At UVA Health, our goal is to have at least 80% of eligible adults in our community be up-to-date on their colorectal cancer screening (CRC). What type of screening should happen and when will vary, depending on the patient's risk factors and insurance.
Recommendations for Colorectal Cancer Screening
Average-risk adults should begin CRC screening at age 45. People without high-risk factors are at average risk.
| Age | Considerations |
|---|---|
| up to 45 | Symptomatic or high-risk individuals (see high-risk factors table) should be referred for diagnostic or high-risk screening colonoscopy. |
| 45-75 |
Average-risk individuals with life expectancy of 10+ years should be screened by stool-based or visual exams; High-risk (see high-risk factor table) should be referred to colonoscopy. |
| 75-85 | Screening decision should be made based on life expectancy, preferences, and screening history. |
| 0ver 85 | Screening not recommended. |
| High-Risk Factors | Considerations |
| Family history - CRC or advanced polyps | Having one or more 1st-degree relatives with a diagnosis of CRC increases risk for CRC. |
| Personal history - Precancerous polyps | A personal history of CRC or precancerous polyps increase the risk for CRC; follow recommendations from most recent colonoscopy. |
| Personal history - genetic factors | Confirmed or suspected Lynch Syndrome, FAP, or other related genetic syndromes increase risk for CRC. |
| Personal history - IBD | Crohn's disease or ulcerative colitis increase risk for CRC; follow recommendations from gastroenterologist. |
| Personal history - Pelvic irradiation | Radiation to the abdomen/pelvis increases risk for CRC. |
Options for Colorectal Cancer Screening Referrals
Average-risk individuals have options for CRC screening.
Any patient between the ages of 45-75 should get screened. Several screening options exist for average-risk patients in this age group. 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 |
Who Should Get a Colonoscopy?
Individuals should be screened with colonoscopy if they:
- Are high-risk
- Have a positive result from another test (FIT, Cologuard, CTC colonography)
- A history of precancerous polyps (surveillance colonoscopy)
- 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)
Choosing the Right Screening Test: 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.
Ordering a Screening at UVA
You can order all CRC screening tests through UVA EPIC.
Referring providers outside of UVA can sign up to use UVA EpicCare.
| Screening Option | How to Order | Providing the Test to the Patient | Following up for Test Completion |
|---|---|---|---|
| FIT (Fecal Immunochemical Test) | Stool Occult Blood (FIT) in UVA 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 UVA EPIC | Cologuard will contact the patient and mail a stool kit and instructions to the patient’s address usually within 1-2 weeks of the order. | Cologuard will call patient or mail reminders for up to 2 months. |
| Colonoscopy | UVA EPIC Colonoscopy orderset |
This is ordered as an after-visit procedure. The patient will be contacted by gastroenerology to schedule. Non-UVA providers: See how to make a referral. |
Results will be posted in UVA EPIC as a procedure after completion. |
| CT Colonography | UVA EPIC order for CT Colonograpy Screening- Virtual |
This is ordered as an after-visit procedure. The patient will be contacted by radiology to schedule. Non-UVA Health providers: See how to make an imaging referral. |
Results will be posted in UVA EPIC as imaging after completion. |
After Your Patient’s Screening
Share the results with your patient.
Positive FIT, Cologuard, or CTC tests: Refer patient for colonoscopy (optimally completed within 6 months).
Negative screening results: complete EPIC Health Maintenance to keep patient's screening current. If the results are negative, establish a plan for the next screening.
Note: Completing EPIC health maintenance will help the patient and provider keep CRC screening current.
Costs & 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.
