Blue Review
A newsletter for physician, professional, facility, ancillary and Medicaid providers

March 2018

Colorectal Cancer Screening Options and Statistics – Get the Conversation Started Today

Will You Commit?
In 2018, the American Cancer Society estimates there will be 140,250 new cases of colorectal cancer and 50,630 deaths nationwide. For Texas alone, it is estimated that there will be 10,080 new cases of colorectal cancer with an estimated 3,740 deaths. The incidence of colorectal cancer from 2008-2012 was highest among non-Hispanic blacks followed by non-Hispanic whites, American Indians, Alaska Natives and then Hispanics. The incidence rate of colorectal cancer is lowest among Asian and Pacific Islanders. Death rates from colorectal cancer are reflective of the incidence rates.1

Colorectal cancer screenings are recommended for adults age 50 through 75 who are at average risk for colorectal cancer and who are asymptomatic. Some patients may need to be screened for colorectal cancer at an earlier age. Risk factors for colorectal cancer include older age, a personal history of colon cancer, polyps or inflammatory bowel diseases, family history of colon cancer or polyps, black adults and/or male.2

Even though some screening methods are not appropriate or feasible for everyone, having a conversation with your patients to encourage colorectal cancer screenings will most likely result in them getting screened regardless of the method chosen. It is also important to be aware that some screening methods may not be covered and an out-of-pocket cost may result.

The American College of Gastroenterology recommends colonoscopy as the preferred cancer prevention screening method and Fecal Immunochemical Testing (FIT) as the preferred cancer detection option.3

Advantages of FIT include:

  • PCPs may stock FIT tests in the office and dispense as appropriate following a brief discussion with their patients.
  • Depending on the FIT test brand, testing may be accomplished with a single specimen.2

Colorectal Cancer Screening Options:

  • Colonoscopy – Screening and diagnostic follow up of positive results can be done during the same exam. Screening interval is every 10 years.2
  • Flexible sigmoidoscopy – Patients screened by flexible sigmoidoscopy may still require a colonoscopy. Screening interval is every five years or every 10 years with yearly FIT.2
  • CT colonography – Extra-colonic findings are common.2 Screening intervals are every five years.2
  • Stool-based tests – Positive test results require further screening by colonoscopy.4 This type of screening includes:
    • FIT or immunologic Fecal Occult Blood Test (iFOBT) – No dietary restrictions. FIT tests may be one or two sample tests. Screening interval is every year.2
    • Guaiac-based stool tests or gFOBT – Less sensitive than FIT testing and typically requires more samples and dietary restrictions. Screening interval is every year.2
    • Stool DNA with FIT testing, also known as Cologuard – Exact Sciences (FDA approved).2 Screening interval is every one or three years.2

According to the American Cancer Society, “The guaiac-based fecal occult blood test (gFOBT) detects blood in the stool through a chemical reaction. This test can’t tell if the blood is from the colon or from other parts of the digestive tract (such as the stomach). If this test is positive, a colonoscopy will be needed to find the reason for the bleeding. Although blood in the stool can be from cancers or polyps, it can also have other causes, such as ulcers, hemorrhoids, diverticulosis (tiny pouches that form at weak spots in the colon wall) or inflammatory bowel disease (colitis). Over time, this test has improved so that it’s now more likely to find colorectal cancer. The American Cancer Society recommends the more modern, highly sensitive versions of this test for screening.”

Start the Conversation! 
Your recommendation that your patients get screened for colorectal cancer carries the greatest impact for colorectal cancer screening compliance.

Additional Information
For more information on this initiative, read our previous article: Colon Cancer Screenings Goal: 80% Participation in 2018 – Will You Commit?. And, you can share this article with your patients on colon cancer from the LifeTimes health and wellness website: Growing Cancer Risk for Younger Adults – What You Should Know.

Free Continuing Education Courses
The Centers for Disease Control and Prevention is providing free continuing education for PCPs, nurses, nurse practitioners and clinicians who perform colonoscopies. Access Screening for Colorectal Cancer: Optimizing Quality to download, print or watch the presentations on YouTube (expires March 10, 2019).

References

1 (n.d.). American Cancer Society, Cancer Facts & Statistics . Retrieved Dec. 9, 2016

2 (n.d.). Home – U.S. Preventive Services Task Force (USPSTF). USPSTF. Retrieved Dec. 6, 2016

3 American College of Gastroenterology. Colorectal Cancer Screening . (n.d.). Retrieved Dec. 6, 2016

4 The JAMA Network, Force, U. P. (2016). USPSTF Recommendation Statement: Screening for Colorectal Cancer . Retrieved Dec. 6, 2016