HEALTH Mass. nears lofty cancer-screening goal

Massachusetts is poised to become the first state in the nation to meet an ambitious new cancer-screening goal, but medical experts say there is still work to do.

When caught early, colorectal cancer is highly treatable and preventable, but too few people are getting the recommended screenings. The most common screening procedure is a colonoscopy, a procedure in which doctors examine a patient’s rectum and large intestine with a small camera mounted on a flexible tube. During the exam, doctors can use the scope to take biopsies and remove precancerous polyps.

“Colorectal cancer is one of the leading causes of cancer death of both men and women in the United States,” said Neil Maniar, the American Cancer Society’s vice president of health systems for New England. “What makes it a little different from other types of cancer is we have the ability to prevent it if we detect it early. It’s a cancer we can detect early, yet it remains one of the leading causes of cancer death in the country.”

The American Cancer Society, the Centers for Disease Control and Prevention and the National Colorectal Cancer Roundtable launched their “80 percent by 2018” program in 2014. The group hopes to see 80 percent of adults age 50 and older get the recommended colorectal cancer screenings by 2018.

Nationally, the screening rate is approximately 63 percent, up from 59 percent in 2013. In Massachusetts, approximately 76 percent of adults age 50 and older have had the recommended screening, the highest rate in the country.

If those screening rates hit 80 percent by 2018, the National Colorectal Cancer Roundtable estimates 203,000 deaths will be prevented nationally by 2030, including 2,827 in Massachusetts.

“In Massachusetts, we’re best positioned to reach the 80 percent target,” Maniar said. “That last 4 percent reflects disparities between population groups and people who are not getting screened because they’re feeling good.”

Nationally, minority groups and low-income populations have lower screening rates.

Edward M. Kennedy Community Health Center, with locations in Framingham, Milford and Worcester, has seen its patients’ colorectal cancer screening rates increase from 39 percent to 59 percent since joining the initiative in 2015.

“Some of our patients had a lot of barriers,” said Susan Melucci, director of quality improvement. “We have a culturally and linguistically diverse population.”

Some patients, she said, did not fully understand how to prepare for a colonoscopy. The health center’s instructions for the FIT test, an alternative to the colonoscopy in which patients send in their own stool samples from home, were previously only available in English.

Additionally, Edward M. Kennedy Community Health Center has worked with UMass Memorial Hospital to streamline its referral process for cancer screenings, improving show rates.

“As a community health center, our mission is that we help people live healthier lives,” Melucci said. “One of the many things I learned participating in this is colorectal cancer is one of the few almost preventable cancers. You have a colonoscopy, they detect and remove a precancerous growth, and then you don’t have cancer there.”

Colonoscopies, which are recommended every 10 years for adults 50 and older, remain the most reliable form of screening, Maniar said. Before a colonoscopy, patients are typically restricted to a clear-liquid diet the day before the exam, and may not be able to eat or drink anything the morning of the exam. Depending on the patient, a doctor may also give instructions to take a laxative the night before the procedure.

Since patients are sedated during a colonoscopy, doctors recommend that they not drive or work for the rest of the day. The sedatives partially wear off after an hour, but it may take the rest of the day for the patient to fully recover from the effects. That presents major challenges for some patients, Maniar said.

For some patients, alternate screening methods may be an option. The FIT test, for example, requires less preparation than a colonoscopy and does not involve the use of a sedative. The patient takes multiple stool samples at home. The FIT test, however, is not as reliable at detecting pre-cancerous polyps and should be performed annually to be effective.

Doctors may also perform virtual colonoscopies, non-invasive imaging procedures that are slightly less complex than a colonoscopy. Like a colonoscopy, they still require a patient to prepare by doing a bowel-cleansing. If polyps are detected, they will require a second procedure to remove them and perform biopsies.

Raising public awareness and working with community health organizations to create actionable strategies for breaking down barriers to screening could have a profound effect, Maniar predicts.

“This is one of those public health campaigns where we know we can save thousands of lives,” he said.