Screening Members for Colorectal Cancer

Colorectal cancer is one of most dangerous digestive cancers, often leading to morbidity or mortality. According to The American Cancer Society , the overall lifetime risk of developing colorectal cancer is about 1 in 23 for men and 1 in 25 for women. Due to the prevalence of colorectal cancer, Highmark recommends providers perform the following colorectal cancer screenings for patients aged 50 and up:

Effective January 1, 2022, there will be an age change from 50 to 45 years old based on the recommendations of the United States Preventive Task Force.

Providers should remind members that alternative screening tests that come out positive may require a follow-up diagnostic colonoscopy. This could mean new bowel preparation, work disruption and additional cost.

Members should also be aware that costs for a diagnostic colonoscopy following a positive alternative colorectal screening will be billed under medical benefits with potential member cost sharing.

Why Colonoscopies and FIT Tests Are the Preferred Tests

The U.S. Multi-Society Task Force on Colorectal Cancer classified colorectal cancer screenings into tiers based on performance and effectiveness, ranking both colonoscopy (every 10 years) and an annual FIT for first-tier screening as preferred methods for detecting colorectal cancer. These two tests are used to detect and prevent colorectal cancer before symptoms develop and aid in taking biopsies and removing polyps or other areas of abnormal tissue.

The U.S Multi-Society Task Force on Colorectal Cancer set these guidelines to maximize the risk-benefit ration based on the member’s risk factors. A screening colonoscopy is the gold standard and is recommended for individuals aged 50-85 even if they feel perfectly fine.

Dr. Katie Farah, chief medical officer at Allegheny Health Network’s (AHN) Wexford Hospital, said in her interview for the Ask a Doc series , “The tier-based classification represents the most up-to-date, evidence-based recommendations from the American College of Gastroenterology, the American Gastroenterological Association and the American Society for Gastrointestinal Endoscopy. We want patients as well as primary care providers (PCPs) and other referring physicians to use the tier 1 screening tests - that’s colonoscopy as the first test of choice and, if refused by the patient an annual standard FIT…a stool-based screening with a high sensitivity for detecting colon cancer and colon polyps which has been noted to have fewer false positives reported in comparison to other screenings…as the second tier 1 option.

“While other tests are marketed for screening of colorectal cancer, they are currently considered tier 2 and may not be medically appropriate for your patient. For example, the FIT-DNA (Cologuard) stool-based screening is not approved for individuals at high risk of colorectal cancer and has shown a high rate of false positives leading to an additional procedure deemed diagnostic.”

Highmark wants to work with you to encourage our eligible members to complete their colorectal cancer screenings. They can save lives.