March is National Colorectal Cancer Awareness Month – Get Screened!
Colorectal cancer remains a major source of cancer cases and mortality worldwide. The American Cancer Society recently estimated that 149,500 new cases of colorectal cancer and 52,980 deaths are likely to occur in 2021 just in the United States. This makes colorectal cancer the fourth highest in terms of cancer incidence and second highest in mortality in the country – only lung cancer causes more cancer deaths in the U.S. Additionally, African Americans are more likely to be diagnosed with the disease and to die from it.
Yet colorectal cancer is among the most preventable of all cancers. Over the past three decades, timely screening and removal of polyps (precancerous lesions) before they progress to cancer have contributed to sustained decreases in colorectal cancer incidence and mortality. So progress is being made, but there is still a ways to go.
In 2000, March was designated as National Colorectal Cancer Awareness Month by then-President Bill Clinton, who declared “our most effective weapon in defeating colorectal cancer is early detection and treatment.” Every year since then survivors, patients, medical providers, researchers and advocates work to collectively disseminate information about colorectal cancer and its prevention to the general population, promoting awareness and action that will reduce the toll of this highly preventable disease.
Alarming trend in adults under age 50
For quite some time, national guidelines have recommended that colorectal cancer screening begin at the age of 50, when risk of the disease starts to climb markedly. However, in recent years, researchers and physicians have observed that colorectal cancer is increasing in people under age 50. Screening has generally not been recommended for those under 50 unless major symptoms occur.
Those who study the disease do not fully understand the reasons behind this increase, but there is growing concern among doctors, researchers and of course patients and their families. This has led to reconsideration of screening guidelines by the United States Preventive Services Task Force – the federal panel that recommends them.
In October 2020, that panel conducted a comprehensive and in-depth evaluation. It recommended that the age limit to be screened for colorectal cancer be lowered to include adults age 45-49. This brings the Task Force in line with what the American Cancer Society recommended in 2018.
The revised recommendations are formally in draft form now, but they should be finalized within the next several months. The Affordable Care Act mandates that colorectal cancer screening follow these guidelines, and that private insurers and Medicare cover approved screening tests with no co-payments.
Once the new guidelines are in place, adults age 45-49 who are increasingly vulnerable to colorectal cancer will become eligible for insurance that fully covers screening.
Elimination of surprise Medicare “loophole” charges
The second development concerns a loophole in Medicare coverage of screening colonoscopies. While Medicare must cover colorectal cancer screening with no co-payments, a co-payment is charged if a polyp or other tissue is found and removed during a colonoscopy. The rationale for this has been that removal of tissue is considered a diagnostic rather than a screening procedure.
This distinction has led to patients being surprised with a co-payment they weren’t expecting. Often Medicare patients undergoing a colonoscopy think that they are fully covered for the procedure, only to be confused when they are billed for a co-payment after the procedure had been done.
This coverage exemption has come under fire by many medical providers and public health advocates, who believe the removal of precancerous lesions to be an integral part of the screening process, rather than a separate diagnostic procedure. This situation, known as the Medicare loophole, has become a barrier to preventive colonoscopy in an older population that is at high risk of colorectal cancer.
After many years of advocacy and lobbying around this issue by organizations such as Fight Colorectal Cancer and the American Cancer Society Cancer Action Network, the loophole was finally closed in December 2020, when Congress passed, and President Trump signed, the Removing Barriers to Colorectal Cancer Screening Act of 2020. This act, part of the COVID-19 Economic Relief Bill, requires the waiving of coinsurance charges associated with colorectal cancer screening tests, regardless of whether tissue is removed during the test. It will be phased in during an eight-year period beginning in 2022.
The future of colorectal cancer screening
In a proclamation to the nation on March 1, President Biden encouraged “all citizens, government agencies, private businesses, nonprofit organizations and other groups to join in activities that will increase awareness and prevention of colorectal cancer.” The new screening guidelines will help make that happen in the future.
A number of effective options for colorectal cancer screening were approved under the new guidelines. These include tests that look for the presence of blood or specific DNA biomarkers in fecal samples, and visualization tests that directly examine the inner lining of the colon and allow removal of tumors or precancerous lesions.
New technologies are emerging that should make screening easier and more effective. For example, liquid biopsies involve analysis of easily obtained bodily fluids, such as blood or urine. Doctors may soon to able to isolate and analyze cells or DNA that come from tumors and that are present within the bloodstream.
Also, molecules in urine may be potentially important as biomarkers for detection of colorectal lesions.
Though the utility of technologies such as these is still under study, it is clear that in the near future, we should witness the appearance of simpler, more accessible and more sensitive tests for colorectal cancer. It is important to note, however, that these noninvasive tests must be followed up by a colonoscopy if anything of concern is noted.
As National Colorectal Cancer Awareness Month reminds us, it is important for people of all ages to be aware of risk factors for colorectal cancer, of symptoms that may be indicative of the disease, and of strategies and guidelines for screening and prevention. Talk to your doctor and your insurance provider about colorectal cancer and its prevention. The more you know, the better.