Recent changes expand access to colorectal cancer screening

Over the past year, two major changes have increased access to colorectal cancer screening, making the early detection exam less expensive and expanding access.

By the numbers it looks like Nevada’s doing great; in 2020 the CDC estimates 71.9% of Nevadans were up to date with colorectal cancer screening.

But, we know that those numbers will likely change as the effects of new screening policies and the pandemic factor in. What we cannot be sure of is how the numbers will shake out. Rather than dwell on that this year during Colorectal Cancer Awareness Month, let’s explore what’s happening with improvements to screening access.

First, in 2021 the recommended age at which to begin colorectal cancer screening was lowered to 45 for people at average risk. Over the past several years there have been a number of reports and studies finding that despite an overall decline in colorectal cancer mortality, there’s been an increase in incidence among adults under 50. Moving the screening initiation age earlier may help to find more of these cancers earlier, when they’re easier to treat.

The recommendations for modality remain the same: for colonoscopy every 10 years, or FIT, FOBT or stool DNA test annually. People are higher risk may need to screen more often based on their physician’s recommendation.

In early 2022 access to follow-up colonoscopy was expanded by the Biden administration. Clarity was also issued on what services are included in a screening colonoscopy. The guidance affirms that private insurers must cover colonoscopy with no cost sharing when follow up is needed after a non-invasive blood stool test, such as FIT, FOBT or stool DNA. And during a screening colonoscopy, services such as polyp removal were confirmed to be part of the screening coverage, not a separate cost.

This is a big win for improving colon cancer screening rates and reducing disparities. We know that offering test options improves compliance with recommendations for screening. For many people, taking time off work or finding transportation to and from a colonoscopy can also be challenging, if not impossible. And for those who opt for an at-home screening test, those who would be required to pay for a diagnostic colonoscopy may have found that to cause financial concern sufficient to avoid screening altogether.  

By including the cost for follow-up colonoscopy in the screening coverage, the administration has signaled that at-home screening tests are effective and valuable tools in ensuring every eligible American can screen for colorectal cancer.

In Nevada, NCC is working this month to expand access even more by supporting Medicaid coverage of Cologuard stool DNA testing as a screening option. The current list of covered tests includes FIT/FOBT, colonoscopy, and several other less frequently used or recommended tests. Coverage of stool DNA testing will be one more step to improving our state’s colorectal cancer screening rates and decreasing deaths.