US Colorectal Cancer Screening Resources

US Colorectal Cancer Screening Resources in United States

US Colorectal Cancer Screening Resources

Updated: October 2006

Colorectal cancer, or cancer of the colon or rectum, is the second leading cause of cancer-related deaths in the United States for men and third leading cause for women. The American Cancer Society estimates 148,610 new cases will be diagnosed and 55,170 deaths will occur in 2006.

RISK FACTORS

The risk for developing colorectal cancer increases with advancing age.  Other risk factors include inflammatory bowel disease, a personal or family history of colorectal cancer or colorectal polyps, and certain hereditary syndromes. Lack of regular physical activity also contributes to a person’s risk for colon cancer, as well as low fruit and vegetable intake, a low-fiber and high-fat diet, obesity, alcohol consumption, and tobacco use.

SCREENING

Colorectal cancer screening tests can find polyps, or abnormal growths, before they turn into cancer. Screening tests can also find colorectal cancer early, when treatment works best and the chance for a full recovery is very high.

Several scientific organizations recommend regular screening for all adults aged 50 years or older. Recommended screening procedures and intervals are as follows:

  • Fecal Occult Blood Test every year.
  • Flexible sigmoidoscopy every 5 years.
  • Double-contrast barium enema every 5 years.
  • Total colon examination by colonoscopy every 10 years.

Persons at higher risk should begin screening at a younger age and may need to be tested more frequently.

According to the Centers for Disease Control and Prevention (CDC), screening for colorectal cancer lags far behind screening for other cancers.  In 2000, only 45% of men and 41% of women aged 50 years or older had undergone screening.  Use of screening for colorectal cancer was particularly low among those respondents who lacked health insurance, those with no usual source of health care, and those who reported no doctor’s visits within the preceding year.  If caught in its early stages, people treated for colon cancer have a 5-year relative survival rate of 90%.  As many as 60 percent of deaths from colorectal cancer could be prevented if everyone age 50 and older were screened regularly.  The map below summarizes recent screening rates.

STATE POLICY

Supporters of mandated insurance coverage of colorectal screening tests argue that  these policies are cost beneficial, because they encourage the identification of precancerous polyps or cancer at its earliest stages.  Treatment costs for more advanced colorectal cancer are expensive and confer higher risks to the patient.  Opponents of mandated insurance benefits believe that requiring companies to cover these policies increases overall costs, and results in less people able to afford insurance premiums.   Colorectal cancer tests are said to increase the cost of premiums by four to eight dollars.  Currently, 18 states require coverage of colorectal cancer screening tests.  A few other states require that they be offered or available through Medicare Supplemental policies.  The map below summarizes 50-state colorectal cancer screening requirements.

The following table provides detailed information on state colorectal cancer screening laws.  Grayed or italicized states offer, rather than require, colorectal cancer screening coverage as an insurance or Medicare policy benefit.

Many state laws refer to American Cancer Society (ACS) guidelines which were developed for average risk women and men ages 50 and older.   ACS guidelines also allow for  five different screening options: yearly fecal occult blood test (FOBT), flexible sigmoidoscopy every 5 years, yearly fecal occult blood test plus flexible sigmoidoscopy every 5 years, double contrast barium enema every 5 years, and colonoscopy every 10 years.  And finally, ACS defines high-risk individual as having:

(a)  A family history of: familial adenomatous polyposis; hereditary non-polyposis colon cancer; or breast, ovarian, endometrial or colon cancer or polyps;
(b)  Chronic inflammatory bowel disease; or
(c)  A background, ethnicity or lifestyle that the physician believes puts the person at elevated risk for colorectal cancer.


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