Implementing a Nationwide Colorectal Cancer Screening Program

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Colorectal cancer (CRC) is the third most diagnosed cancer in the United States, and the second leading cause of cancer death among both men and women.  Early detection is key in the fight against CRC. Generally speaking, screening for CRC should begin at age 50.  If current screening guidelines were universally followed and all pre-cancerous polyps were removed, an estimated 60% of all CRC deaths could be prevented – an estimated 30,000 to 44,000 lives a year!.  Although the new Affordable Care Act improved access to preventive health measures, a large loophole persists:  A legislative correction is necessary to waive the beneficiary copay, which can be prohibitive, for colorectal cancer screenings that become therapeutic during the same clinical encounter. Currently, there are two legislative bills (HR912 & S494) in Congress addressing this issue and providing for full coverage of appropriate CRC screenings by expanding an existing Centers for Disease Control and Prevention (CDC) pilot program, Colorectal Cancer Control Program (CRCCP), nationwide to provide CRC screenings and treatment for low-income, uninsured and underinsured individuals who are not eligible for Medicare. CRCCP aims to increase CRC screening rates to 80%, from its current level of 64%, by 2014. Forward movement of these policies can be accomplished with a multi-modal approach to garner congressional support and to increase community awareness. This sustainable option is acceptable to the generable population and has definite positive human rights implications as those predominantly affected by CRC are of low socioeconomic status, have inadequate access to healthcare, and are disproportionately exposed to conditions contributing to poor health. In addition to saving thousands of lives, this legislation has the potential to save billions in Medicare expenditures. Help save lives by asking your Senator and Representative to cosponsor HR912/S494.

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For more information on Colorectal Cancer Screening, visit the following websites:

http://www.cancer.gov/cancertopics/types/colon-and-rectal

http://www.ccalliance.org/

http://energycommerce.house.gov/subcomms/subcommittees.shtml

http://help.senate.gov

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5 Responses to “Implementing a Nationwide Colorectal Cancer Screening Program”

  1. friso vr Says:

    This is an ever increasingly valuable debate with America’s growing older population and lifestyle behaviors which put them at higher risk for colorectal cancer (CRC).

    Fortunately, the Affordable Care Act (ACA) promotes prevention. It does come at a small cost to patients, and sometimes this is too much of a barrier. However, the biggest cost is to the healthcare system. The cost/benefit analysis could be used for CRC, but maybe there is another way to reduce the number of CRC deaths.

    In The Netherlands, the NDDO Institute for Prevention and Early Diagnostics (NIPED) discovered that 10% of the 50+ year old Dutch population studied required a colonoscopy and 5% underwent surgery to remove polyps. NIPED utilized a health risk assessment tool to screen these individuals before subjecting them to more invasive and costly diagnosis. This saves the patient uncomfortable, costly and time consuming procedures as well as the system much time and expense.

    Do all 50+ Americans need invasive CRC screening?

  2. efperlini Says:

    It is true that not all Americans need invasive CRC screening. There are other options including fecal occult blood testing, barium enema, flexible sigmoidsocopy, etc. However, there are barriers and sensitivity issues that can make these tests less comprehensive. With FOBT, the patient must collect 2 separate stool samples at home, smear them on a card and remember to either bring them back to the clinic or to mail them in to be developed. In researching rates of CRC screening in under- or un-insured people in the US, a huge barrier to FOBT was actually the act of having to deal with stool. Flexible sigmoidoscopy also does not cover the entire colon and could miss more proximal disease – which could then present at more advanced stages if follow up testing to the flexible sigmoidoscopy such as FOBT came back positive.

    Certainly if someone has a family history of CRC, then early comprehensive screening should be undertaken.

    Here is the data reported from the USPSTF website:
    Sensitivity: Hemoccult II < fecal immunochemical tests ≤ Hemoccult SENSA ≈ flexible sigmoidoscopy < colonoscopy
    Specificity: Hemoccult SENSA < fecal immunochemical tests ≈ Hemoccult II < flexible sigmoidoscopy = colonoscopy

    Therefore, in populations who have limited access to healthcare having a comprehensive screening method – likely a colonoscopy – might be the best option if regular visits are not feasible, as they clear the patient for a longer period of time as compared to less-invasive methods.

  3. riwunze Says:

    Frisco vr brings up a good point, I will have to look into the Netherlands study, but colonoscopy is the best screening tool for colon cancer and offers true prevention which is better than some other screening test that have gotten more hype. At this point, colonoscopies are worth the money it cost but the colonoscopy is not the only screening tool for CRC.

    Screening test are not without risk and cost. In general, prevention tends to save money in the long run but they do have immediate cost. Increasing cost of health care is a real and important issue especially with American’s aging population, increasing longevity and expectations, increasing incidence of obesity and other chronic diseases. We may need more individualized, targeted, and/or tiered evidenced based screening methods.

    With the decreased amount of money being provided to uninsured, underinsured, medicare/caid for health care I foresee situations where they will be forced to use a tiered screening pathway no matter the situation. I have seen it already, in some county clinics in Texas, patients need a positive fecal occult test before being allowed to have a colonoscopy and even before this they may be sent to have a barium study or a flex sig if pressed. Granted this stepwise approach also had to do with a limited amount of specialist for this population. I volunteer at a clinic for the uninsured in Maryland and we have been told to give patients fecal occult cards before referral to screening colonoscopies.

    With the push for the coverage of prevention I worry about lack of an adequate amount of providers/physicians to perform these test as some physicians are less willing to take medicare/aide or under resourced patients. Hopefully this is only occurring in my town, but in some physician blogs physicians are stating they plan on accepting only certain types of patients.

  4. mtahir1 Says:

    The issue of cancer screening, especially CRC – the third commonest form of cancer in the U.S., is very important and I appreciate the blogger efforts to raise this important issue. With the increase in aging population, the risk of developing various cancers will increase, as cancer is more prevalent in older population. So, the debate for cancer screening and ways to find cost-economical options will be raised on & off. CRC is the second leading cause of cancer related deaths in the U.S. However, as the blogger mentioned, those with low-socioeconomic status are the one who are more disadvantaged, in terms of not getting screening and then developing an advanced stage disease with less chances of survival. With the advancement of medical knowledge, technologies and procedures, the cost of health care is bound to rise and providing gold standard health care for all by the Government will become not only increasingly difficult but unrealistic. Therefore, it is more important to work aggressively on preventive side and raise awareness about healthy behaviors.

    Colonoscopy is the gold standard screening for CRC. However, recently virtual colonoscopy has been introduced into practice as an alternative to conventional colonoscopy. Its efficacy is almost equal to conventional colonoscopy but is non-invasive and costs less than half the cost of conventional colonoscopy. Procedures like virtual colonoscopy may be better option for screening with less cost and almost the same efficacy as of the conventional colonoscopy.

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