Your professional recommendation and a discussion of your patients’ options can encourage patients to schedule their screening for colorectal cancer.
The US Preventive Services Task Force says,
“There is convincing evidence that colorectal cancer screening substantially reduces deaths from the disease among adults aged 50 to 75 years and that not enough adults in the United States are using this effective preventive intervention.”1
As you and your patient discuss the available colorectal screening options, it may be helpful to discuss a few key points about each type of screening—including what the patient’s responsibility is for each type of screening. By letting your patients know what to expect, you can help make the preparation process more manageable and less intimidating.
Some of the screening tests you should talk about include colonoscopy, fecal occult blood testing (FOBT), and the fecal immunochemical test. You might want to share the comparison card "Which Screening Test Is Right for Me?" with your patients.
Managing Patient Expectations
One of the best ways you can help increase colorectal cancer screening among patients is to make sure you are managing expectations before the screening even occurs. This includes discussing coverage and the potential cost implications associated with screenings.
Most insurance plans classify colorectal cancer screening as a preventive health care service and, therefore, cover the cost of the screening. However, patients should know that preventive services like screening tests sometimes result in a follow-up diagnostic procedure, especially if a polyp is found and biopsied. While preventive services like colorectal cancer screening may be covered by insurance, once a service becomes diagnostic, this may alter a patient’s coverage. The patient may be required to pay an out-of-pocket expense (co-pay, deductible, coinsurance).2
Additionally, a deductible may need to be paid if the colonoscopy is prescribed to diagnose an unknown health problem, like if a patient is experiencing such symptoms as bleeding or irregularity.2 In this circumstance, the procedure would be considered diagnostic.2
Below is a chart with patient-friendly language that you may use to help educate patients.
Preventive Screening vs Diagnostic Testing3,4
Understanding the Differences and Resulting Impact on Coverage
|Preventive Screening||Diagnostic Testing|
A test (eg, colonoscopy or FOBT) performed on a patient who does not have symptoms but who is in a group at risk for colorectal cancer, such as those:
A colonoscopy to diagnose a health condition in response to symptoms, such as:
|Example A: For a patient’s 45th birthday, he chooses to have a simple FOBT.||Example A: The FOBT has a positive result; his doctor recommends a colonoscopy to determine the cause of the bleeding. The colonoscopy may be considered diagnostic since it will be used to determine why the patient has blood in his stool.|
|Example B: A patient’s mother had colorectal cancer, so she opts for a colonoscopy.||Example B: During the preventive screening colonoscopy, polyps are found, removed, and sent to a lab for testing. The testing itself may be considered diagnostic since the lab results will need to be reviewed to determine if the polyp is cancerous.|
LoveYourColon.org is intended to provide general information consistent with guidelines. The website is not intended to provide medical advice for any particular patient or replace professional HCP training.
- Colorectal cancer: screening. June 2016. US Preventive Services Task Force website. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/colorectal-cancer-screening2?ds=1&s=colorectal. Accessed January 22, 2018.
- Colorectal cancer screening tests. American Cancer Society website. https://www.cancer.org/content/cancer/en/cancer/colon-rectal-cancer/detection-diagnosis-staging/screening-tests-used.html. Accessed January 22, 2018.
- Preventive vs. diagnostic care. Healthy Times. Blue Cross Blue Shield of Massachusetts website. https://www.bluecrossma.com/healthy-times/archives/spring-2011/preventive-diagnostic.html?keepThis=true&TB_iframe=true&height=600&width=830&modal=true. Accessed January 22, 2018.
- Wolf AM, Fontham ET, Church TR, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society [published online ahead of print May 29, 2018]. CA Cancer J Clin. 2018. doi: 10.3322/caac.21457.