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

February 2017

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

The second of a four-part series on Colorectal Cancer (CRC) Screenings

Will You Commit? 
In 2017, the American Cancer Society estimated there would be 135,430 new cases of colorectal cancer and 50,260 deaths nationwide. For Texas alone, it was estimated that there would be 9,690 new cases of colorectal cancer with an estimated 3,700 deaths. 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

Even though some screening methods are not appropriate or feasible for all patients, having a conversation with your patients to encourage colorectal cancer screenings is most likely to result in your patients 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.
  • 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 5 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:
    • 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 1 or 3 years.2
  4. CT colonography – Extra-colonic findings are common.2 Screening interval is every 5 years.2
  5. Serology – Methylated SEPT9 DNA is a new screening method. SEPT9 DNA has low sensitivity (48%) for detecting colorectal cancer. One test brand was FDA approved in April 2016.2 The 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

Free Continuing Education 
The Centers for Disease Control and Prevention provides free continuing education for PCPs, nurses, nurse practitioners and clinicians who perform colonoscopies. Access Screening for Colorectal Cancer: Optimizing Quality  (CME), to download, print or watch the presentations on YouTube (expires March 10, 2017).

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

Thank you for your continued support and interest in colorectal cancer screenings for our members. If you’d like, you can access the January 2017 Blue Review publication for first article titled, Colon Cancer Screenings Goal: 80% Participation by 2018 – Will You Commit?

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.
3 American College of Gastroenterology. Colorectal Cancer Screening. (n.d.). Retrieved Dec. 6, 2016
4 Force, U. P. (2016). USPSTF Recommendation Statement: Screening for Colorectal Cancer. Retrieved Dec. 6, 2016.
5 American Cancer Society Recommendations for Colorectal Cancer Early Detection. (n.d.). Retrieved Dec. 6, 2016.