At UVA, our goal is to have at least 80% of eligible adults in our community be up-to-date on their colorectal cancer screenings. What type of screening should happen and when will vary, depending on the patient's risk factors and insurance.
Options for Colorectal Screening
Any patient between the ages of 45-75 should get screened. Several screening options exist for patients in this age range with an average risk. Offering appropriate options to patients improves the likelihood of screenings being completed.
|
|
Recommended Interval |
Pros |
Cons |
|---|---|---|---|
|
Stool-based options |
|
|
|
|
FIT (fecal immunochemical test) |
1 year |
Inexpensive, completed at home, non-invasive, highly sensitive, and specific |
Annual testing, a positive result indicates need for diagnostic colonoscopy |
|
Cologuard (FIT-DNA) |
3 years |
Completed at home, navigation support is provided, highly sensitive and specific |
A positive result indicates need for diagnostic colonoscopy |
|
Visualization options |
|
|
|
|
CT Colonography |
5 years |
Less invasive than colonoscopy, no sedation required |
Requires full bowel prep, significant findings indicate need for diagnostic colonoscopy |
|
Colonoscopy |
10 years |
A complete visual inspection, polyps found are typically removed during procedure |
Expensive, invasive, requires full bowel prep and sedation |
Patients of any age should have colonoscopy if they have:
- A high risk for colon cancer including any family history of colorectal cancer in a first-degree relative or any history of inflammatory bowel diseases (such as Crohn’s) or inherited syndrome (such as Lynch Syndrome)
- Symptoms of colon cancer such as rectal bleeding, abdominal pain, or narrowing of stool (diagnostic colonoscopy)
- Positive results from other screening methods (diagnostic colonoscopy)
- A history of precancerous polyps (surveillance colonoscopy)
American Cancer Society provides more details about determining risk levels for colon cancer.
Costs and Coverage
All Affordable Care Act-compliant insurance plans are required to fully cover colorectal cancer screening without enforcing coinsurance or deductibles. This includes all Virginia Medicaid and Medicare plans.
It is important to note that the specific screening options covered by an individual plan may vary. The patient should discuss coverage with their insurance provider to fully understand their coverage and potential financial liability.
Positive findings from stool-based screenings or CT colonography must be referred to colonoscopy. The colonoscopy would be classified as a diagnostic colonoscopy and may therefore result in copayments or deductibles being applied.
Ordering a Screening
Stool-Based Testing:
|
Stool-based options |
How to order |
Providing the test to the patient |
Following up for test completion |
|---|---|---|---|
|
FIT (fecal immunochemical test) |
Stool Occult Blood (FIT) in EPIC |
Kit to be provided from clinic supply during office visit. The kit contains prepaid mailer for the patient to return the sample, as well as detailed instructions on how to complete the test |
An EPIC reminder should be placed by the clinician at the time of placing the order to ensure test has been resulted within 3-4 weeks. Follow up with patient on any unresulted tests as appropriate |
|
Cologuard (FIT-DNA) |
Cologuard in EPIC |
Fully handled by manufacturer. Cologuard will contact the patient, explain how to complete the test, and mail the kit to the patient's address |
Fully handled by manufacturer. Cologuard will work directly with the patient to ensure test completion |
CT Colonography: place an EPIC order for CT Colonoscopy Screening-Virtual (after visit procedure).
Colonoscopy: use the Colonoscopy orderset in EPIC.
After Your Patient’s Screening
Share the results with your patient, and establish a plan for colonoscopy if results are positive. If the screening was negative, establish a plan for the next screening. It is acceptable to change screening methods in years subsequent to a negative screening. For example, a patient with a negative FIT this year might choose to do a Cologuard next year in hopes of obtaining a three year interval between screenings.
Once a patient has a history of precancerous polyps, they should follow the individualized surveillance recommended by their gastroenterologist.
Additional Tools for Clinicians
Colorectal Cancer Alliance decision tool is a short survey that patients can complete on their own or with a provider. This tool can help determine which screening option is best based on personal risk factors. This short, three-section quiz inquires about any current symptoms, prior screening tests and results, family history of CRC/hereditary CRC syndrome, sex, and race. When completed, it offers screening option(s) with links describing each test, advantages/disadvantages, insurance coverage, and basic facts.
American Cancer Society Conversation Cards provide single-page informational sheets covering the most used CRC screening tests (FIT, Cologuard, colonoscopy, flexible sigmoidoscopy, and CT colonography) to help patients select the option that is right for them. Each easy-to-read “card” has helpful graphics with succinct, useful information about how each test is done, how often, how much it will cost, if time off of work is required, and what happens if the chosen test is positive.
