Colorectal Cancer Screening:  What are States Doing?

Updated: August 2011


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 143,460 new colon and rectal cancer cases were diagnosed in 2012, and approximately 51,690 people died from colorectal cancers.  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://radiology.rsna.org/content/248/3/717/suppl/DC1

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.  As of 2011, approximately 53.2% of men and of women aged 50 years or older had undergone screening in the past 10 years.  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 25 states or 4 tribal territories, you may be eligible for free or low-cost colorectal cancer screening through the CDC-funded Colorectal Cancer Control Program (CRCCP): http://www.cdc.gov/cancer/crccp/about.htm

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.

Additional Resources

American Cancer Society: Colorectal Cancer Facts & Figures 2011-2013

American Cancer Society Cancer Action Network: "How Do You Measure Up? 2013

Centers for Disease Control & Prevention: Colorectal Cancer Basic Information


                                                        Colorectal Cancer Control Programs, 2010

 United States Map of Colorectal Cancer Control Programs

 

 

 

 

 

 

 

 

 

 

 

 

 

Although colorectal cancer—cancer of the colon or rectum—is the second leading cancer cause of death, it doesn’t have to be. Screening programs and prevention efforts by state colorectal cancer control programs have reduced mortality rates in recent years. Twenty-two states and four tribal organizations started these programs with funding from the Centers for Disease Control and Prevention (CDC) in 2009.

These cancer control programs have funding to provide colorectal cancer screening and followup care to low-income men and women ages 50 to 64 who are underinsured or uninsured for screening, when no other payment option is available. Screening can find precancerous polyps (abnormal growths in the colon or rectum) so that they can be removed before cancer develops. Screening also helps identify colorectal cancer at an early stage, when treatment often leads to a cure. If everyone age 50 or older had regular, recommended screening tests and all precancerous polyps were removed, as many as 60 percent of deaths from colorectal cancer could be prevented.

While screening procedures—considered a secondary prevention method—can effectively reduce mortality by identifying undiagnosed cases, primary prevention efforts are often more cost effective. These prevention efforts reach more people than state screening programs.

Some examples of primary prevention policies used in state colorectal programs include community-wide efforts to reduce behaviors associated with increased cancer risk, such as:

  • Reducing tobacco use.
  • Reducing alcohol abuse.
  • Encouraging healthier food choices and opportunities for exercise.

Sources: Centers for Disease Control and Prevention, state websites, and National Conference of State Legislatures. Thomas R. Frieden, et al., “A Public Health Approach to Winning the War Against Cancer,” The Oncologist 13 (2008): 1306-1313.


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  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 29 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 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 2010

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.

Alaska
(2006)
21.42.395

All individual & group plans Persons who are 35-40 in high risk group, African American or anyone over 40. Examinations and tests age for those 35-40 in high risk group or person 40 or older.
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
(1999)

1367.665 (2000)

Medicare supplement policies

 

 

 

All individual & group plans

All Medicare supplemental policies.

 

 

 

Anyone

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.

 

Mandate covers ALL medically accepted cancer screening tests.

Connecticut
(2001)
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. 

District of Columbia
(2002)
31-2931
All individual and group plans, including Medicaid Individuals defined by ACS as average and high risk. In accordance with ACS screening options.

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.

 Hawaii
 (2009)
 SB 2599
 Act No. 157
 All health insurance plans  Individuals age 50-75

In accordance with the evidence-based recommendations established by the United States Preventive Services Task Force.

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.

 Kentucky
 (2010)
KRS § 304.17A-257
All benefit plans  Individuals over age 50 and those under 50 deemed high risk by the ACS. All colorectal cancer examinations and laboratory tests specified in current American Cancer Society guidelines for colorectal cancer screening.

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.
 Maine
(2009)
24-A M.R.S. § 2763
 Group and individual insurers  Individuals 50 years of age or older; or
 Less than 50 years of age and at high risk for colorectal cancer according to the most recently published colorectal cancer screening guidelines of a national cancer society
Examination and laboratory test recommended by a health care provider in accordance with the most recently published colorectal cancer screening guidelines of a national cancer society.

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.

Minnesota
(1998)
62A.30
All policies and plans  Individuals defined by the standard practice of medicine. In accordance to standard practices of medicine.

Missouri
(1999)
376.1250

All individual and group plans

Individuals defined by ACS as average risk.

In accordance with ACS screening options.

Nebraska
(2007)
44-7,102
All individual and group plans  Individuals over 50 years old. Such screening coverage shall include a maximum of one screening fecal occult blood test annually and a flexible sigmoidoscopy every five years, a colonoscopy every ten years, or a barium enema every five to ten years, or any combination, or the most reliable, medically recognized screening test available.

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.

New Mexico
(2007)
 All individual and group plans  For anyone determined by health care provider. In accordance with the evidence-based recommendations established by the United States preventive services task force.

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
(mandated offering 2006)

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.
 Pennsylvania
 (2010)
40 P.S. § 764i
 All health insurance policies group health, sickness or accident policy or subscriber contract or certificate offered to groups of fifty-one (51) or more employees.  Nonsymptomatic covered individuals who are fifty (50) years of age or older. A colonoscopy or any combination of colorectal cancer screening tests in accordance with the American Cancer Society guidelines on screening for colorectal cancer published as of January 1, 2008.

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.

 Vermont
 (2009)
 Act No. 34
 All health insurance plans  Persons 50 years or older or otherwise determined as high risk. Annual fecal occult blood testing with 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.

Washington
(2007)
48.43 RCW

All health insurance plans  Individuals at high risk under 50 years old or anyone over 50 years old. Examinations and laboratory tests consistent with the guidelines or recommendations of the United States preventive services task force or the federal centers for disease control and prevention (CDC).

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.

 Wisconsin
 (2010)
  SB 163
All health insurance plans  As determined by the commissioner, in consultation with the secretary of health services and after considering nationally validated guidelines, including guidelines issued by the American Cancer Society for colorectal cancer screening,
shall promulgate rules that do all of the following:
1. Specify guidelines for the colorectal cancer screening that must be covered under this subsection.
2. Specify the factors for determining whether an individual is at high risk for colorectal cancer and as medically appropriate.
 In accordance with ACS screening options.

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.  American Cancer Society, 2009.

Contact NCSL 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.