M&D Clinical Corner: Community Pharmacist’s Guide to Colorectal Cancer Awareness - Morris & Dickson

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April 12, 2024

M&D Clinical Corner: Community Pharmacist’s Guide to Colorectal Cancer Awareness

The Clinical Corner is a monthly feature that highlights a variety of important pharmacist topics that is written by Morris & Dickson’s staff pharmacist, Paula Belle (RPh).

This month’s Clinical Corner will provide information on Colorectal Cancer Awareness:

  • The Need for Colorectal Cancer Awareness
  • The Pharmacist’s Role
  • Identify Patients
  • Educate Patients
  • Refer/Follow Up with Patients
  • Resources for Pharmacists

The Need for Colorectal Cancer Awareness

  • Colorectal cancer (CRC) is the fourth most commonly diagnosed cancer and the second leading cause of cancer-related deaths in the United States. [1]
  • The median age at CRC diagnosis is 66 years, and the median age of death from CRC is 72 years. [1]
  • It was estimated that 153,020 adults would be diagnosed with CRC in 2023, and 52,550 would die as a result of CRC. [1]
  • The incidence of CRC in young adults (CRCYAs) is increasing globally, and it is now the third leading cause of cancer death among young adults under 50 years old. [2]
  • Delayed diagnosis and more advanced disease presentation in young adults contribute to worse outcomes. [2]
  • Effective, reliable screening has led to a substantial (>30%) decrease in CRC incidence and mortality among adults aged >50 years over the past 15 years. [1]

The Pharmacist’s Role

  • Pharmacists have the opportunity to educate patients about the significance of CRC, help promote lifestyle changes, and provide recommendations for CRC screenings. [3]

Identify Patients

  • Pharmacists are in a prime position to identify patients who are candidates for screening, referring them to their healthcare provider. [3]
  • The CDC recommends that patients aged 45 to 75 years old get screened regularly for CRC. [4]
  • Patients under age 45 who feel they may be at increased risk for CRC should consult with a physician. [4]
  • Positive family history remains the most significant known risk factor for adults younger than 50, contributing to approximately 20% of cases. [2]
  • A recent 2021 systematic review found that potential causal factors for early‐onset CRC include processed meat, sugary drinks, excessive alcohol intake, physical inactivity, and smoking. [2]
  • Patients at increased risk for developing CRC include those with [5]:
    Inflammatory bowel diseases such as Chron’s or ulcerative colitis.
    Personal or family history of colorectal cancer or colorectal polyps.
    Certain genetic syndromes.

Educate Patients

  • Counseling About CRC Risk
    • Patients can be coached to make lifestyle changes that will reduce their CRC risk such as [5]:
    • Increasing regular physical activity.
    • Eating a diet high in fruits and vegetables.
    • Eating a high-fiber, low-fat diet including reducing processed meats.
    • Losing weight.
    • Reducing alcohol consumption.
    • Discontinuing tobacco use.
  • Pharmacists can emphasize that colorectal polyps and CRC don’t always cause symptoms, especially at first. [4]
  • If patients do have symptoms, they may include [6] :
    • A change in bowel habits.
    • Blood in or on the stool.
    • Diarrhea, constipation, or feeling that the bowel does not empty all the way.
    • Abdominal pain, aches, or cramps that don’t go away.
    • Unexplained weight loss.
  • Counseling on CRC Screening
    • A screening test is used to look for a disease when a person doesn’t have symptoms. [7]
    • Screening tests can find precancerous polyps, so that they can be removed before they turn into cancer. Screening tests can also find CRC early, when treatment works best. [7]
    • The U.S. Preventive Services Task Force recommends several CRC screening strategies, including [7]: Stool tests.
      • Direct visualization tests including:
      • Flexible sigmoidoscopy.
      • Colonoscopy.
      • CT colonography (virtual colonoscopy).
  • Stool Tests for CRC
    • Stool-based exams are quick and noninvasive, can be done at home, and do not require bowel preparation. [3
    • However, their usefulness is limited by their inability to detect nonbleeding polyps or cancers. [3]
    • If any of these tests return a positive result, follow-up with a colonoscopy may be required. [3]
    • Guaiac-based fecal occult blood test (gFOBT) :
      • This test uses the chemical guaiac to detect blood in the stool. [8]
      • It is done once a year. [8]
      • For this test, patients receive a test kit from their health care provider.[8]
      • The patient performs the test at home, using a stick or brush to obtain a small amount of stool. [8]
      • Three stool samples obtained at home on different days should be submitted. [3]
      • Patients should also avoid ingesting certain foods and medications, including red meat, NSAIDs, iron products, or vitamin C before the test to avoid false positives. [3]
      • The test is returned to the doctor or a lab, and the samples are checked for blood. [8]
      • gFOBT is the most commonly used stool-based exam, but it is considered to be less accurate when compared with others. [3]
    • The fecal immunochemical test (FIT) :
      • The FIT test uses antibodies to detect blood in the stool. [8]
      • It is also done once a year in the same way as a gFOBT. [8]
      • This test has been found to be more sensitive and specific for detecting CRC when compared to gFOBT. [3]
      • It is more convenient compared with gFOBT because it only requires one stool sample and has no dietary restrictions. [3]
    • The FIT-DNA test (also referred to as the stool DNA test) [8]:
      • This test combines the FIT with a test that detects altered DNA in the stool.
      • For this test, patients collect an entire bowel movement and send it to a lab, where it is checked for altered DNA and for the presence of blood.
      • It is done once every three years.
  • Direct Visualization Tests
    • Direct visualization tests include colonoscopy, flexible sigmoidoscopy, and computed tomographic colonography. [3]
    • These tests have greater sensitivity compared with stool-based tests and allow for the early identification of adenomatous polyps before they progress to CRC. [3]
    • They do require the patient to complete a bowel preparation prior to testing; however, because of their increased sensitivity, they are recommended to be performed less often. [3]
    • Colonoscopy is the most widely used screening test for colorectal cancer and is considered the gold standard. [3]
    • Flexible Sigmoidoscopy
      • For this test, the doctor puts a short, thin, flexible, lighted tube into the patient’s rectum [8]
      • The doctor checks for polyps or cancer inside the rectum and lower third of the colon [8]
    • Colonoscopy
      • This is similar to flexible sigmoidoscopy, except the doctor uses a longer, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon. [8]
      • During the test, the doctor can find and remove most polyps and some cancers. [8]
      • Colonoscopy also is used as a follow-up test if anything unusual is found during one of the other screening tests. [8]
      • Colonoscopy is recommended every 10 years (for people who do not have an increased risk of CRC). [8]
    • CT Colonography (Virtual Colonoscopy)
      • Computed tomography (CT) colonography, also called a virtual colonoscopy, uses X-rays and computers to produce images of the entire colon, which are displayed on a computer screen for the doctor to analyze [8]
      • A complete bowel preparation is required but sedation is not necessary [3]
      • It is recommended that virtual colonoscopy be performed every 5 years. [8]
    • Pharmacists can help patients understand the advantages and disadvantages of each testing type and recommend that they consult a physician as the type of test to select depends on [8]:
      • The patient’s preferences.
      • The patient’s medical conditions.
      • The patient’s personal of family history of CRC or polyps.
      • Whether the patient has certain genetic syndromes that increase risk.
      • The likelihood that the patient will get the test completed.
      • The testing resources available to the patient.
  • For patients who will be undergoing a colonoscopy, pharmacists can ensure the patient’s understanding regarding the importance of the bowel preparation and promote the safe use of these products. [3]

Resources for Pharmacists


  1. Olga Hilas, P., MPH, BCPS, BCGP, FASCP Professor, Department of Pharmacy Practice St. John’s University College of Pharmacy & Health Sciences Queens, New York. Colorectal Cancer Screening in the United States. 2024 [cited 2024 February]; Available from: https://www.uspharmacist.com/article/colorectal-cancer-screening-in-the-united-states.
  2. Kim, B.J. and M.H. Hanna, Colorectal cancer in young adults. Journal of Surgical Oncology, 2023. 127(8): p. 1247-1251.
  3. Emily M. Ambizas, P., MPH, BCGP Associate Clinical Professor St. John’s University, College of Pharmacy & Health Sciences Queens, New York Clinical Specialist, Walgreens Pharmacy Whitestone, New York. The Pharmacist’s Role in Colorectal Cancer Screening. 2024 [cited 2024 February]; Available from: https://www.uspharmacist.com/article/the-pharmacists-role-in-colorectal-cancer-screening.
  4. Centers for Disease Control and Prevention. Colorectal Cancer Awareness Feature | CDC. 2023 2023-11-27T07:20:49Z [cited 2024 February]; Available from: https://www.cdc.gov/cancer/dcpc/resources/features/colorectalawareness/.
  5. Centers for Disease Control and Prevention. What Are the Risk Factors for Colorectal Cancer? | CDC. 2023 2023-07-31T12:58:21Z [cited 2024 February]; Available from: https://www.cdc.gov/cancer/colorectal/basic_info/risk_factors.htm.
  6. Centers for Disease Control and Prevention. What Are the Symptoms of Colorectal Cancer? | CDC. 2023 2023-02-23T09:19:41Z [cited 2024 February]; Available from: https://www.cdc.gov/cancer/colorectal/basic_info/symptoms.htm.
  7. Centers for Disease Control and Prevention. What Should I Know About Screening for Colorectal Cancer? | CDC. 2023 2023-02-23T09:20:09Z [cited 2024 February]; Available from: https://www.cdc.gov/cancer/colorectal/basic_info/screening/index.htm.