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NEW Recommended Guidelines for Colorectal Cancer Screening

Monday, June 18, 2018   (0 Comments)
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Audrey Fine is the Senior Manager Primary Care Systems, West Region, for the American Cancer Society, Inc. 


 

Colorectal cancer is the third most common cancer in both men and women and a leading cause of U.S. cancer deaths. Early colorectal cancer usually has no symptoms. Even though the exact cause of most colorectal cancers isn't known, prevention and early detection are possible because most colorectal cancer develop from polyps. Primary care practitioners play an important role in getting their patients screened for colorectal cancer. The patient population seen at FQHCs has a much lower screening rate across the U.S. compared to the general population - 39.89% in 2015 at FQHCs according to HRSA UDS data compared to 67.3% in 2016 for the general population according to the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System.

Up until recently the widely accepted recommendation was for all individuals ages 50 and older at average risk to be screened. However, an updated guideline from the American Cancer Society, released May 30, 2018, says colorectal cancer screening should begin at age 45 for people at average risk, based in part, on data showing rates of colorectal cancer are increasing in young and middle-aged populations. 

Colorectal cancer incidence has declined steadily over the past two decades in people 55 and over due to screening that results in removal of polyps, as well as changes in exposure to risk factors, but there has been a 51% increase in colorectal cancer among those under age 50 since 1994. Death rates in this age group have also begun to rise in recent years, indicating that increased incidence rates do not appear to be solely the result of increased use of colonoscopy. A recent analysis found that adults born around 1990 have twice the risk of colon cancer and four times the risk of rectal cancer compared with adults born around 1950, who have the lowest risk. Lowering the starting age is expected to benefit not only the segments of the population who suffer disproportionately from colorectal cancer - blacks, Alaska Natives, and American Indians - but also those individuals otherwise considered to be at average risk.

The American Cancer Society (ACS) recommends:


* Adults ages 45 and older with an average risk of colorectal cancer (CRC) undergo regular

  screening with either a high-sensitivity stool-based test or a structural (visual) exam (i.e.,

  colonoscopy, CT colonography or flexible sigmoidoscopy) depending on patient preference

  and test availability. 


* As a part of the screening process, all positive results on non-colonoscopy screening tests

  should be followed up with timely colonoscopy. 


* Average-risk adults in good health with a life expectancy of greater than 10 years should

  continue colorectal cancer screening through age 75. 


* Clinicians should individualize colorectal cancer screening decisions for individuals ages

  76 through 85, based on patient preferences, life expectancy, health status, and prior

  screening history. 

The recommended options for colorectal cancer screening are: fecal immunochemical test (FIT) annually; high sensitivity guaiac-based fecal occult blood test (HSgFOBT) annually; multi-target stool DNA test every 3 years; colonoscopy every 10 years; CT colonography every 5 years; or flexible sigmoidoscopy every 5 years. The new guideline does not prioritize screening test options. Conversations between clinicians and patients will help patients decide which test is best for them.

One of the biggest concerns people will have is insurance coverage for screening persons aged 45-49. The health care law known as the Affordable Care Act requires insurance coverage without cost-sharing based on recommendations issued by the United States Preventive Services Task Force (USPSTF). 


The USPSTF recommends individuals begin screening at age 50. While insurers could choose to offer coverage of colorectal cancer screening earlier, they are not required to do so. Consumers should seek information about what their insurance policy will cover, and what out-of-pocket expenses they may incur should they begin screening at age 45. ACS and ACS CAN (Cancer Action Network) are working to educate insurers, lawmakers, and other stakeholders on the rising rates of CRC among younger individuals, the evidence in support of screening for individuals aged 45-49, and the importance of expanding insurance coverage of screening for this age group.

For more information, visit cancer.org

 

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