Colorectal Cancer Screening Options

April 4, 2017

Part 2 of a 3-part series regarding Colorectal Cancer (CRC) Screenings

Thank you for your continued support and interest in colorectal cancer screenings for our members. In the February 2017 Blue Review publication, the first article titled, "Colorectal Cancer Screenings: 80% by 2018, will you commit?" discussed Blue Cross and Blue Shield of New Mexico's (BCBSNM's) pledge, in cooperation with the American Cancer Society® and the National Colorectal Cancer Roundtable to have 80% of BCBSNM's members age 50-75 screened for colorectal cancer by 2018. The series continues below with Colorectal Cancer Screening Options.

Will You Commit?

The American Cancer Society (ACS) estimated that in 2017 there would be 135,430 new cases of colorectal cancer and 50,260 deaths nationwide.1 For New Mexico alone, it is estimated that there will be 800 new cases of colorectal cancer with an estimated 340 deaths.2 The incidence of colorectal cancer from 2009-2013 was highest among non-Hispanic blacks, followed by American Indian and Alaska Natives, non-Hispanic whites, and Hispanics. Colorectal cancer rates are lowest among Asians and Pacific Islanders.3 Colorectal cancer death rates are reflective of the incidence rates.3

Colorectal cancer screenings are recommended for adults starting at age 50 who are at average risk for colorectal cancer, and who are asymptomatic. Some patients may need to be screened for colorectal cancer at an earlier age.

Risk factors for colorectal cancer include,4

  • Older age,
  • Overweight or obesity,
  • Smoking,
  • Physical inactivity,
  • Diet high in red and processed meat,
  • Heavy alcohol use,
  • A personal history of colon cancer, polyps, or inflammatory bowel diseases,
  • A family history of colorectal cancer or polyps,
  • Having certain genetic syndromes, such as familial adenomatous polyposis (FAP) and Lynch syndrome (hereditary non-polyposis colorectal cancer, or HNPCC),
  • Being a black adult or an Ashkenazi Jew, and/or
  • Type 2 diabetes

Even though some screening methods are not appropriate or feasible for all patients, having a conversation with your patients to encourage colorectal cancer screenings is one of the strongest influences on your patients getting screened. However, it's important to be aware that some screening methods may not be covered by your patient's health plan and your patient may be responsible for an out-of-pocket cost. Consider this when having these conversations.

Colorectal cancer screening options

  • Colonoscopy – Screening and diagnostic follow up of positive results can be done during the same exam. Screening interval is every 10 years.5
  • Flexible sigmoidoscopy – Patients screened by flexible sigmoidoscopy may still require a colonoscopy. Screening interval is every 5 years.5
  • Stool-based tests – Positive test results require further screening by colonoscopy.5
    This type of screening includes:
    • Fecal Immunochemical Testing, FIT or iFOBT. No dietary restrictions. Highly sensitive versions of these tests should be used with the take-home multiple sample method. Screening interval is every year.5
    • Guaiac-based stool tests or gFOBT - Less sensitive than FIT testing and typically requires more samples and dietary restrictions. The take-home multiple sample method is recommended. Screening interval is every year.5
    • Stool DNA testing. Screening interval is every 3 years.5
  • CT colonography - Positive test results require further screening by colonoscopy. Screening interval is every 5 years.5
  • Double-contrast barium enema - Positive test results require further screening by colonoscopy. Screening interval is every 5 years.5

According to the ACS, a stool specimen from a digital rectal exam tested "for blood with a gFOBT or FIT is not an acceptable way to screen for colorectal cancer."5 Research has shown that a stool specimen obtained by digital rectal exam will miss more than 90% of colon abnormalities, including most cancers.5

Start the conversation! Your recommendation that patients get screened for colorectal cancer carries the greatest impact for colorectal cancer screening compliance.

Thank you for your commitment to this important preventive screening!

The Centers for Disease Control (CDC) is providing FREE continuing education for PCPs, nurses, nurse practitioners, and clinicians who perform colonoscopies.

Visit the CDC's Screening for Colorectal Cancer: Optimizing Quality (CME) Learn more about third-party links page to download, print, or watch the presentations on YouTube! CME expires Mar. 10, 2019.