March is Colorectal Cancer Awareness Month.

Prevention Strategies

Mitigating the Impact of COVID-19 on Colorectal Cancer Screening

Messaging around patient safety is key to ensuring patients come in for their screening exams.

The COVID-19 pandemic presented new challenges in the fight against colorectal cancer, the second-deadliest cancer afflicting both men and women in the U.S. today. 

Many elective procedures were suspended in the early surges of the pandemic, including elective screening colonoscopies. A July 2020 review on the impact of COVID-19 on cancer screening estimated screenings for colorectal cancer fell 86 percent between Jan. 20, 2020, and April 21, 2020. 

As part of a Colorectal Cancer Awareness Month initiative, the Colorectal Cancer Alliance has started a screening pledge, with the goal of having 10,000 signatures before the end of March. Signers of the pledge commit to speaking with their doctors about screening options for colorectal cancer. 

Dr. Seth A. Gross, Clinical Chief of Gastroenterology and Hepatology at NYU Langone Health, said elective colorectal screening was temporarily halted during the peak of the pandemic in early Spring 2020. In recent months, however, screening exams are being done routinely.   

The American Cancer Society and American College of Gastroenterology both recommend individuals begin colorectal cancer screening at age 45. Regular screenings should continue until age 75. Colorectal cancer is considered a preventable disease because of the effectiveness of early detection and removal of precancerous lesions with colonoscopy. 

That’s why it’s important for patients experiencing symptoms such as bleeding, weight loss, or abdominal pain to seek medical attention and not ignore their symptoms, Gross said. Even healthy patients who are due for their screening colonoscopy should still be keeping their appointments despite the pandemic, he said. 

“You just have to trust everyone has your best interest in mind,” he said, noting that medical offices, ambulatory surgery centers, and hospitals have strict procedures in place to protect patients from getting COVID-19. 

For gastroenterologists, this messaging around patient safety is key to ensuring patients come in for their screening exams, Gross said.  

The American College of Gastroenterology has produced a toolkit to help gastroenterologists educate patients about the effectiveness of screening colonoscopy in preventing colorectal cancer. It includes patient education materials such as brochures and handouts and social media posts for Colorectal Cancer Awareness Month. 

Colorectal cancer rates decreased by 1 percent annually from 2013 to 2017, according to the American Cancer Society 2021 Cancer Facts and Figures report. Death rates fell 55 percent between 1970 and 2018, according to the report.  

In 2000 there was a general shift in the primary screening method for colorectal cancer from sigmoidoscopy and fecal occult blood test (FBOT) to colonoscopy. Subsequent research suggests endoscopic removal of adenomas — the primary interventional measure in screening colonoscopy — has been effective in reducing colorectal cancer cases. 

An international panel of gastroenterologists predicted in April 2020 that interruptions in scheduled screening colonoscopy could result in late diagnoses of almost 3,000 colorectal cancer cases. The panel also predicted up to 22,000 high-grade adenomatous polyps with malignant potential would be missed by the end of the year.

Colorectal cancer is preventable, treatable, and beatable when caught early, Gross said. Everyone is encouraged to speak to their doctor about colorectal cancer screening.

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