COLORECTAL CANCER SCREENING:  WHAT ARE STATES DOING?

Updated: July 2009

BACKGROUND

Colorectal cancer, or cancer of the colon or rectum, is the third leading cause of cancer-related deaths in the United States for both men and women. The American Cancer Society estimates 108,070 new colon cancer and 40,740 new rectal cancer cases will be diagnosed and 49,960 deaths will occur in 2008.  This accounts for about 9 percent of all cancer deaths.

For more detailed information about colorectal cancer prevention, screening and treatment, please see the American Cancer Society's resources here.

RISK FACTORS

The risk for developing colorectal cancer increases with advancing age, and over 90 percent of colorectal cancers are diagnosed in people aged 50 and older.  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.

SIGNS & SYMPTOMS

Early stage colon or rectal cancers have very few symptoms, which makes screenings more important in catching the cancer early.  Advanced stage symptoms may include rectal bleeding, blood in the stool, a change in bowel habits and cramping pain in the lower abdomen.  The most common way of finding colon and rectal cancers is through regular screenings.

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.  The American Cancer Society and Multi GI Task Force published updated screening guidelines in early 2008. Those guidelines can be found here: http://caonline.amcancersoc.org/cgi/content/full/58/3/130#SEC2

For a 50 state map and listing of colorectal cancer screening statistics, click here: http://www.statehealthfacts.org/comparemaptable.jsp?ind=666&cat=2

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 (FOBT or FIT) every year.
• Stool DNA Testing (sDNA) , Interval uncertain
• Flexible sigmoidoscopy every 5 years.
• Double-contrast barium enema every 5 years.
• Total colon examination by colonoscopy every 10 years.
• Computed tomographic colonography (virtual colonoscopy) every 5 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.

If you live in one of the following locations, you may be eligible for free or low-cost colorectal cancer screening through the CDC-funded screening demonstration program. To learn more:

• Suffolk County, New York: Call (631) 444-7644
• Baltimore, Maryland: Call (410) 887-3456 or 1 (866) 632-6566
• King, Clallam, and Jefferson counties, Washington: Call 1 (800) 756-5437
• Nebraska: Call 1 (800) 532-2227
• St. Louis, Missouri: Call (314) 879-6392

If you live elsewhere in the U.S., please call 1 (800) 4-CANCER or 1 (800) ACS-2345 to learn more about screening options in your community. You may also be able to find information about free or low-cost screening by calling your local department of health.

  Source: CDC, 2008 Behavioral Risk Factor Surveillance System

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, at least 26 states and the District of Columbia require coverage of colorectal cancer screening tests.  A few other states require that they be offered or available through Medicare Supplemental policies.  The table below summarizes state colorectal cancer screening coverage details.

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.

Sources: Centers for Disease Control and Prevention, National Cancer Institute. Updated March, 2006.  American Cancer Society, 2009.

Contact NCSL Cancer Program for more information. 

This site is made possible by support from the Centers for Disease Control and Prevention and the American Cancer Society Cancer Action Network.

Its contents are solely the responsibility of the authors and do not necessarily represent the official views of Centers for Disease Control and Prevention or the American Cancer Society Cancer Action Network.