Colorectal cancer (CRC) is the second-deadliest cancer in the U.S.; however, screening rates remain too low due to a combination of lack of awareness, patient fear, and health care system barriers. Many patients don’t realize they are at risk because early-stage CRC has no symptoms, making screening the only way to detect and prevent disease progression.
As frontline health care providers, nurse practitioners (NPs) and physician associates/assistants (PAs) are uniquely positioned to address these challenges. With their ability to educate patients, incorporate conversations about screenings into routine visits and facilitate the process, NPs and PAs can play an important role in increasing CRC screening.
Why early detection is important
CRC symptoms usually only appear at an advanced stage when treatment options are limited. The five-year survival rate for late-stage CRC is just 14 percent, but when caught early, that number jumps to over 90 percent.
The recommended screening age was reduced in 2019 from 50 to 45, but many patients are not aware of the change. Public figures like Katie Couric and James Van Der Beek are increasingly using their platforms to encourage conversation, share their personal experiences with cancer, and help drive public awareness. This is an important step forward, but health care providers can continue driving action at the patient level to increase screenings.
We’re also learning more from research about environmental risk factors for CRC, including a potential link between microplastics and increased colorectal cancer rates. While research continues, it’s important to remember that early detection is still the best defense. Providers can reinforce the importance of CRC screening, help patients understand their risk, and encourage timely screenings.
Another critical gap is screening those with a family history of CRC. Unlike breast or prostate cancer, colorectal cancer is rarely discussed within families, leaving many at-risk individuals unaware that they should begin screening earlier than the general population. To close this gap, providers should prioritize family history discussions as a routine part of patient visits, even beyond wellness exams. Identifying at-risk individuals early can ensure they start screening at age 40 or 10 years before their relative’s age at diagnosis. This is a small change that could prompt a conversation among relatives and lead to life-saving early detection.
The role of NPs and PAs in screening
As primary care providers, NPs and PAs have regular, ongoing interactions with patients, making them well-positioned to initiate screening discussions. A simple “When was your last colorectal cancer screening?” can be woven into routine visits to keep the topic at the forefront of patient care. Many patients mistakenly believe they don’t need screening unless they have symptoms, while others assume colonoscopy is the only option. Shifting the conversation from “You need a colonoscopy” to “You need a colorectal cancer screening, and there are multiple options” gives patients a greater sense of control and can help reduce hesitation.
One of the most common reasons patients avoid screening is fear of bowel prep. Addressing these concerns proactively by discussing low-volume prep options, offering alternatives like FIT and Cologuard, and providing cost-saving resources can help improve adherence. Ensuring that stool-based tests are given to patients in-office with clear instructions significantly increases completion rates. When a colonoscopy is necessary, scheduling the appointment before the patient leaves the office can improve follow-through and reduce patient drop-off.
Navigating the future of screening
Blood-based CRC screening is an emerging technology that could one day expand access, but it comes with limitations. Unlike stool-based tests, which detect DNA from precancerous or cancerous cells, blood tests rely on circulating tumor DNA, which is often too low in early-stage CRC to be detected reliably. While blood-based screening may complement existing methods in the future, it should not replace stool tests or colonoscopy, as it lacks the sensitivity needed for early detection. Relying solely on blood-based screening could provide patients with false reassurance, delaying necessary treatment.
A collaborative approach to increasing screening rates
Increasing CRC screening rates requires a coordinated effort across health care settings. NPs and PAs can work alongside medical assistants, front desk staff, and GI specialists to make sure patients are getting their screenings. Office workflows can help ensure that patients receive kits with all necessary materials, educational resources are available, and scheduling occurs in real time to minimize missed follow-ups. Collaboration with GI specialists can also help address long wait times for colonoscopies, ensuring timely access for patients who need further evaluation.
Beyond the clinical setting, peer collaboration plays a critical role in improving screening strategies. Professional networks like The American Association of Nurse Practitioners, POCN, and the American Academy of Nurse Practitioners are great resources where providers can share best practices, learn from colleagues, and stay updated on advancements in CRC screening. Engaging in discussions, attending continuing education events, and adopting proven strategies can make a significant impact in closing the screening gap.
Saving lives, one conversation at a time
CRC screening should be a routine, accessible, and patient-centered part of care. By initiating conversations, addressing barriers, and streamlining the screening process, NPs and PAs can help detect more cases early when they are most treatable. We can work together to close the CRC screening gap by building trust with patients through conversation, making prevention part of routine care, and prioritizing early detection. Simply introducing the topic of screening to patients is an opportunity to inform, empower, and ultimately save lives.
Elisabeth Evans is a nurse practitioner.
