Blue Review
A newsletter for contracting institutional and professional providers

September 2017

Colorectal Cancer Screening Options and Statistics – Get the Conversation Started

Part 2 of a 4-part series discussing Colorectal Cancer Screening. Part 1 was published in the August 2017 issue of the Blue Review.

Will You Commit?
In 2017, the American Cancer Society (ACS) estimated there would be 135,430 new cases of colorectal cancer and 50,260 deaths nationwide. For Illinois alone, it was estimated that there would be 5,580 new cases of colorectal cancer with an estimated 2,030 deaths.1 The incidence of colorectal cancer from 2008-2012 was highest among non-Hispanic blacks followed by non-Hispanic white, American Indian, 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

Start the Conversation
Your recommendation that your patients get screened for colorectal cancer carries the greatest impact with your patients. Even though some screening methods are not appropriate or feasible for all patients, what is important is that the options are discussed. Keep in mind that some screening methods may not be covered and an out-of-pocket cost to the patient may result. Regardless of the method chosen, your encouragement to get a colorectal cancer screening will most likely result in your patients getting screened.

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:
Primary Care Physicians (PCPs) may stock FIT tests in the office and dispense as appropriate following a brief discussion with their patients. Patients complete the test in the privacy of their own home.
Depending on the FIT test brand, testing may be accomplished with a single specimen.2

Colorectal Cancer Screening Options:

  1. Colonoscopy – Screening and diagnostic follow up of positive results can be done during the same exam. Screening interval is every 10 years.2
  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
  3. Stool-based tests – Positive test results require further screening by colonoscopy.4 This type of screening includes:
  1. 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
  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
  3. Stool DNA with FIT testing, also known as Cologuard – Exact Sciences which is approved by the U.S. Food and Drug Administration (FDA).2 Screening interval is every one or three years.2
  1. CT colonography – Extra-colonic findings are common.2 Screening interval is every five years.2
  2. Serology – Methylated SEPT9 DNA is a new screening method. One test brand was FDA approved in April 2016.2 The United States Preventive Services Task Force (USPSTF) does not give a screening interval for SEPT9 DNA testing.

According to the American Cancer Society, a stool specimen from a digital rectal exam tested for blood with a gFOBT or FIT is not an acceptable way to screen for colorectal cancer.5 Research has shown that a stool specimen obtained by digital rectal exam will miss more than 90 percent of colon abnormalities, including most cancers.5

Learn more. The Centers for Disease Control & Prevention (CDC) is providing free continuing education for PCPs, nurses, nurse practitioners and clinicians who perform colonoscopies. Visit the CDC website to access Screening for Colorectal Cancer: Optimizing Quality* and other CDC training resources.

Thank you for your continued support and interest in colorectal cancer screenings for our members. Part 1 of the Colorectal Cancer Screening series – Colon Cancer Screenings Goal: 80% Participation by 2018 – Will you commit? – can be found in the August 2017 Blue Review.

References
1(n.d.). American Cancer Society, Cancer Facts & Statistics. Retrieved Dec. 9, 2016.
2(n.d.). Home – U.S. Preventive Services Task Force. Final Recommendation Statement: Colorectal Cancer: Screening - US Preventive Services Task Force. Retrieved Dec. 6, 2016.
3American College of Gastroenterology. Colorectal Cancer Screening. (n.d.). Retrieved Dec. 6, 2016
4Force, U. P. (2016). USPSTF Recommendation Statement: Screening for Colorectal Cancer. Retrieved Dec. 6, 2016.
5American Cancer Society Recommendations for Colorectal Cancer Early Detection. (n.d.). Retrieved Dec. 6, 2016.

*https://www.cdc.gov/cancer/colorectal/quality/

The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. The reference to any particular brand, type or method of testing is solely for informational purposes and is not, and should not be, construed as an endorsement, representation or recommendation for any particular test. Physicians and other health care providers are encouraged to use their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment.