We Need to Stop Letting Systemic Hurdles Stand in the Way of Cures
Colorectal cancer screening is a microcosm for everything that’s right and wrong in healthcare today. Simultaneously a miracle of modern science, a case study in the power of preventive care, and a stark reminder of just how many barriers can stand in the way of people receiving that care, the disease continues to humble healthcare’s greatest minds.
The stats tell the story. Between 1970 and 2018, colorectal cancer death rates declined 55%, thanks largely to growing prevalence of colonoscopies and efforts to increase access to screening. As a result, today, the five-year survival rate when colorectal cancer is caught at an early stage is roughly 90%. Still, despite these amazing odds, the disease is expected to cause 52,550 deaths in the U.S. this year, making it the second-leading cause of cancer death in this country. For Black Americans, the outlook is even worse, with a 20% high likelihood of diagnosis and a 40% higher likelihood of death than most other racial groups.
The numbers may tell a story, but patients and families from across the country are driving a sense of urgency to act now.
Moving Beyond Excuses
It's not acceptable. We have a disease that we know how to prevent. We know where the obstacles are that keep people from getting screened. Yet, we continue to lose tens of thousands of family members and friends because we allow systemic barriers to keep everyone from getting the care they deserve. Blaming everything from reduced volume of screening during the pandemic to cultural beliefs and fears is insufficient. Accepting this or even worse inaction is inexcusable when these barriers and stigma continue to slow down progress. We are seeing patients at later stages of disease, as confirmed by the American Cancer Society's most recent report on colorectal cancer. Facing the fact we are not making strides is hard. There are currently 44 million screening-eligible people in this country that have never been screened for colorectal cancer. This is likely an underestimate, given that we are still measuring the impact that COVID has had on preventative screening rates.
The biggest challenges we have in screening for colorectal cancer is not the science or the technology; they are communication and access issues. Whether through lack of information, misinformation or stigma, too many people are not aware of the importance of screening. Worse, even among those who are aware of the need, far too many people lack the time, insurance coverage or transportation required to take time out of work to get screened or seek follow-up care in the event of a positive result.
Both can be addressed with the right mix of public and private sector partnerships, but doing so will require a fundamental break from the status quo. This March, we gathered to support President Biden’s call to action to increase cancer screenings by 10 million as a part of the White House Cancer Moonshot Program. We are ready to deviate from the status quo.
A coalition of public and private leaders have come together with a commitment to tackle the development of, A blueprint to equitable colorectal cancer screening in America. This effort is designed to build a national coalition of insurers, industry, federal agencies, healthcare providers, retail businesses, and patients willing to focus on an action plan to reduce the number of lives impacted by colorectal cancer by 2030.
Hard Facts That Connect-the-Dots
This diverse group of stakeholders are coming together around a handful of key priorities. The first is guaranteeing funding to support the expansion of the CDC’s Colorectal Cancer Control Program (CRCCP), which works with clinics, hospitals and other healthcare organizations to provide screening tests to men and women with low incomes who do not have adequate insurance for colorectal cancer screening services. The program, which has been proven to increase screening rates among the most vulnerable populations, is currently only active in 35 states. It needs to be rolled out nationwide. Think about it this way, with an increased screening prevalence to 70% we could reduce Medicare spending by $14 billion in 2050.
Studies continue to show that empowering patients with a choice can increase screening compliance. Patients can choose a non-invasive colorectal cancer screening with easy-to-use at-home stool tests followed by a colonoscopy if positive. Starting in 2023, Medicare, ACA and commercial plans will now cover, as part of preventative care, a follow-up screening colonoscopy after a non-invasive stool-based test returns a positive result, which means that beneficiaries will not have out-of-pocket costs for both tests. Educating patients and providers is necessary. Perhaps most importantly, we are rallying the full force of patient advocacy groups, private sector companies, providers and federal and state governments together to expand education and outreach efforts in communities with the lowest screening rates. And we need to do that with hard data that not only makes the case for screening, but also informs more proactive, targeted intervention.
For example, we know from our own research tracking real-world patient behaviors that younger colorectal cancer patients (under age 35) tend to present first with abdominal pain much more frequently than older patients, and that those first encounters typically occur in an emergency room. That’s a critical detail that needs to be built into provider protocols. We’ve also found through our work with BLKHLTH that Black patients wait an average of eight days longer than White patients before receiving treatment and that Black patients are more likely than White patients to be diagnosed with colorectal cancer only after their cancer has metastasized. If ever there were an obvious target for increased outreach and education, this is the prime example.
A Model for the Future of Healthcare
Our focus is on taking action, operationalizing change. We need to dig deeper into the systemic and behavioral patterns that accompany these diseases to identify the optimal opportunities to intervene, educate and – ultimately – drive the type of large-scale behavioral change that is necessary to unlock the full potential of medical science.
Advances in data science have made that type of analysis possible today, but we need to stay open-minded. Relying on decades-old assumptions only reflects our own lack of courage to ask questions and be willing to adapt to change. We are ready for change, we can harness the power of data to develop effective strategies to reach and connect with every at-risk patient and empower them to find the right path to the best possible outcome. We must be relentless. We can do more than dream of a moonshot – we can accomplish one for the colorectal cancer community.
Find more information about Komodo Health and FightCRC's commitment to tackling colorectal cancer, or read our latest Fast Facts, which includes recent insights on the disease, treatment protocols, and care.