September is an important month, as it marks both Prostate and Ovarian Cancer Awareness Month. More than merely spreading awareness about these two forms of cancer, though, providers and care teams’ responsibility is to ensure that patients come in for timely screenings that can determine early diagnoses and impact improved outcomes. I sat down once again with Lightbeam Clinical Transformation Advisor, Christine DiNoia, BSN, RN, to discuss the importance of targeting patients for screening, whether it is because of their age or family history.
Christine, why is getting patients into their doctor’s offices for cancer screenings so critical?
While some cancers can be hard to detect at their earliest stages, there are specific tests that can help find cancers before they become advanced. Specific cancers may not have obvious signs or symptoms, and we know that early detection can lead to improved treatment and outcomes. Survival rates can drop dramatically with increased stages. When you are with your provider, it is critical to discuss how you can do better at preventing cancer, understanding your specific risks for cancer, and learning your family’s cancer history.
What are some questions patients should ask themselves to determine scheduling a screening?
Patients should do preliminary research independently via reliable sources, like the Centers for Disease Control & Prevention (CDC) and the National Cancer Institute, to see if they meet the basic criteria. Some things used to determine who a physician recommends for a specific screening are biological sex, age, race and ethnicity, family history, and other risks. What I mean by other risks are things like smoking history, sun exposure, previous cancer diagnoses, diet, and the like. Those items help patients share with the provider to make an accurate recommendation and order the appropriate screening tests.
If patients do not know their family history, is there a way to find out?
Research suggests that approximately 10% of cancers have some genetic predisposition. Having an idea of family history is certainly helpful, but if it is unavailable, there are genetic markers for some cancers. For example, the BRCA gene mutations can indicate breast or ovarian cancers. Therefore, in the absence of detailed family history, the provider may recommend genetic counseling. If the patient decides to, the counselor can determine if they are the right candidate to receive genetic testing. Several companies will also do DNA testing to give insight into genealogy and ethnicity with personalized health reports. We are lucky in 2020 to have these different technology avenues available to everyone.
What are the first steps a care team should take to begin initiatives around increasing cancer screenings?
There are several national initiatives around particular cancer screenings to equip care teams with great initial resources. Care teams can find a list of the current national educational campaigns on the CDC website, like videos, podcasts, graphics, and print materials available at no cost for organizations to share with local media. There are often local initiatives and resources to get involved with, too, as it is not uncommon for nearby hospitals to head campaigns like cancer screening. At Lightbeam, we are here to help clients in a hands-on way to identify groups of patients that are eligible for vital screenings. We would suggest that a care team identify the initiative or the type of cancer screening they feel they should push for in their population, and then think about easily identifiable traits like age and biological sex to start. With the Lightbeam platform, we can build a cohort that would identify eligible patients and those who have not had a particular screening within the appropriate time frame. We can also support reaching those patients by written campaigns that could be mailed, emailed, or texted to those patients or assist with reaching them by phone to let them know it is time to schedule a screening. Having educational handouts in the providers’ offices is also helpful to answer questions or quell any fears.
What is the role of primary care providers in getting patients in for preventative screenings?
The primary care physician (PCP) role, mainly, is to be the comprehensive record-keeper of a patient’s care journey. Certain PCPs can also perform certain screenings if they have proper training.
Cancer Screening Statistics
The following are statistics to help determine if patients are screened for one of the available screenings. All information is from the CDC Cancer resources and the National Cancer Institute.
Ovarian Cancer
- All women are at risk, but women who have a family history, struggle with infertility, have had breast, uterine, or colorectal cancer, a genetic mutation, or are middle-aged and older are at an increased risk. The CDC also states that women of Eastern European descent or Ashkenazi Jewish background are at a higher risk.
- 85 to 90% of all ovarian cancers are cancerous epithelial tumors or carcinomas that begin in the tissue that lines the ovaries.
Prostate Cancer
- The most common risk factor is age. The older a man is, the greater the chance of getting prostate cancer.
- Men are at an increased risk of developing prostate cancer if they are African American or have a family history of prostate cancer.
- A patient might be at an increased risk if they were diagnosed already with prostate cancer or other family members who have had breast, ovarian, or pancreatic cancer.
Breast Cancer
- There is a greater chance for early detection with the administering of self-exams, mammograms, and breast Magnetic Resonance Imaging (MRI).
- Women are at an increased risk for breast cancer if they have a family history of breast or ovarian cancer, a genetic mutation, started their period before age 12, started menopause after 55, and others.
- Women who are 50 to 74 years old should receive a mammogram every two years.
Skin Cancer
- If you are fairer skinned, sunburn easily, have a large number of moles, are older, or have a family history of skin cancer, you should begin yearly skin checks by a dermatologist.
Cervical Cancer
- Women should begin receiving Pap tests (or Pap smears) at age 21 to identify precancerous cells in the cervix. Normal Pap test results may mean a woman can wait three years until their next test.
- Increased risk factors for women to develop cervical cancer include HIV, taking birth control pills for longer than five years, smoking, having three or more children, and several intimate partners.
Colorectal Cancer
- Colorectal cancer develops from precancerous polyps in the colon or rectum.
- Any adult between the ages of 50 and 75 should begin screening for colorectal cancer.
- The US Preventive Services Task Force recommends screening beginning at age 50. Depending on family history or if a patient battles inflammatory bowel disease, a provider may recommend starting screening at age 45.
- Approximately 90% of colorectal cancer diagnoses are in patients age 50 or older.
Lung Cancer
- A patient with a personal history of heavy smoking, is currently smoking, has quit smoking within the past 15 years, and is between 55 and 80 years old should screen yearly for lung cancer. The screening is a low-dose CT scan to detect abnormal growths.
Laurel Derr is Lightbeam’s Marketing & Event Coordinator.