Although screening rates for colorectal cancer (CRC) have increased over the years, screening rates remain low nationally, a source of frustration for providers and health plans.

Scientists from the Veterans Affairs Center for the Study of Healthcare Provider Behavior, Sepulveda, California, reassessed member-reported responses to telephone surveys performed in 2000 and in 2003 implementation of a quality improvement program to measure CRC screening rates. All those participating in the surveys were members of a large managed care plan, based in Southern California. The researchers included in the definition of CRC screening the use of a fecal occult bleed test and/or colonoscopy (including flexible sigmoidoscopy).

At the baseline interview in 2000, health plan members reported mean screening rates of 38% of any test, 23% for endoscopy, 22% for the fecal occult blood test. As the Figure illustrates, results of a survey performed after 2003 showed that CRC screening rates increased, but not greatly.

Their analysis revealed that when people discussed the risk of CRC with a physician, the chance of having any of the screens more than doubled. If health plan members reported barriers to screening, the odds of a member screening decreased by at least 25%.

In related news, the American Cancer Society announced that it was recommending that two CRC screening tests be added to the guidelines for adults 50 years and older: (1) virtual colonoscopy and (2) a DNA test using stool samples. Neither of these tests are routinely covered by managed care plans at present, but it is hoped by the Society that inclusion in guidelines may be the first step to coverage. Recognizing that only half of the appropriate population receives any CRC screen, any additional tests that may attract others to arrange appointments for screenings can only improve this statistic. The DNA stool test may be just what the doctor ordered, a sensitive cancer screen that does not require the bowel preparation or trip to the colonoscopy suite necessary with the traditional invasive colonoscopy.

Farmer MM, Bastani R, Kwan L, et al: Predictors of colorectal cancer screening from patients enrolled in a managed care health plan. Cancer 2008;112:1230–1238.