Nebraska can make progress against colon cancer. Here's how:

Colorectal cancer is a silent killer. Symptoms may not appear until after the cancer has spread and become difficult to treat. However, by testing people without symptoms (screening), most colorectal cancers can be prevented or found early, when treatable. Yes, colon cancer is preventable, treatable and beatable. But we must get in the game if we want to be on the winning team.

Historically, Nebraska has had low screening and high incidence rates. In 1997, only 38% of Huskers were screened. We were last in the country in 2001 while being near the top for deaths. Nebraska was in the unenviable position demonstrating how failure to screen increases cancer. Many efforts were initiated to reverse this trend including the “Stay in the Game” campaign featuring Jerry Tagge beginning in 2007. We made progress. In 2018, Nebraska’s screening rate rose to 68% (33rd in the nation) while incidence and death rates fell.

Colonoscopy is the most common screening test. Cancers can be detected at an early, treatable stage, and prevented by removing precancerous polyps. A negative colonoscopy should be repeated every 10 years.

Approximately 70-75% of screening colonoscopies find no polyps or cancer (negative exam). If we could reliably predict negative exams, we could potentially decrease the number of needed colonoscopies, leading to more efficient screening.

This might be accomplished by greater use of stool tests. Stool tests that identify hidden blood (FOBT or FIT) are done yearly; tests for DNA (MT-sDNA or FIT-DNA), every three years. Both are “at-home” tests. If stool tests are positive, colonoscopy is required to complete the screening (the “screening continuum”).

If stool tests are negative, colonoscopy might be avoided, since polyps or cancer are unlikely. To be effective, stool tests must be repeated every year (hidden blood) or every three years (DNA).

Stool tests are not for everyone. However, greater utilization for those at low risk for polyps/cancer could reduce costs for individuals and health insurers. Although not fully verified, there is evidence that individuals who smoke, are non-Caucasian or obese with limited physical activity are at increased risk of polyps/cancer and may not be good candidates for stool testing.

Also, individuals who are experiencing symptoms (rectal bleeding or blood in the stool) or with high-risk factors should have a colonoscopy, not stool testing. High-risk factors include personal histories of colorectal cancer or certain types of polyps, family histories of colorectal cancer, personal histories of inflammatory bowel disease (ulcerative colitis or Crohn’s disease), confirmed or suspected hereditary colorectal cancer syndromes, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC), or personal histories of radiation to the abdomen or pelvis to treat prior cancer. It is critical to share such information with a health care provider to discuss the appropriate timing and frequency of colonoscopy.

Screening is the best approach to fight colorectal cancer. Yet, there are financial barriers faced by Nebraskans that may impact screening participation. For example, a positive stool test may result in the required colonoscopy (“screening continuum”) being defined as “diagnostic,” resulting in patient responsibility for co-pays and deductibles for what is actually a continuation of the screening exam. This serves as a barrier to stool test alternatives for low-risk patients and to screening participation for those who prefer stool tests.

A team approach of health care providers, government entities and health insurers could overcome such barriers. Together, we could refine policies and clarify definitions for diagnosis, screening and polyp removal. Success could save money and result in positive health benefits for Nebraska.

March is Colon Cancer Awareness Month, but colon cancer education and awareness should never cease. Cohesive education, clear screening recommendations, and recognition of the “continuum of screening” are Nebraska’s best team approach to reduce the financial, social and emotional burden of, and win the battle against, colorectal cancer.

Dr. Alan Thorson

A team approach of health care providers, government entities and health insurers could overcome such barriers. ... Success could save money and result in positive health benefits for Nebraska.

Dr. Alan Thorson is the president of the Nebraska Cancer Coalition, a partnership of individuals representing public and private health organizations. He is currently a clinical professor of surgery at both Creighton University School of Medicine and the University of Nebraska College of Medicine. He is a past president of the Association of Program Directors for Colon and Rectal Surgery and the American Board of Colon and Rectal Surgery.