Submitted by Stephanie Pitsilos, MD – Augusta Health Staunton Medical Associates & ACP Quality Committee Chair
Colorectal Cancer (CRC) is the 2nd leading cause of cancer death in the United States, but CRC is preventable. In fact, 9 out of 10 people whose CRCs are found early and treated appropriately are still alive five years later.
Primary Care Practical CRC Review
Given the incidence of CRC and its preventable nature, the key is that we in primary care take the time to educate our patients about CRC and encourage them to “DO SOMETHING.” If a screening colonoscopy is refused, then the option of a non-invasive test should be offered.
Documentation is critical for quality reporting. Don’t forget to document the CRC screening results!
- Colonoscopies and flexible sigmoidoscopies – It’s best to have the procedure report in the medical record. If no report is available, document the procedure year and results.
- Fecal Immunochemical DNA Test (FIT DNA) – Document the test date and results
- Fecal Occult Blood Test (FOBT) – We recommend doing FIT DNA test over the FOBT test ($ for FIT DNA versus $ for FOBT). Document the date the stool cards were returned and results.
The newest screening guidelines came out from the US Multi-Society Task Force on Colorectal Cancer in June of 2017, and highlights include:
- Cancer prevention tests are preferred over detection tests.
- Screening is recommended for African Americans beginning at age 45.
- CT colonography every 5 years replaces double contrast barium enema as the radiographic screening alternative
- FIT replaces older guaiac-based fecal occult blood testing.
- Annual Hemoccult Sensa and fecal DNA testing (COLOGARD) every 3 years are alternative cancer detection tests.
- A family history of only small tubular adenomas in first-degree relatives is not considered to increase the risk of CRC.
- Individuals with a single first-degree relative with CRC or advanced adenomas diagnosed at age ≥60 years can be screened like average-risk persons.
Augusta Care Partners is focused on improving the colorectal cancer screening rates for patients in our Medicare population and those in the Augusta Health employee health plan (part of our HQEP agreement). Below are graphs illustrating our current colorectal cancer screening rates and targets for both of the network’s managed populations. In the coming weeks, registries identifying those patients who are due for CRC screening will be provided to our primary care practices.