December commentary

Dear Primary Care & ObGyn Provider, Hospitalist, Community Health Center Director and APRN:

You and your team play THE pivotal role in the prevention and early detection of colorectal cancer (CRC) among our community. In Kentucky, the single most important factor screening which influences the patient to be screened is the recommendation from their primary care physician.

Although screening rates have markedly improved in Kentucky, much work remains to be done as CRC remains
the second most common cause of cancer related deaths and the leading cause of cancer deaths among nonsmokers
over the age of 50.

Normal risk individuals have several of options for screening in addition to screening colonoscopy every 10 years or flexible sigmoidoscopy every five years. They include non-invasive fecal testing which include both annual FIT (Fecal Immunochemical Test) and every 3 years multi-target stool DNA tests. For individuals determined to be at high risk, screening colonoscopy remains the preferred screening strategy.

Currently, screening is recommended between the ages of 50 and 75 for normal risk individuals. Eliminating system barriers around CRC screening such as out of-pocket expenses and non-economic burdens are being managed though the implementation of the ACA and are being advanced with recent KY state legislation (KY HB 69/SB61)
effective January 1, 2016 that allows for 100 percent coverage when billed with CPT code 82247, importantly, without cost share to the member.

By expanding to noninvasive fecal testing options, we can reduce non-economic burdens by including tests that require no bowel prep and are not affected by diet or medications. We can meet the national goal of screening 80 percent of our population by 2018!

Whichever primary strategy you  choose to use for your patients, recognize that you have many choices to offer and this promotes compliance. Therefore, it is extremely important to offer your normal risk patients a choice that includes either screening colonoscopy or noninvasive fecal testing (FIT or mt-SDNA).

Studies have demonstrated increased CRC screening compliance within practices that offer both choices to patients. The non-invasive FIT test can be performed in the privacy of the patient’s own home and is preferred by many patients.

It is important to be aware that the newer noninvasive fecal testing based strategies are equivalent to a colonoscopy-based strategy in their ability to reduce CRC mortality in conjunction with colonoscopy for positive results.

Remember, the best screening strategy is the one that gets the job done and there is not the ‘gold standard colonoscopy’ concept anymore. Of note, GUAIAC- based fecal testing is no longer recommended for
colorectal cancer screening and should be transitioned to the non-invasive fecal testing choices listed above.

Professional society recommendations and ACS recommendations are meaningless without your personal recommendation. Let’s meet the challenge and work together to make colon cancer disease of our past!

Divya Cantor, MD, MBA, FACOG
Senior Clinical Officer KY
Anthem Blue Cross Blue Shield

Whitney Jones, MD
Founder, Colon Cancer Prevention Project
Founder, KY Cancer Foundation
Clinical Professor, University of Louisville

Peter L Thurman, MD, MBA
Medical Director, Kentucky Medicaid
Anthem Blue Cross Blue Shield