COLORECTAL CANCER SCREENING: WHAT ARE STATES DOING?
Updated: October 2006
BACKGROUND
Colorectal cancer, or cancer of the colon or rectum, is the second leading cause of cancer-related deaths in the United States for men and third leading cause for women. The American Cancer Society estimates 148,610 new cases will be diagnosed and 55,170 deaths will occur in 2006.
RISK FACTORS
The risk for developing colorectal cancer increases with advancing age. 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.
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.
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 every year.
- Flexible sigmoidoscopy every 5 years.
- Double-contrast barium enema every 5 years.
- Total colon examination by colonoscopy every 10 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.
Percentage of Adults Aged 50 Years or Older Who Had Colorectal Cancer Tests Within the Recommended Screening Intervals*, by State, 2004
Source: CDC, 2004 Behavioral Risk Factor Surveillance System
*Fecal occult blood test within the past year and/or sigmoidoscopy/colonoscopy within the past 10 years.
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, 18 states require coverage of colorectal cancer screening tests. A few other states require that they be offered or available through Medicare Supplemental policies. The map below summarizes 50-state colorectal cancer screening requirements.
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.
Colorectal Cancer Screening Laws By State
2006 |
|
State
Year of Enactment
Bill Number/Citation |
Coverage Requirements |
|
Policies covered: |
Consumers covered: |
Benefits and Services covered: |
|
Alabama
(2004)
AL S 403 |
Mandated offering for
group health benefit
plans |
Persons who are 50
years of age or older
or high risk. |
Examinations and tests in accordance with ACS guidelines.
|
Arkansas
(2005)
HB 2781, Act 2236 |
Individual and group HMOs, Medicaid, State Employees' and Public School Teachers' Health Insurance Program. |
Persons: (1) who are 50 years of age or older; (2) who are less than 50 years of age and at high risk for colorectal cancer according to the ACS guidelines; and (3) experiencing specified symptoms of colorectal cancer. |
Examinations and tests in accordace with ACS guidelinges. The covered person will determine the choice of screening strategies in consultation with a health care provider. |
|
California
(1992)
CAL. INS. CODE §§ 10194 and 10194.2 |
Medicare supplement policies only |
All Medicare supplemental policies. |
Provide preventive medical care coverage of up to $120 per year for services not covered by Medicare, including: (1) a mammogram; and (2) a fecal occult blood test. Tests may be done at a frequency considered medically appropriate. |
|
Connecticut
(2001)
SB 325
Public Act No. 01-171 |
All individual & group plans |
Individuals defined by ACS as average and high risk. |
Annual fecal occult blood test. Colonoscopy, flexible sigmoidoscopy and radiologic imaging according to American College of Gastroenterology guidelines.
|
|
Delaware
(2000)
Title 18Chap. 35
Sub. Chap III§ 3562 |
All individual and group plans, HMO's, health service corporations |
Individuals defined by ACS as average and high risk; screening performed at frequency determined by physician. |
Annual fecal occult blood test, colonoscopy every 10 years, flexible sigmoidoscopy every 5 years, and double contrast barium enema every 5 to 10 years. |
|
Georgia
(2002)
33-24-56.3 |
All health insurance plans |
Individuals defined by ACS as average and high risk. |
In accordance with ACS screening options. |
|
Illinois
(1999, amended 2003)
SB 1417 |
All individual and group plans |
Individuals defined by ACS as average risk. |
All cancer screenings and laboratory tests in accordance with the published ACS guidelines or other existing guidelines from government agencies, including the NCI, the CDC, and the American College of
Gastroenterology. |
|
Indiana
(2000)
HB 1293 |
Mandated offering for individual policies; mandated benefit for group self insurance program and HMOs for state employees, and employer-based plans |
Individuals defined by ACS as average and high risk. |
In accordance with ACS screening options. |
|
Louisiana
(2005)
HB 36
Act 505 |
All insurers or HMOs issuing or renewing on or after Jan. 1, 2006 |
Individuals defined by American College of Gastroenterology and ACS as average risk. |
Routine screening includes a fecal occult blood test, flexible sigmoidoscopy, or colonoscopy provided in accordance with ACS. |
|
Maryland
(2001)
HB 190/SB 100 |
Insurers, HMOs and nonprofit health services plans |
Individuals defined by ACS as average and high risk. |
In accordance with ACS screening options. |
|
Missouri
(1999)
376.1250 |
All individual and group plans |
Individuals defined by ACS as average risk. |
In accordance with ACS screening options. |
|
Nevada
(2003)
SB 183
NRS 695G.168 |
All individual and group plans |
Individuals defined by ACS as average risk. |
In accordance with ACS screening options. |
|
New Jersey
(2001)
17B:26-2.1u |
HMOs and all individual and group plans |
Individuals defined by ACS as average and high risk. |
In accordance with ACS screening options. |
|
North Carolina
(1991, 1995, 2001)
§58-3-179 |
Teachers and State Employee Major Medical Plan and all health insurance plans |
Individuals defined by ACS as average and high risk. |
In accordance with ACS screening options. |
|
Oklahoma
(2001)
§36-6060.8a |
Individual and group policies (mandated offering) |
Individuals defined by ACS as average and high risk. |
Plans required to offer coverage for colorectal examinations and laboratory tests in accordance with accepted published medical practice guidelines. |
Oregon
(2005)
SB 501 |
HMOs and all individual and group plans, that cover medical, surgical and hospital costs, after Jan. 1, 2006 |
Individuals age 50 and over and high risk as recommended by a physician. |
In accordance with ACS screening options. |
|
Rhode Island
(2000)
§27-18-58 |
All individual and group plans |
Nonsymptomatic individuals. |
In accordance with ACS screening options. |
|
Tennessee
(2003)
§57-7-2363 |
All individual and group plans(mandated offering) |
Individuals defined by ACS as average risk. |
In accordance with ACS screening options. |
|
Texas
(2001)
§1363.001 |
All health insurance plans |
Persons 50 years or older. |
Annual fecal occult blood test and a flexible sigmoidoscopy every five years or a colonoscopy every 10 years. |
|
Virginia
(2000)
§38.2-3418.7:1 |
State employees health insurance program, and individual and group plans |
Individuals defined by ACS as average and high risk. |
In accordance with ACS screening options. |
|
West Virginia
(2000)
§33-25A-8e |
All health insurance plans |
Persons age 50 and over; Symptomatic persons less than 50 years of age when reimbursement or indemnity for laboratory or X-ray services are covered under the policy. |
Annual fecal occult blood test, flexible sigmoidoscopy every 5 years, colonoscopy every 10 years and a double contrast barium enema every 5 years. |
|
Wyoming
(2001)
HB 0026 |
HMOs and all group plans |
Nonsymptomatic individuals |
Colorectal cancer examination and laboratory tests. |
Sources: Centers for Disease Control and Prevention, National Cancer Institute. Updated March, 2006.
Contact NCSL Cancer Program for more information.
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