Colorectal Cancer Screening Fall 2018 Agenda CRC Screening - - PowerPoint PPT Presentation

Colorectal Cancer Screening

Fall 2018

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Agenda

• CRC Screening Landscape
• Colonoscopy: The Gold Standard
• Other Available CRC Screening Options
• Q & A

When Should Screening Start?

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• CRC screening is generally recommended for all

average-risk patients aged 50-75

• People with a family history of colorectal cancer or

polyps are at increased risk and might need to start screening before age 50

• The American Cancer Society recently released its

2018 guideline which recommends that average- risk adults aged 45 years and older start screening

• African Americans have the highest death rates

from CRC when compared with all other racial groups in the United States

• The American College of Gastroenterology

(ACG) and the American Society for Gastrointestinal Endoscopy (ASGE) recommend CRC screening in African Americans to begin at age 45

• 3. Bénard F, Barkun AN, Martel M, von Renteln D. Systematic review of colorectal cancer screening guidelines for average-risk adults: Summarizing the current global recommendations. World Journal of Gastroenterology. 2018;24(1):124-138. http://dx.doi.org/10.3748/wjg.v24.i1.124.
• 4. Williams, R., White, P., Nieto, J., Vieira, D., Francois, F., & Hamilton, F. (2016). Colorectal Cancer in African Americans: An Update: Prepared by the Committee on Minority Affairs and Cultural Diversity, American College of Gastroenterology. Clinical and Translational

Gastroenterology, 7(7), e185. http://doi.org/10.1038/ctg.2016.36. 5. American Society for Gastrointestinal Endoscopy. Media backgrounder on Colorectal Cancer Screening. https://www.asge.org/home/about-asge/newsroom/media-backgrounders-detail/colorectal-cancer-screening. Accessed October 22, 2018. 6. American Cancer Society. American Cancer Society Updates Colorectal Cancer Screening. http://pressroom.cancer.org/releases?item=770. Accessed October 22, 2018.

Current CRC Screening Landscape

• One in three Americans are not being screened
• Providing choices increases screening compliance; but only to a point
• Increasing attention in the news regarding colonoscopy vs. other tests

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References: 1. Fight Colorectal Cancer. About Colorectal Cancer. Facts and Stats. https://fightcolorectalcancer.org/prevent/about-colorectal-cancer/facts-stats. Accessed October 22, 2018.

• 2. American Cancer Society. Survival Rates for Colorectal Cancer, by Stage. https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/survival-rates.html. Accessed October 22, 2018.

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Colonoscopy: The Gold Standard

• Preventing cancer is always better than finding cancer
• Colonoscopy is the only screening method that can both detect and remove pre-cancerous polyps
• Colonoscopy is the only suitable test for people who have risk factors such as family history of CRC
• 5. American Society for Gastrointestinal Endoscopy. Media backgrounder on Colorectal Cancer Screening. https://www.asge.org/home/about-asge/newsroom/media-backgrounders-detail/colorectal-cancer-screening. Accessed October 22, 2018.
• 7. Pan J, Xin L, Ma Y-F, Hu L-H, Li Z-S. Colonoscopy Reduces Colorectal Cancer Incidence and Mortality in Patients With Non-Malignant Findings: A Meta-Analysis. The American Journal of Gastroenterology. 2016;111(3):355-365. https://dx.doi.org/10.1038%2Fajg.2015.418.

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MSTF Screening Recommendations

• First-tier options are colonoscopy every 10 years or annual FIT
• Second-tier options include CT colonography every 5 years, Cologuard every 3 years, or flexible

sigmoidoscopy every 5 to 10 years

• Third-tier tests include capsule endoscopy every 5 years due to limited evidence and barriers to

access

• 8. Rex D, Boland C, Dominitz J et al. Colorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer. The American Journal of Gastroenterology 2017;112:1016-1030. http://doi.org/10.1038/ajg.2017.174.

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NEJM Study on CRC Screening Options

• 9. Imperiale T, Ransohoff D, Itzkowitz S, et al. Multitarget Stool DNA Testing for Colorectal-Cancer Screening. New England Journal of Medicine, 2014;370:1287-1297. https://www.nejm.org/doi/full/10.1056/nejmoa1311194.

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NEJM: Cologuard and FIT

• 9. Imperiale T, Ransohoff D, Itzkowitz S, et al. Multitarget Stool DNA Testing for Colorectal-Cancer Screening. New England Journal of Medicine, 2014;370:1287-1297. https://www.nejm.org/doi/full/10.1056/nejmoa1311194.

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Insurance Considerations

• Medicare will cover 100 percent of the initial CRC screening test chosen by a patient
• If the initial test is positive, then subsequent testing may result in a large patient deductible and/or

co-insurance bill because the second test would be considered a diagnostic or therapeutic service under Medicare billing codes

• 8. Rex D, Boland C, Dominitz J et al. Colorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer. The American Journal of Gastroenterology 2017;112:1016-1030. http://doi.org/10.1038/ajg.2017.174.
• 11. American Cancer Society. Colorectal Cancer: Early Detection, Diagnosis, and Staging: Insurance Coverage for Colorectal Cancer Screening. https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/screening-coverage-laws.html. Accessed October 22,

2018.

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Review: Help Patients Choose the Best Option

• Colonoscopy: The gold standard – the only suitable test for people with risk factors
• MTSF: Offer patients Colonoscopy, then FIT, followed by Cologuard and CT Colonography
• Insurance: Patients should understand screening benefit to avoid costly insurance co-payment
• 8. Rex D, Boland C, Dominitz J et al. Colorectal Cancer Screening: Recommendations for Physicians and Patients from the U.S. Multi-Society Task Force on Colorectal Cancer. The American Journal of Gastroenterology 2017;112:1016-1030. http://doi.org/10.1038/ajg.2017.174.