Each year, over 2,200 Minnesotans are diagnosed with colorectal cancer. And sadly, more than 700 die from it. Colon cancer is in fact the no. 2 cancer killer in the United States as a whole – even though it’s 90 percent curable if caught early.
That’s why getting screened for this cancer is so important. The American Cancer Society says regular screenings should start at age 45 for African Americans and Native Americans, who are at higher risk for the disease. And screening should start at age 50 for all other races and ethnicities, since risk increases with age across the board.
In Minnesota, though, only 71 percent of the adults who have reached these ages are getting timely screenings. And screening rates among populations of color are even lower at only 56.2 percent.
(To protect patient privacy, a fictitious photo and name has been used)
Annette is a 61-year-old African American woman. She is physically active, works full time and has three grown kids. She’s also a HealthPartners patient. Every year for the past 10 years, her doctor has recommended a colonoscopy to screen for colon cancer. And each year, Annette has politely declined. Her friends and relatives have told her it is very uncomfortable. “Besides I’m healthy,” Annette would say. “And my family members have never had colon cancer or polyps. I really don’t think I need one.”
A colonoscopy is an exam where the doctor gently eases a thin, flexible, hollow, lighted tube inside the colon. There’s a camera attached to the end. It’s what the doctor uses to look for small growths (called polyps) that could become cancerous. The doctor can do all this and remove any polyps that might be found in only 30 minutes. But, the exam also requires patients to:
- use laxatives and be on a clear liquid diet for a full day before to clear their colons;
- undergo some discomfort, as carbon dioxide is pumped into the colon to keep it open during the procedure; and,
- find someone to drive them to and from the clinic, because of the relaxation medicine that is given to them during the exam.
All of these are reasons why Annette and so many other patients say no to colonoscopies when their doctors suggest them. (And they’re also why many patients avoid seeing their doctor in the first place.)
The best cancer screening test is the one that patients will complete
The low screening rates that currently exist in the U.S. are why HealthPartners is expanding our use of another form of screening. This is a stool sample test called the FIT (Fecal Immunochemical Test). It works by looking for a specific type of blood in a patient’s stool.
When Annette came into the clinic for her annual check-up this year, she again declined a colonoscopy. But when her doctor made a follow-up suggestion for a FIT test, she agreed to try it. Annette took home the FIT kit and mailed it back two days later. Then later that week, a clinic nurse contacted her with the results. The nurse explained to her that the FIT showed some blood in the stool. And with that information, Annette agreed to schedule a colonoscopy that could find out where the blood was coming from.
What is a FIT screening?
The FIT is an annual screening that’s done for colon cancer. It is comfortable, convenient and done right at home. Patients receive a “FIT kit” that includes step-by-step instructions. Using the sample stick found in the kit, a patient collects a stool sample. The kit is then sent back to the clinic lab for testing. A FIT does not require any specific diet or medication preparation. Patients who do not return their kit receive a follow-up letter at two weeks. If they still haven’t returned it after 30 days, they receive a phone call.
All patients who return the test are contacted with their results within a few days. Blood in a patient’s stool could be a sign of a noncancerous colon polyp. It could be a sign of a pre-cancerous polyp. Or it could be a sign of cancer. That’s why a follow-up colonoscopy is needed for any FIT test result that shows blood in the stool.
During the colonoscopy, Annette’s doctor found and removed a polyp. This growth had been the source of Annette’s bleeding. The clinic took a closer look at the removed polyp, found that it was not cancer and notified Annette. They also asked her, though, to come back in five years for another colonoscopy. This will be the best way of making sure that no more polyps develop. And as of now, Annette says she plans to get one again at that time. “It really wasn’t that bad,” she said.
How HealthPartners has been innovating our use of the FIT Test
2009: HealthPartners clinics begin mailing FIT tests to patients who elect them.
2014: Our Park Nicollet clinics begin routinely recommending the FIT test more often. In just 6 months, their colorectal screening rates increase by 7 percent. Among populations of color, screening rates improve even more – by 10 percent. This screening option shows promise of being a key to reducing disparities in colorectal cancer screening.
2015: Our HealthPartners clinics streamline their FIT screening process. Before, patients had had to respond to a letter each year and say they agreed to complete a FIT again. So HealthPartners cuts that letter from the process. They instead begin mailing an annual FIT test to anyone who has completed one in the past. That makes the test even more convenient for patients.
2017: Four Park Nicollet clinics pilot a new approach to mailing FIT tests. They try sending the test to any 50 to 75 year-old patient who has never before had a colon cancer screening. This results in FIT tests arriving for the first time in the mailboxes of 6,000 patients. One in 4 of the tests sent are completed – and those clinics’ screening rates go up 6 percent.
HealthPartners clinics build on this pilot in an attempt to reduce the racial disparity that exists in colorectal cancer screening. They try sending FIT kits specifically to 46 to 75 year-old patients of color who have never been screened for colon cancer. This results in 3,000 tests being mailed. And once again, about 25 percent of the tests are returned. This boosts screening rates by 3.5 percent.
Today: Our organization is successfully screening for colon cancer in more than 70 percent of our patients of color who are eligible. And in 2018, HealthPartners is named the CRC Organization of the Year for this work.
With many HealthPartners and Park Nicollet cancer clinics throughout the Twin Cities, the latest in cancer screening tests and treatment is always close to home.