New Hampshire Can Lead Nation in Increasing Colorectal Screening for Cancer, says Primary Care Research Expert

June 11, 2010
Lebanon, NH

Dr. Dietrich

Allen Dietrich, MD

New Hampshire has an opportunity to become a national leader in screening for colorectal cancer by following through on the delivery of three "sweet spots" of patient care, stated Allen Dietrich, MD, one of the nation's leading researchers in primary care and Associate Director for Population Sciences at Dartmouth-Hitchcock Norris Cotton Cancer Center.

These sweet spots include the New Hampshire Colorectal Cancer Screening Program (NHCRCSP), a new collaboration among the Cancer Center, the New Hampshire Department of Health and Human Services, and the Centers for Disease Control and Prevention, which aims to educate the public about the benefits of colorectal cancer screening and offers low-income residents who meet certain requirements the opportunity for free screenings. Another is the fecal immunochemical test, or FIT, which is less invasive and time-consuming than a colonoscopy, the standard screening test. These sweet spots support the third: greater application of what we know about health care network and primary care office systems to support screening. These systems have been "inspired and informed by experience here and elsewhere," said Dr. Dietrich.

Nationwide, more than 147,000 new cases of colorectal cancer (CRC) are reported every year, with nearly 50,000 deaths reported per year, according to the American Cancer Society. In New Hampshire, 730 new cases of colorectal cancer are reported each year and 330 are reported in Vermont.  "Applying what we know about CRC screening could prevent 18,800 cases of colon cancer a year (nationally)," Dr. Dietrich emphasized.

Dr. Dietrich spoke as the holder of the James J. Carroll Chair in Oncology at Dartmouth Medical School and Norris Cotton Cancer Center. The Carroll Chair and Distinguished Lecture honor Dr. Dietrich's career as a "pioneer in primary care research," said Cancer Center Director Mark Israel, MD, in his introduction. In his lecture on May 27 at Dartmouth-Hitchcock Medical Center, Dr. Dietrich pointed out that some challenges must be addressed before New Hampshire can take the lead in CRC screening.

"Primary care has not lived up to its promise for CRC screening," he stated. "There is little time in a typical primary care visit to address issues related to preventive care. Patients are often confused by what little information they do receive. There are a lot of screening tests that can detect colorectal cancer, and people have to decide if they want to be screened and if so what test is right for them."

In addition, the government can play a positive role, Dr. Dietrich said. "Health plans and clinicians should receive incentives to help their patients consider appropriate screening tests. One of the things that's going to help us is health-care reform. There's some very positive language in the bill that was passed about insurance coverage for screening," he observed, adding, "Of course, we'll have to see how it gets implemented."

He is also optimistic about the role genetic testing might play in the future. "I love the idea of being able to risk-profile people better. Looking ahead 10 years, it would be wonderful to say, 'Your risk is one in 20' or 'your risk is one in 1,000.' I think that day will come." He added, "We also don't do as much as we should with family histories of patients. Patients could make it their business to know their family health history and to tell their clinicians about it, and clinicians should make it a priority to ask!"

"But I don't think we can wait," Dr. Dietrich concluded. "There are too many lives that can be saved with the sweet spots that are there now."

The James J. Carroll Chair of Oncology at Norris Cotton Cancer Center and Dartmouth Medical School recognizes a faculty member with an outstanding professional history as an inspiring educator, a supportive mentor, a productive scientist at the leading edge of cancer research, a respected senior scholar of national academic stature, and an astute and judicious institutional leader. The Samuel Roberts Noble Foundation established the chair in 1979 in memory of James J. Carroll, a Dartmouth graduate who served as senior investment advisor to the Noble Foundation for 20 years before he died of cancer in 1975.

Dartmouth-Hitchcock Norris Cotton Cancer Center combines advanced cancer research at Dartmouth Medical School with patient-centered cancer care provided at Dartmouth-Hitchcock Medical Center, at Dartmouth-Hitchcock regional locations in Manchester and Keene, NH, and St. Johnsbury, VT, and at 11 partner hospitals throughout New Hampshire and Vermont. It is one of 40 centers nationwide to earn the National Cancer Institute's "Comprehensive Cancer Center" designation.

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