Thread by @IssakaMD

By one report, #colorectal cancer screenings have declined by 86% due to #COVID19.

Thankful for the opportunity to propose strategies to address this problem with #MaSomsouk @UCSFCVP in @JAMAHealthForum
jamanetwork.com/channels/healt…

“As states continue shelter-in-place ordinances that keep Americans at home/…/primary care physicians and gastroenterologists should advocate for mailed fecal immunochemical test (FIT) outreach in their health care systems to reduce colorectal cancer mortality” 2/

“Mailed FIT outreach is evidence-based and addresses barriers to screening at the patient level by providing convenient at-home testing, at the provider level by addressing clinic visit time limitations, and at the health system level by maximizing the reach of screening” 3/

“FIT is not a perfect intervention, but it has the advantage of enabling effective screening in remote health care settings at a low cost, making it very useful during times of mandated social distancing.” 4/

“To ensure that mailed FIT outreach does not increase existing colorectal cancer screening disparities, implementation strategies should proactively apply a health equity lens in the following ways…” 5/

“(1) prioritize mailed FIT for those not up to date with screening, (2) ensure mailed FIT includes everyone despite health plan or associated incentives, and (3) support federal policy that waives co-insurance for follow-up colonoscopy completion after abnormal FIT results” 6/

“Primary care physicians and gastroenterologists can maintain momentum in decreasing colorectal cancer mortality within health care organizations by taking the following steps…” 7/

“1. Advocate for establishing mailed FIT outreach programs (stay tuned for @samirguptaGI et al. paper)
2. Set clear expectations that follow-up colonoscopies for abnormal FIT results will receive priority scheduling after the moratorium on screening colonoscopies is lifted” 8/

“3. Create workflows to track patients with abnormal FIT results until colonoscopy is completed
4. Increase gastroenterology staffing to accommodate the expected surge in procedural demand” 9/

“5. Offer evening or weekend colonoscopy sessions to enable patients and gastroenterologists to colorectal cancer screening and surveillance backlogs” 10/

“Colorectal cancer is one of the few cancers for which there are multiple screening options. Now is the time for the United States to use the full arsenal available to combat this disease” /FIN

CC: @AmericanCancer @CDC @FightCRC @CCAlliance @UW_PHI @KiraNewmanMDPhD @drfolamay @DMGrayMD @SophieBalzoraMD @AdjoaGIMD