Nurses Play Integral Role in Newly Issued Colorectal Screening Guidelines

The American Cancer Society (ACS) recently updated its guidelines to lower the age to start colorectal cancer screening to 45. Nurses will play a vital role in implementing this important change.

“Nurses play such an integral role in patient care, so they also do a tremendous amount of patient education. So, incorporating this new knowledge in to their interactions with patients is very important,” Susan K Peterson, PhD, MPH, from the Department of Behavioral Science in the Division of Cancer Prevention and Population Sciences at the University of Texas MD Anderson Cancer Center, said in an interview with Oncology Nursing News^®.

The guidelines, recently published in CA: A Cancer Journal for Clinicians, recommend the following:

• Adults aged 45 and older with an average risk for colorectal cancer should undergo regular screening—either with a high-sensitivity stool-based test or a structural exam, depending on patient preference and test availability.
• All positive results on non-colonoscopy screening tests should be followed up with timely colonoscopy.
• Average-risk adults in good health with a life expectancy of greater than 10 years should continue colorectal cancer screening through age 75; for those 76 to 85 years, clinicians should individualize colorectal cancer screening decisions based on patient preferences, life expectancy, health status, and prior screening history; and those over age 85 should be discourages from continuing colorectal cancer screening.

The authors of the guideline noted that the change in age is designated as a qualified recommendation, “because there is less direct evidence of the balance of benefits and harms, or patients’ values and preferences, related to colorectal cancer screening in adults aged 45 to 49 since most studies have only included adults aged 50 or older.” They went on to say that the previous recommendation of screening at 50 is a strong recommendation give that there is a greater strength of evidence and the judgment of the overall benefit.

The ACS’s review incorporated more recent studies of the rising incidence trends in younger adults and showed that multiple screening strategies beginning at 45 years of age, including colonoscopy at the conventional 10-year interval, had a more favorable benefit-to-burden ratio with more life-years gained compared with starting screening at age 50.

For screening, nurses can help patients identify their options: fecal immunochemical test (FIT) annually; high sensitivity guaiac-based fecal occult blood test (HSgFOBT) annually; multi-target stool DNA test (mt-sDNA) every 3 years; colonoscopy every 10 years; CT colonography (CTC) every 5 years; and flexible sigmoidoscopy (FS) every 5 years.

To start, nurses can play a vital role in sparking conversations between individuals and their family, and in turn, relaying this information to their healthcare providers.

“Educating patients about the important of being aware of symptoms they may be having and seeking the appropriate care is very important,” Peterson said. Starting the discussions about colon cancer screening earlier than the age it is supposed to start, bringing it up in the early 40s and making people aware that this is something they need to start doing.”

For example, Peterson noted this should be a part of annual care discussions. “Many women are aware of mammograms, and that is something that might come up frequently during well-women visits, but the same discussion needs to occur with regard to colon cancer screening as well, and nurses play a vital role in all of that,” she added.

In addition, the ACS also developed new materials to facilitate conversations between clinicians and patients to help individuals decide which test is best for them, which can also be a useful tool for nurses.

“Hopefully the guidelines will raise awareness among physicians that this is not just a disease for persons who are older,” Peterson said. “There are compelling stories of individuals who have symptoms, and they went to see a doctor, and physicians may not attend to them or may dismiss (their symptoms) because of a person’s age.”