2021 USPSTF Colorectal Cancer Screening Recommendation Lowers Screening Age from 50 to 45: Implications for NCCRT Partners – June 7, 2021

On May 18, 2021, the United States Preventive Services Task Force (USPSTF) released a final Recommendation, Evidence Summary, and Modeling Study on screening for colorectal cancer. The primary difference from the previous 2016 recommendation is that average risk adults are now recommended to start screening at age 45, in alignment with the American Cancer Society’s 2018 recommendation.

During this NCCRT webinar, a panel of expert speakers discussed:

  • What changed in the new recommendation? And what data informed the decision to lower the screening age to 45?
  • How does the new recommendation impact insurance coverage and what is the timeline?
  • When will the new guideline be reflected in colorectal cancer screening quality measures and national screening rate indicators?
  • What data do we have on screening in 45-49 year olds and what do we know about them?
  • The experiences of one state (Indiana) that began implementing screening at age 45 statewide following legislation to lower the screening age in 2019.

Speakers:

  • Heather Dacus, DO, MPH; Director, Bureau of Cancer Prevention and Control, NYS Department of Health; NCCRT Policy Action Strategic Priority Team Co-chair (Moderator)
  • Robert Smith, PHD; Senior Vice President, Cancer Screening; American Cancer Society; NCCRT Co-chair
  • Anna Schwamlein Howard; Principal, Policy Development, Access to and Quality of Care; American Cancer Society Cancer Action Network
  • Sepheen Byron; Assistant Vice President of Performance Measurement, the National Committee for Quality Assurance 
  • Stacey Fedewa, PhD; Scientific Director, Screening and Risk Factors Surveillance; American Cancer Society
  • Bryan Hannon; Regional Government Relations Director; American Cancer Society Cancer Action Network

What Can Comprehensive Cancer Control Coalitions
Do to Advance 80% in Every Community?

 

Comprehensive cancer control (CCC) programs and coalitions play a critical role in promoting colorectal cancer screening messages and activities in community settings across the United States. From educating coalition members to raising public awareness about colorectal cancer screening options, CCC programs and coalitions can support the national 80% in Every Community campaign and help make increasing colorectal cancer screening rates a leading public health priority.

This brief contains useful information and resources that will accelerate efforts to improve screening rates in your state, tribal organization, or territory.

Improving Colorectal cancer Screening: Promising Practices for State Medicaid Agencies

This report follows up on a 2015 report commissioned by the NCCRT, Colorectal Cancer Initiatives in Medicaid Agencies—A National Review. That report broadly described the activities being undertaken by Medicaid programs in all 50 states, identifying ten states that had adopted more robust approaches to colorectal cancer screening.

To develop a deeper understanding of how these higher-performing states are approaching the challenges of colorectal cancer screening, follow-up research was conducted with several of the states (Arizona, Maryland, Minnesota, Montana, New York, and Oregon) that had progressed further on their efforts. 

Thus, this guide establishes nine practices that have shown sufficient promise to merit consideration by other state Medicaid agencies who wish to enhance their screening efforts for this important population.

The 9 promising practices described within this guide include: 

  1. Define a CRC Metric for State Medicaid Plans
  2. Support or Mandate Public Reporting of CRC Screening Rates
  3. Develop an Incentive Program/Value-Based Purchasing Measure for CRC
  4. Provide Education and Technical Support to Managed Care Organizations and Providers
  5. Collaborate with State Public Health Staff
  6. Work Closely with FQHCs that Serve Large Medicaid Populations
  7. Promote Evidence-Based Strategies and Interventions
  8. Facilitate Access by Covering Multiple Tests Without Cost-Sharing
  9. Promote Test Options to Overcome Compliance Barriers, Provider Shortages, Geographic Issues, and Logistical Constraints

State-by-State Colorectal Cancer Screening Landscape

This resource, developed by Exact Sciences, provides a snapshot of the colorectal cancer screening landscape in each state while also putting into context how the different states compare with each other in a range of areas. While the majority of the information included is publicly available, it is difficult to find all this information in one place. This resource is intended to help people better understand what the CRC screening landscape – from coverage to screening rates to legislation – looks like in each state.

Evaluation: The last slide includes reference links for the included information. This involved considerable time and research across multiple websites and through research from Exact Sciences’ legal team.

Permissions: Made publicly available online by Exact Sciences.

Publication date: November 2019; updated August 2020

Post date: November 3, 2020

Contact: Submit comments, questions, and suggestions to Bryan Goettel: bgoettel@exactsciences.com.

Reigniting Colorectal Cancer Screening as Communities Face and Respond to the COVID-19 Pandemic: A Playbook

This resource provides an action-oriented playbook to be adopted throughout the COVID-19 pandemic and aims to align NCCRT members, 80% pledged partners, and colorectal cancer screening advocates across the nation to work together to reignite our screening efforts appropriately, safely, and equally for all communities.

The COVID-19 pandemic has challenged efforts to address inadequate screening and inequities in colorectal cancer outcomes, hindering the progress toward our 80% in Every Community goals. In the early stages of the COVID-19 pandemic, leading agencies, such as the Centers for Medicare & Medicaid Services (CMS) and the American Cancer Society, made recommendations to delay all non-urgent procedures. Colonoscopies to detect colorectal cancer have been delayed or cancelled and patient fears about contracting COVID-19 have led to further reductions in screening. This drop has raised concern that COVID-19 related screening delays will lead to missed and advanced stage colorectal cancer diagnoses and to excess deaths from colorectal cancer. Moreover, this burden will likely not be evenly distributed as screening disparities may be exacerbated in communities and populations that are disadvantaged by both old and new challenges in the COVID-19 era.

The colorectal cancer fighting community stands prepared and well-positioned to respond to and overcome the difficult task ahead, and this document offers the latest (as of June 2020) data, research, and clinical guidelines available related to colorectal cancer screening and COVID-19. 

Aligning Statements include: 

  1. Despite the challenges we face during the pandemic, colorectal cancer remains a public health priority, and we must provide the public with safe opportunities to prevent and detect colorectal polyps and cancer.
  2. Colonoscopy remains safe, is a good option for screening, and is quickly reopening around the country, but identifying patients who should receive higher priority for colonoscopic screening is a critical step.
  3. During a time when availability of elective screening colonoscopy may be limited by the COVID-19 pandemic, colorectal cancer screening can be safely offered through at-home stool-based tests.
  4. Gaining momentum and reigniting screening activities and public messaging will be highly dependent upon local regulatory requirements, public health priorities, and policy change.

Throughout the pandemic, individuals have options to screen for colorectal cancer. There are many safe, effective, and evidence-based screening tests available, including colonoscopy and non-colonoscopy options (e.g., stool-based tests, stool-DNA tests, and CT colonography). In addition to the information included in the Playbook specific to stool-based testing and colonoscopy, CT colonography also serves as an important option for patients. Learn more in an editorial published in Abdominal Radiology (July 2020), “CT Colonography’s role in the COVID-19 pandemic: a safe(r), socially distanced total colon examination.” 

We gratefully acknowledge the contributions of the following individuals and organizations. Thank you to our authors Durado Brooks, Rachel Issaka, Steven Itzkowitz, Michael Sapienza, Ma Somsouk, Richard Wender, Caleb Levell, and Emily Bell. We also extend a special note of gratitude to our committed partners, NCCRT Steering Committee members, and subject matter experts that have contributed to both reviewing and advising on this document, but also for their participation in ongoing discussions aimed at uniting and guiding the colorectal cancer community throughout the COVID-19 pandemic. And finally, we recognize the efforts of the Colorectal Cancer Alliance to provide support, in-kind staff, and continued commitment in coordinating a national response to improving colorectal cancer screening rates during the COVID-19 era. 

Summary Report on Links of Care Pilot to Increase Colorectal Cancer Screening for Underserved Patients

The newly released report, Report on a Pilot Project to Increase Colorectal Cancer Screening Rates and Ensure Access to Specialty Care for Underserved Patients, provides an overview of the Links of Care pilot project (2015-2017), which implemented evidence-based strategies to increase screening rates and timely access to specialists after abnormal screenings in three Federally Qualified Health Centers (FQHCs). Participating FQHCs successfully increased CRC screening rates by 8-28 percentage points, secured low- or no-cost colonoscopies from specialty care providers, and implemented patient navigation to ensure timely follow-up to diagnostic services. The report outlines key facilitators to success.

Congratulations to the evaluators and authors that contributed to this publication, Lesley Watson, Kara Riehman, Mary Doroshenk, Rentonia Williams, Vonda Evans, Lynn Basilio, Maryanne Goss, and Roshan Paudel, as well as the numerous individuals that contributed to the pilot projects’ success.

The NCCRT Resources Center also includes two webinars that feature findings from the Links of Care pilot projects, including a 2017 webinar and a 2015 webinar

Colorectal Cancer Burden Shifting To Younger Individuals: A Close Look At What The Most Recent Data Tells Us About Colorectal Cancer Incidence, Mortality, And Screening Rates – May 18, 2020

This webinar provided a close look at the findings from Colorectal Cancer Statistics 2020, a recent American Cancer Society publication released on March 5, 2020. According to the report, the burden of colorectal cancer is swiftly shifting to younger individuals as incidence increases in young adults and declines in older age groups. Additional report findings include the median age of diagnosis has dropped from age 72 in 2001-2002 to age 66 during 2015-2016 and half of all new diagnoses in people 66 or younger. The publication is accompanied by a consumer version, Colorectal Cancer Facts & Figures and a press release is also available. Learn about these findings and more in this webinar featuring report lead author Rebecca Siegel, MPH.

Speakers:

  • Rebecca Siegel, MPH, Scientific  Director, Surveillance Research, American Cancer Society, Inc.
  • Robert Smith, PhD, Senior Vice President, Cancer Screening, American Cancer Society, Inc. (Moderator)

My CT Colonography Center Locator Tool

The American College of Radiology (ACR) is now offering the My CT Colonography Center online locator, a patient-friendly online tool to find a computed tomography (CT) colonography screening center near you.

Bracco Diagnostics, Inc. originally developed the tool, which includes 120 centers – only a portion of the more than 700 estimated centers that perform CT Colonography (CTC). The ACR will now work with stakeholders to explore ways to achieve the goal of having all facilities that perform CTC registered on a center locator. To date, there are 220 centers registered for the locator tool.

The webpage also includes patient brochures on CTC, a video of a patient receiving a CTC, and more.

Evaluation: This tool was developed as a collaborative effort with Bracco Diagnostic and ACR CTC registry participants discussing a need to increase awareness of CTC screening option for patients.


Permissions:
 Made publicly available online by the American College of Radiology.


Publication date: 
September 2019


Post date: 
April 20, 2020


Contact:
Submit comments, questions, and suggestions info@acr.org.

Nuestras Voces Network Colorectal Cancer Awareness Month Infographic

This bilingual infographic on colorectal cancer was developed by the National Alliance for Hispanic Health’s Nuestras Voces Network Program to raise awareness about the importance of screening, and to promote the information from Centers for Disease Control and Prevention’s (CDC’s) Screen for Life National Colorectal Cancer Action Campaign during National Colorectal Cancer Awareness Month.

This infographic can be shared, posted on social media, printed for community distribution, and customized to include a local organization logo. For more information on how to use this resource in your own community see contact information below.

Evaluation: The content of the infographic was based on evidence-based resources including NCCRT’s 2019 Colorectal Cancer Screening Messaging Guidebook and CDC’s Screen for Life National Colorectal Cancer Action Campaign.

Permissions: Made publicly available online by the National Alliance for Hispanic Health’s Nuestras Voces Network Program. See Contact section below for more information.

Publication date: 2020

Post date: March 30, 2020

Contact: For more information about this infographic and the Nuestras Voces Network Program please contact Marcela Gaitán at mgaitan@healthyamericas.org.

Note: We are not able to share the webinar recording at this time since some of the presentations contain unpublished data, but we will post the recording to this webpage as soon as we have permission to do so. 

Webinar – What Do The Data Tell Us: What Can We Learn From The Latest Colorectal Cancer Screening Rate Trends Over Time? –  January 30, 2020

This webinar provided a look at the latest data that informs how we are doing as a nation with our efforts to reach an 80% colorectal cancer screening rate. The webinar included a review of the key colorectal cancer screening data sets: BRFSS, NHIS, HEDIS, and UDS. Participants heard from experts as they gave an update on where we are progressing and where we still need to focus, to help inform your work ahead. (Note: this webinar was a repeat of a panel that was hosted at the 2019 NCCRT Annual Meeting.)

Speakers:

  • Djenaba A. Joseph, MD, MPH, Medical Director, Colorectal Cancer Control Program, Centers for Disease Control and Prevention
  • Stacey Fedewa, Senior Principal Scientist, Surveillance Research, American Cancer Society, Inc.
  • Mary Barton, MD, MPP, Vice President, Performance Measurement, National Committee for Quality Assurance
  • Minh Nguyen, Pharm D, MPH, Public Health Analyst, Health Resources and Services Administration