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In recognition of National Colorectal Cancer Awareness Month in March, the American Cancer Society is promoting screening tests that are proven to reduce the risk of development of the third leading cause of death in the United States. The lifetime risk of colorectal cancer is 5.5% in men and 5.1% in women. This risk is age dependent, and is 14 times higher in those 50 years of age or older.¹ The American Cancer Society recommends screening for colorectal cancer starting at age 50.

Colorectal screening has resulted in a steady decline in incidence and mortality rates, according to the recent Annual Report to the Nation. The incidence of colon cancer has dropped 2.8% per year from 1998 to 2005 in men, and 2.2% per year for women. Mortality rates from colorectal cancer have declined by 4.3% from 2002 to 2005.²

Although routine screening allows for detection of cancer at an earlier and more treatable stage, Lieberman et al found that only 1.7% of polyps <6 mm were at an advanced histological stage.³

Currently, Medicaid/Medicare elects to only provide benefits for the use of optical colonoscopy for screening, which provides both detection and removal of lesions. This is despite the fact that the American Cancer Society, the American College of Radiology and the U.S. Multi-Society Task Force on Colorectal Cancer have released their first consensus guidelines that support the use of stool DNA and CT colonoscopy (virtual colonoscopy).²

Type of insurance has been associated with colorectal cancer detection and outcomes. Patients with private insurance had better survival outcomes from Stage II colon cancer than those who either had Medicaid or were uninsured with Stage I disease. To counteract this, the American Cancer Society Cancer Action Network is proposing legislation to provide colorectal screening to the underinsured and uninsured.²

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References:

1. American Cancer Society. Colorectal Cancer Facts & Figures 2008-2010. Atlanta, GA. (Incidence, page 3).
2. Nicole Boone. Survival rates for colorectal cancer are high when found early. WBTW News 13. February 27, 2009.
3. The Centers for Medicare and Medicaid Services (CMS). Proposed Decision Memo for Screening Computed Tomography Colonography (CTC) for Colorectal Cancer (CAG-00396N). Lieberman et al 2008 study, page 14.