Improving Colorectal Cancer Screening Rates
While multiple expert medical and scientific panels recommend colorectal cancer screening, one in three Americans between the ages of 50 and 75 have never been screened as recommended.
Patients cite a number of reasons for not being tested:
- Not receiving a doctor’s recommendation
- Lack of screening options
- Affordability concerns
While colonoscopy offers the advantage of polyp removal and biopsy, the invasiveness of the procedure, aversion to the preparation, inconvenience, and risk of complications can make this an unfavorable test for some patients.
Alternate Screening Options
High-sensitivity stool testing is a good alternative for patients who decline more invasive screening options. While these have their own set of pros and cons, they may be more acceptable to some of your reluctant patients:
- Multiple randomized clinical trials have shown that screening with the guaiac-based fecal occult blood test (gFOBT) reduces colorectal cancer deaths
- Fecal immunochemical tests (FITs), which identify intact human hemoglobin in stool, have improved sensitivity compared with gFOBT for detecting colorectal cancer
- Multitargeted stool DNA testing (FIT-DNA) combines a FIT with testing for altered DNA biomarkers in cells shed into the stool, and has increased single-test sensitivity for detecting colorectal cancer compared with FIT alone
Presenting multiple options for colorectal cancer screening to all adults, particularly for those with low income, has shown to increase likelihood of screening. A 2012 study found more patients complete screening when offered a choice of colonoscopy or stool test (69%) as compared to patients that are only offered colonoscopy (38%). The American Cancer Society found that unscreened patients are very responsive to messages indicating there are affordable take-home options available.
To encourage average-risk patients over 50 to get screened, Quest Diagnostics® will send FIT kits directly to your practice. The kits are free and easy for patients to use at home, and do not require dietary or medication restrictions. Call 1-866-MY-QUEST to order a kit for your BlueCross BlueShield patients.
In the end, the best screening test is the one that patients actually agree to. Providing patients with all the screening options will help reduce colorectal cancer morbidity and mortality.
CDC. Prevalence of colorectal cancer screening among adults—Behavioral Risk Factor Surveillance System, United States, 2018.
Lin JS, Piper M, Perdue LA, et al. Screening for Colorectal Cancer: A Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 135. AHRQ Publication No. 14-05203-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2016.
Imperiale TF, Ransohoff DF, Itzkowitz SH, et al. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med. 2014;370(14):1287-97.
Inadomi JM, Vijan S, Janz NK, et al. Adherence to colorectal cancer screening: a randomized clinical trial of competing strategies. Arch Intern Med 2012;172:575-82.
National Colorectal Cancer Roundtable. 80% by 2018 Communications Guidebook: Effective messaging to reach the unscreened. 2015. http://nccrt.org/tools/80-percent-by-2018/80-by-2018-communications- guidebook/ (accessed November 9, 2015)
Working with Us
We want to hear from you! Have a topic request for the next Blue Bulletin? Email us
Stay in Touch! Sign up to receive emails for provider news and information