 52 percent of significant premalignant lesions and 80 percent of the largest pre-cancers that are likely to progress to cancer. In comparison, FIT performed with an 80 percent detection rate of colorectal cancers and only 30 percent of significant premalignant lesions. The study demonstrates that Cologuard is a reliable cancer detection tool.

What’s even more important, however, is the fact that innovative options like Cologuard ensure that those residing in rural areas are not left without suitable screening options that fit their geography and lifestyle. The sDNA test, for example, is prescribed by a primary care physician or other clinician, delivered directly to the patient's doorstep and conducted entirely at home, making it a potential fit for hard-to-reach patients. In addition, the sDNA test is instrumental in supplementing conventional screening procedures currently performed at Ambulatory Surgery Centers where the goal is to increase screening rates and improve CRC prevention efforts. As a result, new options like Cologuard have the potential to help reverse the trend of low screening compliance not only in Alaska, but also in other rural and remote areas and among other underserved populations where patients have limited access to screening.

To build on the current number of screenings for the number two cancer killer, we must address the dismal screening rates in geographically-challenged areas and populations with cultural barriers as well as avoiders of colonoscopy. It is crucial to offer a full menu of evidence-based options, such as the sDNA test, to increase screening participation. While colonoscopy remains the standard for CRC screening, sDNA testing presents another option for patients who face challenges accessing or completing conventional screening methods. The Alaskan Native study confirms Cologuard's advantages in identifying cancer and pre-cancer in patients otherwise unwilling or unable to participate in CRC prevention efforts.

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