March is National Colorectal Cancer Awareness Month. I didn’t need a calendar reminder to start me thinking about this disease.
At this moment, I am recovering from ostomy surgery, the latest stage in a battle with colorectal cancer that has taken me through surgery, chemotherapy, radiation therapy and surgery again. My life, body, and perspective of my role in healthcare as I knew them 15 months ago have changed.
During my treatment and recovery, I have spent a great deal of time thinking about the path that led to my colon cancer diagnosis, about cancer screening more broadly, and about the role of provider organizations like Reid Health in making sure that we identify as many potential cancer cases as early as humanly and technologically possible.
When I turned 50, I had my first colonoscopy, because I knew that colon cancer is one of the most preventable cancers if signs of trouble are detected early on. I had a polyp finding that was benign, which required a second follow-up screening at 55. I received a second clean bill of health and was told I didn’t need another screening for 10 years. Six and half years later, however, after noticing some mild symptoms, my primary care physician referred me to a gastroenterologist, who immediately recommended I undergo another colonoscopy screening. He noted to me that screenings now begin at age 45 and he recommends follow-ups every five years. I quickly discovered I had rectal cancer. In all likelihood, his screening recommendation prevented me from reaching Stage 4 colorectal cancer.
I subsequently underwent surgery to have my rectal tumor removed which noted clean margins and no lymph node involvement. No further treatment was required. Unfortunately, a three-month follow-up appointment revealed new malignant findings, which moved me to Stage 3. I then underwent four months of chemotherapy and subsequent radiation therapy at Reid Health, which was followed by ostomy surgery in January. I cannot say enough about the way our staff—including physicians, nurses, and medical technicians—cared for me, communicated with me, and educated me throughout my journey.
My experience has given me a new perspective on how troubling the different degrees of awareness about screenings for different types of cancer and among different populations are—and the significant public health challenges that result.
As a society, we have done an outstanding job with breast cancer awareness. Ask any 100 women what age they should start getting a mammogram and how often to get one, and I’d wager very close to all 100 know the answer. This level of awareness is a testament to years of clear, consistent, and repeated messages from clinicians, health systems, medical societies, insurers, special-interest groups, schools, public health agencies, and community organizations.
This success is not solely because of communication; it also required that the various clinical societies and providers coalesce around a particular protocol for screening, and for actions based on the results of screening. In turn, that awareness is a significant element of our national healthcare system’s ability to routinely detect breast cancer in early stages of the disease.
But not all forms of cancer have been accompanied by such crisp and consistent messages about screening. This March, I have not heard a drumbeat for colorectal cancer screening of the same volume or regularity that I hear every October during Breast Cancer Awareness Month—or for that matter, year-round—for mammograms. And there is simply not the same level of collective coordination throughout the healthcare community to determine protocols and support concrete actions for colorectal cancer as there is for breast cancer.
In the absence of collective awareness, inconsistency is unfortunately the norm, and the responsibility for determining when to screen patients has largely been left up to individual physicians. As a result, it is hard for anyone—including myself—to keep track of current standards and take appropriate actions based on those standards. Nor am I aware of campaigns of the same scale and clarity around lung cancer, for example, getting a lung CT scan at a certain age if you are a smoker.
I received an exceptional level of care at my own institution when I was diagnosed with colorectal cancer. In the long run, however, the only way to ensure every American has a fighting chance to detect, treat, and survive all forms of cancer is to step up our efforts to educate all Americans about the importance of a timely screening.
The National Colorectal Cancer Roundtable’s goal is to get 80% of the eligible population screened. To achieve that goal, everyone in healthcare—hospitals, physicians, and public health leaders, just to name a few—must work on this together, with successes of the breast cancer advocacy community as our model and inspiration.
Hospitals and health systems play a critical role in creating coordination within this ecosystem. We can work with our physicians to determine consistent standards and protocols. With those in hand, we can use all the data, analytics, and communication tools at our disposal—electronic health records, patient portals, email alerts, telephone calls, advertising, community outreach, and on-site interactions to alert specific individuals about the need for specific screenings.
Through awareness and education, I hope we can develop a more consistent local, regional, and national approach to screening for all forms of cancer—and save as many lives as we possibly can. You can be sure that my health system will be using all our tools, technology, imagination, and energy to lead in this effort.
