Colorectal cancer is the fourth most common cancer and the second-leading cause of cancer death among men and women combined in California. In 2020, an estimated 15,530 new cases of colorectal cancer will be diagnosed statewide, and 5,480 will succumb to the disease. Screening can prevent colorectal cancer by detecting and removing precancerous growths at an early stage when it is easier to treat and outcomes are more favorable. Low-cost screening tests can prevent nearly half of all colorectal cancer cases diagnosed at a late stage. Despite being one of the most preventable types of cancer, one in four adults have never been screened for colorectal cancer, with underutilization more common among the Medi-Cal insured, uninsured, racial, and ethnic minorities. Additionally, there has been an increase in young-onset colorectal cancer (diagnosed under age 50). The following objectives with accompanying strategies detail the steps that can be taken to reduce the morbidity and mortality from colorectal cancer to address these disparities.
By 2025, decrease the rate of late-stage diagnosis of colorectal cancer among those who are covered by Medi-Cal and the uninsured from the baseline of 71% to 64%.
Data source: CCR, 2017
1. Explore adding colorectal cancer screening as a required reported quality measure for Medi-Cal Managed Care plans.
2. Implement FLU/FIT programs in California’s FQHCs.
3. Implement evidence-based strategies (EBS) in California’s FQHCs as outlined in Steps For Increasing Colorectal Cancer Screening Rates: A Manual For Community Health Centers and the National Cancer Institute’s Research-Tested Intervention Programs (RTIPS) website.
4. Clinics and health plans work with patient navigators/community health workers/promotores and implement other proven strategies to ensure appropriate follow-up of colonoscopies after a positive or abnormal Fecal Immunochemical Test (FIT).
By 2025, increase the colorectal cancer screening rate among all Californians from the baseline of 70.8% to 80%
Data source: BRFSS, 2018
1. Implement Evidence-based strategies as outlined in “Steps For Increasing Colorectal Cancer Screening Rates: A Manual For Community Health Centers” and the National Cancer Institute’s Research-Tested Intervention Programs (RTIPS) website.
2. Explore requiring the California Health Care Quality Report Card to report colorectal cancer (CRC) screening for all health plans providing care in California. All health plans should report their CRC screening rate for posting on the quality report card listed above.
3. Develop a FLU/FIT program in every clinic with colorectal cancer screening rates below 60%.
4. Develop clinic navigation to ensure all abnormal stool-based tests receive the required colonoscopy. The percent of abnormal stool testing that receive the needed colonoscopy should be a required quality measure for all health plans using stool-based screening tests.
5. Remove structural barriers (e.g., inconvenient clinic hours, lack of transportation, out of pocket costs, etc.) to CRC screening through the use of patient navigators/community health workers/promotores services.
By 2025, decrease late-stage diagnosis of colorectal cancer among all Californians between the ages of 40 – 49 years from the baseline of 69% to 57%.
Data source: CCR, 2017
1. Family history of CRC should be routinely asked and recorded in all adults to provide opportunities for earlier identification and screening of high-risk individuals, including with genetic testing, when indicated.
2. Encourage colorectal cancer survivors in all health plans and clinics to promote screening within their families.
3. Screening for hereditary cancer syndromes in patients with CRC should be done and include at a minimum a review of personal and family histories of all cancers.
4. Explore requiring genetic testing of removed colorectal cancers for DNA mismatch repair deficiency and/or microsatellite instability with the results reported to the CCR.
5. Health care providers should follow the ACS’s recommendations for evaluation of genetic risk in patients with a family history of colorectal cancer.