Breaking the Barriers to Colorectal Cancer Screening

Abstract

Despite the great strides made to encourage colorectal cancer screening and successful public awareness campaign credited with increasing colonoscopy rates by as much as 20%, one of the major barriers to improved patient compliance is the confusion surrounding insurance coverage for preventative tests. Unfortunately, there is no Federal legislation that requires insurance providers to cover preventative screenings for colorectal cancer. But in recent years, a handful of states have passed legislation designed to encourage screenings. In response to patient and physician uncertainties of whether or not insurance will pick up the tab for colorectal cancer tests, the Entertainment Industry Foundation’s National Colorectal Cancer Research Alliance (EIF’s NCCRA) and the American Gastroenterology Association (AGA) have joined forces to create a report that clearly explains state laws governing insurance coverage for cancer screenings. “EIF’s NCCRA has teamed up with AGA to applaud those states with comprehensive healthcare protections, and reinforce our key message that preventative screening is the first step to beating colorectal cancer,” said Lisa Paulsen, president and CEO of the Entertainment Industry Foundation. “By recognizing states with exemplary legislation, our hope is that others will follow suit.” The 2004 Colorectal Cancer Legislation Report Card helps people make sense out of the varied and complex laws surrounding colorectal tests. An AGA Report Card Taskforce was assembled to determine the evaluation criteria and assign a grade (A–F) for every state in the union, including Washington D.C. Legislative research was collected from numerous public sources including: the National Cancer Institute’s (NCI) State Legislative Database, National Conference of State Legislatures, American Cancer Society (ACS), and Centers for Disease Control and Prevention. This first-of-its kind, on-line report (EIF.NCCRA.org) provides web links to actual legislation for current state laws. There is also a call-to-action for those states with failing grades. People can e-mail a prepared letter to their state’s Senate Health Committee Chair to petition for quality legislation. “We believe that colorectal cancer merits a higher priority in our nation’s public health agenda,” said J. Thomas Lamont, M.D., a member of AGA’s Report Card Taskforce. “If we can persuade more states to pass preventative screening legislation, our states have the potential to save billions of dollars spent annually to treat colorectal cancer and, most importantly, save thousands of lives.” A total of 18 states received passing grades (A–C). In 2000, Virginia was the first state to adopt comprehensive colorectal cancer screening coverage that meets AGA and ACS guidelines, setting the standard for model legislation and receiving a grade “A” in this report. Since then, 12 states have followed its outstanding example, including: Connecticut, Georgia, Illinois, Indiana, Maryland, Missouri, Nevada, New Jersey, North Carolina, Rhode Island, Tennessee, Virginia, and Washington D.C. Another 3 states-Delaware, Texas, and West Virginia-received a “B” rating falling short because the law itself did not reference AGA or ACS. California and Wyoming squeezed by with passing grade of a “C” because legislation is vague and omits specifics on types of tests covered and age requirements for screening. Two-thirds of the country (34 states) remain without legislation. Among those states that failed, Oklahoma does have legislation but received a “D” because it only recommends that coverage be offered, rather than required. Many of these same states have passed insurance provisions for other cancers. For instance, breast cancer advocates have made a tremendous impact overcoming a once taboo subject and have positively influenced patient behavior. As a result, 47 states now require insurers to cover breast cancer screenings. Today, NCI reports that compliance among women to receiving mammograms has increased to 70%, while compliance for colorectal cancer screening among women remains low (27%). Colorectal cancer has the second highest death rate in the United States. Although colorectal cancer is one of the most highly preventable cancers (90% curable with early detection), fewer states have passed preventative screening legislation for this disease when compared with other cancers with lower death rates. Similar legislative advancements have provided coverage for prostate screenings (26 states) and cervical cancer screenings (23 states) whose combined death rates are far below that of colorectal cancer. This year, 5 states: Alabama, Kansas, Kentucky, Mississippi, and Pennsylvania have introduced colorectal cancer screening bills within the 2004 legislative session. Hopefully, this report card will encourage more people living in those states to take action and vocalizing their support of this type of measure. To learn more about the 2004 Colorectal Cancer Legislation Report Card released by AGA and EIF’s NCCRA, please visit www.eif.nccra.org.