Colorectal cancer is one of the most common cancers among both men and women in Arkansas, but it’s also one of the most survivable with regular screening and early detection. In 2022, the latest year for which data are available, 147,931 new cases of colorectal cancer were reported in the U.S., according to the Centers for Disease Control and Prevention (CDC). Of those, 1,541 were reported in Arkansas; only five states had higher per capita rates of new cases.
March is Colorectal Cancer Awareness Month, a national health observance that seeks to raise awareness of the disease and promote early detection.
Screenings Should Start at Age 45
Colorectal cancer has a high survival rate when detected early, yet only 65% of U.S. adults age 45 or older have received a colorectal cancer screening, and only 37% of adults ages 45 to 49 have been screened. The recommended age range for regular colorectal cancer screenings used to be 50 to 75, but in May 2021 the U.S. Preventive Services Task Force (USPSTF) recommended that people begin receiving screenings at age 45 (people with certain risk factors may need to start screening earlier).
The change was prompted by a growing number of cases among people under age 50. The American Cancer Society reports that among adults under 50, the colorectal cancer incidence rate has risen about 3% per year since 1998. Also increasing is the colorectal cancer death rate among people under age 50, which has risen by about 1% per year since 2004.
The reasons for the increase in colorectal cancer cases among younger people are not fully understood, but sedentary lifestyles, obesity, smoking, heavy alcohol use, and diets that are high in processed meats, high in fat, or low in fiber have all been associated with the disease.
The 2020 death of actor Chadwick Boseman at age 43 and the death in February of actor James Van Der Beek at age 48, both from colorectal cancer, have heightened awareness that the disease is not only a concern past age 50. Boseman’s death also drew attention to health disparities: Black adults in the U.S. were 11% more likely to be diagnosed with colorectal cancer than White adults in 2022, according to the American Cancer Society. In Arkansas, the rate of new colorectal cancer cases among White adults in 2022 was 41.0 per 100,000 people, compared to 46.8 per 100,000 people among Black adults, according to the CDC.
Insurers Required to Cover Screenings
The USPSTF assigns grades to its recommendations that range from A (highest certainty of substantial benefit) to D (moderate or high certainty of no net benefit, or of the harms outweighing the benefits; the USPSTF discourages the use of services with this grade). The recommendation for adults ages 45 to 49 to receive a colorectal cancer screening has a B grade, and the recommendation for adults ages 50 to 75 to receive regular screenings continues to have an A grade.
The federal Affordable Care Act requires insurers to cover preventive medical services if the services are recommended by the USPSTF with a grade of A or B, which means that insurers are now required to cover preventive screenings for people as young as 45 — although some insurers were already voluntarily covering screenings for the 45-to-49 age group before the task force changed its recommendation. The requirement became effective Jan. 1, 2023.
In Arkansas, the General Assembly enacted a state law in April 2021 that, consistent with the USPSTF’s recommendation (then still in draft form), required insurers to cover colorectal cancer screenings for people as young as 45. That requirement took effect Jan. 1, 2022.
The Arkansas law, Act 779 of 2021, includes as part of a preventive screening any follow-up colonoscopies performed after patients receive positive or abnormal results on non-colonoscopy tests. Prior to Act 779, it was common for Arkansans to face out-of-pocket costs for follow-up colonoscopies. A 2021 report by ACHI and the national nonprofit Fight Colorectal Cancer, prepared before Act 779 took effect, found that among Arkansas patients ages 50 to 75 enrolled in Medicare, commercial insurance, or Medicaid, more than 3 out of 5 who received follow-up colonoscopies experienced out-of-pocket costs.
In 2022, the U.S. Department of Labor issued guidance clarifying that insurers nationwide are required to cover follow-up colonoscopies.
Barriers Persist
Despite the legal protections in place, some insured colonoscopy patients have reported receiving bills for services related to their procedures, such as polyp removal, surgical supplies, or the use of a recovery room. This has occurred even though the Center for Medicaid and Medicare Services has clarified that when a colonoscopy is performed as a screening procedure consistent with the USPSTF’s guidelines, “cost sharing may not be imposed for items and services that are an integral part of performing the colonoscopy,” including polyp removal.
Arkansans who have healthcare coverage and believe they have received unfair medical bills can file complaints with the Arkansas Insurance Department.
Patients may also face other barriers to colorectal cancer screenings, such as fear, limited access to healthcare providers, inability to take time away from work, lack of transportation, language barriers, and lack of awareness about available resources or the current recommendations.
These barriers may be most prevalent among residents of rural areas, people with low incomes, and people of color. A March 2023 survey conducted by The Harris Poll for Exact Sciences found that 5% of White adults ages 45 to 75 in the U.S. delayed or avoided colorectal cancer screenings because they did not know how to get screened, compared to 10% of Black adults and 20% of Hispanic adults.
Colorectal Cancer Awareness Month provides an excellent opportunity, particularly for healthcare professionals, to educate the public about the importance of timely screenings for colorectal cancer and encourage policymakers to work to reduce the barriers to screenings that many Americans continue to face.
For further reading, see ACHI Health Policy Director Craig Wilson’s column for Talk Business & Politics, “45 Is the New 50 (for Colorectal Cancer Screening).”
