Colorectal Cancer Screening

The American Public Health Association,

Recognizing that colorectal cancer (CRC) is the nation's second leading cause of cancer mortality, and that incidence and mortality could drop significantly with universal screening because this cancer is prevented when the adenomatous polyps that transform into cancers are identified and removed, and survival improves when colorectal cancers are removed at an earlier stage; and

Recognizing that the nation's health improvement plan, Healthy People 2010, addresses colorectal cancer with two objectives: to reduce mortality from colorectal cancer, and to increase the proportion of adults who receive a colorectal cancer screening examination; and

Acknowledging that there are disparities in the incidence and mortality of CRC that affect under-served populations including African Americans and other minority groups and disparities would be addressed if screening tests with high positive and negative predictive values were universal; and

Acknowledging that evidence-based guidelines from national authorities recommend several effective screening methods for average-risk individuals age 50 and over and screening methods of the highest sensitivity (colonoscopy) for those at increased risk; and that screening has been determined to be cost effective; and

Recognizing that national screening rates for the eligible population remain under 50 percent (BRFSS, 2002) while Healthy People 2010 set a goal of 50 percent of the eligible population screened by 2010, and the American Cancer Society set a goal of 75 percent of the eligible population screened by 2015; , that over 90 percent of Americans age 55 and older visited a doctor for a check up within the prior two years, and there exists sufficient capacity to screen the entire population with fecal occult blood testing (FOBT) and follow-up colonoscopy (for all positives) within one year's time; and that quality standards disseminated for health plans by the National Committee for Quality Assurance referred to as HEDIS measures now include colorectal cancer screening on the list of reportable measures to be publicly reported in 2006; and furthermore

Recognizing that barriers to screening persist and vary by region of the country, and include lack of health insurance, lack of coverage for CRC screening, poor availability of screening and diagnostic services due to inadequate reimbursement for primary care services, , limited supply of endoscopists, lack of up-to-date knowledge, and fragmentation and lack of continuity in the delivery system; therefore APHA:

1. Urges insurers and employers to remove barriers to colorectal screening by providing full coverage without co pays or deductibles for all the updated screening options recommended by the American Cancer Society (ACS), the Consortium of Gastroenterology Societies (Consortium), or the U.S. Preventive Services Task Force (USPSTF);
2. Urges state governments to require that all health insurers and coverage plans include full coverage for colorectal cancer screening (and related diagnostic work-up) according to the updated recommendations of national expert panels such as the American Cancer Society, the Consortium and the USPSTF, and collaborate to develop viable alternatives for residents who lack health insurance;
3. Urges state and local health departments to include colorectal cancer in all cancer screening programs and to promote screening to their client populations;
4. Supports improved primary and continued education of public health professionals to promote preventive screening, with attendant complete diagnostic exams, to reduce the incidence and mortality of colorectal cancer;
5. Urges the Centers for Medicare and Medicaid Services to provide an entry level physical exam to all new Medicare enrollees that includes colorectal cancer screening that is exempted from co pays and deductibles; 
6. Urges providers of primary healthcare services to improve their office systems such that every eligible patient they care for receives a recommendation for colorectal cancer screening; 
7. Urges collaboration between pharmacies and medical providers to promote patient knowledge of colonoscopy preparation procedures.

Urges the U.S. Department of Health and Human Services to:

• Collect accurate data by utilizing culturally competent data collection instruments. 
• Promote colorectal cancer screening using tests of high positive and negative predictive values and attendant diagnostic work-up.
• Encourage the establishment of policies such as those listed above that apply to insurers, state and local governments, academic health centers, primary healthcare providers, and the Public Health Service. 
• Provide continued financial support for the Centers for Disease Control and Prevention to expand its demonstration project of screening low-income men and women who have inadequate or no insurance coverage for colorectal cancer screening. 

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