About 137,000 new cases of cancer in the colon or rectum are diagnosed each year in the United States; with 50,000 deaths, it is the third leading cause of cancer death. Fortunately, screening tests are available that can find colorectal cancer early.
The Permanente Medical Group is a member of the National Colorectal Cancer Round Table, which launched a new campaign on March 17 that sets a national goal of 80 percent of adults age 50 and older screened for colorectal cancer by 2018.
Kaiser Permanente Northern California currently screens 81 percent of its eligible members—people between 50 and 75 years old or with other risk factors for colorectal cancer—making the region a national leader. KP Northern California has the seventh highest screening rate for colorectal cancer of all health systems in the country and the highest rate of all the KP regions.
Theodore R. Levin, MD, research scientist with the Division of Research and gastroenterologist at the Walnut Creek Medical Center, is the region’s clinical lead for colorectal cancer. Dr. Levin and his colleagues launched their own ambitious campaign in 2006 to improve colorectal cancer screening. By promoting new screening options and increasing member outreach, the region’s rate jumped from 40 percent to more than 80 percent in just a few years. At the same time, the mortality of members due to colorectal cancer declined.
Why is colorectal cancer screening so important?
As a gastroenterologist, I see many cases of colorectal cancer that could have been prevented with appropriate screening. By finding and removing polyps in the colon that can become cancerous, we can stop progression of the disease.
How does colorectal cancer screening work in KP Northern California?
We follow national guidelines that recommend 3 types of tests for colorectal cancer: colonoscopy every 10 years, sigmoidoscopy every 5 years, or fecal testing annually. We offer these options to all our members who need to be screened, with additional emphasis on fecal testing. We use a test called the fecal immunochemical test, or FIT, which requires only one stool sample that is taken at home and mailed to our lab in Berkeley. Unlike colonoscopy and sigmoidoscopy, FIT is noninvasive and does not require sedation or bowel preparation.
We have good evidence that FIT works. A recent review published by our scientists showed that FIT is accurate and effective in finding 80 percent of colorectal cancers and ruling out colorectal cancer in 94 percent of patients. We also have evidence that patients prefer FIT screening over colonoscopy.
Why have we been so successful?
When KP Northern California members turn 50, we start sending them FIT kits in the mail, followed by reminder letters, emails, and phone calls. When they go to the doctor for any reason, they are reminded that their colorectal cancer screening is due and are handed a FIT kit. We make it difficult for our members to avoid the message that they need to be screened.
What would you say to eligible KP members and employees who have not been screened for colorectal cancer?
We like to say that the best screening test is the one that gets done. While we do not advocate for any particular type of screening, FIT has allowed us to screen more people, and prevent more cancers and cancer deaths.