March is national colorectal cancer awareness month! The American Cancer Society estimates that in 2018 the number of new colorectal cancer cases will be above 97,000, and there will be greater than 43,000 new rectal cancer cases in the United States.
Colorectal Cancer Awareness
March is national colorectal cancer awareness month! The American Cancer Society estimates that in 2018 the number of new colorectal cancer cases will be above 97,000, and there will be greater than 43,000 new rectal cancer cases in the United States. In one Michigan screening program, pre-cancerous polyps were removed from 652 patients and 11 cancers were identified out of 7,114 screenings from 2006-2015.
While colonoscopies may be considered the gold standard for colorectal cancer (CRC) screenings, stool tests are a good screening option and can play a pivotal role in early detection of colorectal cancer. The most effective stool screenings are obtained by high-sensitivity fecal immunochemical tests (FIT), high-sensitivity guaiac-based FOBTs, or FIT-DNA tests. Keep in mind that Cologuard may not be the best test for every individual, and it may not be covered by all payers. It is also important that stool collection instructions are followed to reduce the chance of false negative results. Stool samples obtained by digital rectal exam (DRE) should never be used for CRC screenings as they have low sensitivity for cancer detection (missing 19 of 21 cancers in one study). Individuals with abnormal FIT, FOBT or FIT-DNA test results must follow up with a colonoscopy.
What about people who cannot afford this preventive screening? Colorectal cancer screening is a core benefit of preventive health coverage with no or little out-of-pocket cost to the individual.
Typically, patient costs are lower when services are performed in an ambulatory surgery center compared to a hospital. Also, grant-funded and low-cost options are available for people who meet age and income requirements. For example, the Michigan Colorectal Cancer Early Detection Program (MCRCEDP) provides free colonoscopies or fecal immunochemical tests (FIT) for asymptomatic men and women ages 50-64. Eligible individuals must also be uninsured or underinsured or be low income defined as ≤250% of the federal poverty guidelines (see below). Contact IHP to learn more about these grant-funded screenings.
What can be done to increase screening rates? Individuals are more likely to complete CRC screenings when providers discuss the importance of screenings and provide counseling to identify potential barriers and to determine the best screening for each individual. Patient education and outreach using a variety of methods are also vital to make sure that individuals are being screened within the recommended timeframes. Provider offices should monitor patient gaps in care and conduct outreach as appropriate using mail, secure e-mail, portal reminders, or phone calls. Care managers can also be effective with patient education and with the identification and removal of barriers such as transportation, fear, and cost. Additional resources to increase screening rates are available at