Q&A: Jennifer Weiss Discusses Colorectal Cancer Screening Across Wisconsin

Last fall, Dr. Weiss was awarded a research grant from the Wisconsin Partnership Program’s Collaborative Health Sciences Program to increase colorectal cancer screening rates in the state by leveraging the strategies of high-performing clinics. The Partnership Program recently sat down with Dr. Weiss to learn about her new project and what she hopes it will accomplish.

Q: Can you briefly describe your new project on improving colorectal cancer screening rates in Wisconsin?

A: Yes! We want to take the lessons that we’ve learned on improving colon cancer screening rates here at UW Health, and see how we can adapt them for rural and other urban settings. We recognize that those settings are different, and that there are some rural clinics and some urban clinics that are doing very well and have screening rates over 80 percent. We want to learn from those high-performers and use their techniques and screening strategies to help inform lower performers in rural and urban settings about how they can improve screening rates.

Q: What are some of the reasons that people don’t get screened for colorectal cancer when they should?

A: I think there’s a lot of reasons why — patient reasons, provider reasons and health care system reasons.

At a patient level, I think a lot of people don’t think it’s a high priority. They might not have colon cancer in their family, so they think they’re not at risk, which is not necessarily true. They also might have competing health risks that are more urgent and symptomatic, so they don’t feel like screening is worth their while. And some people are scared of colonoscopies, because they’re invasive procedures, and they don’t realize that there are other ways to screen for colon cancer, including stool-based tests that are done at home.

From a provider perspective, primary care doctors have a lot of pressing matters that they need to discuss with patients, so they might not have enough time in a clinic visit to talk to patients about colon cancer screening options. And from a health care system perspective, there’s a lack of providers that can provide colonoscopies. So health care systems need to start talking about other tests that can be done for colon cancer screening. Patients can also get lost to follow up if  systems aren’t in place to effectively identify who’s in need of colon cancer screening, who’s overdue for colon cancer screening, and who’s due for their follow-up exam.

Q: What do you hope the outcome of this work will be?

A: What I hope is that we are going to find some really innovative colon cancer screening strategies that are being used at high-performing clinics in both rural and urban settings, and that we will find out that those strategies are more pertinent, feasible and sustainable within each of those health care settings than just taking the interventions that we did at UW Health — being a large academic institution — and trying to put them into those other contexts.

Q: What are the broader impacts of this research for Wisconsin, and the field of cancer research?

A: The broader impact for Wisconsin is that our goal as a state is to get colon cancer screening rates above 80 percent, which is in line with the National Colorectal Cancer Roundtable Initiative of 80 percent in every community. So by targeting and going to different communities and finding out exactly how high-performing clinics in those communities are succeeding, we want to raise up all rural clinics and all urban clinics to 80 percent — doing so will play a huge role in decreasing the incidence and mortality of colorectal cancer across Wisconsin.

I’m also hopeful that our methodology can be applied to other health care quality improvement initiatives, in multiple states, across multiple types of cancer screenings. For example, our methodology could be applied to clinics that are doing really well with screening for HPV vaccination to help prevent HPV associated cancers. We could learn from those high-performers and translate their strategies in a similar way.

Q: How can this work be understood through a health equity lens?

A: We don’t just want to identify clinics that are high-performing overall: another one of our goals is to pull out high-performing clinics for specific underserved and underrepresented populations, like Hispanic Wisconsinites and those on Medicaid, and learn about what makes them so successful. For example, it’s possible that we’ll find during our qualitative interviews that having a medical assistant who speaks Spanish helps a clinic do well when it comes to screening Hispanic patients. Those are the kind of things that we’re hoping to find out.

Q: What does the Partnership Program’s support mean to the project?

A: I would not be able to do this project without the Partnership Program’s support. I think that it’s really important from a state perspective that we have a funding organization whose goal is to improve health in Wisconsin. We apply for a lot of federal grants, and federal grants are looking at more generalizable information and applicability across the entire nation. It’s very hard to get grant funding for a lot of the stuff that we’re doing, and especially if we want to really improve locally and regionally, it’s important to have organizations that are focused on improving the health of Wisconsin to fund our work.

Q: Why did you decide to focus on gastroenterology and colorectal cancer in particular?

A: That’s a great question. I get asked this a lot by medical students who rotate on our service. I really did enjoy cancer prevention when I was in medical school, so I knew I wanted to be in a career where I would be helping with cancer prevention. I also really enjoyed gastrointestinal diseases, and then kind of found a marriage of those two in helping to prevent gastrointestinal cancers, with colorectal cancer being the most common. So that is where I have focused most of my research. But I also run the GI genetics clinic, so I see individuals clinically who are at high risk for all types of gastrointestinal cancers.

Q: What do you wish the public knew about your research?

A: What I really want people to know about my work is actually about colon cancer screening in general. Colon cancer is one of the most preventable cancers, so if people participate regularly in high-quality screening programs, we can prevent colon cancer, because we can identify the precancerous colorectal polyps and we can remove them. We can intervene before something turns into colon cancer, which is potentially lifesaving.

Q: What do you find most rewarding about your work?

A: Helping people, and hopefully preventing cancers and just spreading the knowledge that colon cancer screening is easy to do. And it’s something that we know is beneficial, and we know could really make a huge impact on people’s lives and quality of life.