August 6, 2020
Recommended screening for
colorectal cancer should begin at age 50, or earlier for those
at higher risk. But for people who don’t have a primary care provider who often
makes referrals for screenings such as colonoscopies, keeping up with the
recommendations may be difficult. Living in a rural area can add to the
challenge. Primary care doctors may be several miles away and facilities that
perform colonoscopies may be far away, too. Plus, the procedure requires a day off
work, sedation, and a ride home to recover.
In 2016, Premera noticed that some of its members
in rural Alaska hadn’t received recommended colorectal cancer screenings.
Understanding the challenges of living in rural areas, we decided to find a way to erase
barriers to receiving this important preventive care.
An alternative to colonoscopies
The good news is that there are alternative
screenings for colorectal cancer. One is a FIT, or fecal immunochemical test. A FIT
doesn't require a doctor's office visit, a procedure or a special diet and laxatives
beforehand. Patients receive a kit in the mail at home. They collect a small
stool sample and mail it back to a lab. A sample that’s positive for blood in the
stool could indicate early stage colorectal cancer.
Premera
mailed FIT kits to customers in Alaska who were overdue for screening. Each FIT
kit came with a postage-prepaid envelope. This approach contributed to a high rate of test kit returns—twenty percent of recipients returned a
sample. Within a few months, a Premera nurse reached out to those with positive test results to schedule follow-up screening.
Expanding at-home colorectal cancer screening
Using what it had learned from the rural Alaska program, Premera expanded the program
for customers in rural Washington, focusing on those who hadn’t listed a
primary care provider. We made follow-up calls to recipients, confirming they’d
received the kits and reminding them about the benefits of sending in their sample.
Their results, so far, are promising:
In Alaska, more than 4,000 members
received FIT kits and approximately 1 in 4 returned their test kits. Of those
who returned a kit, 5.5%, or 55 members had positive results, meaning
additional follow-up was necessary.
In
Washington, more than 1,100 members received FIT kits and approximately 1 in 4
mailed in their kits as well. Of those, 4.2%, or 11 members had positive
results, meaning additional follow-up was necessary.
Safe screening during a global pandemic
Premera
has expanded at-home screening with FIT kits for all customers now, given
social distancing protocols related to COVID-19.
Expanding screening now is essential
Catching
possible early stage colorectal cancer is more important than ever. New
research from the Blue Cross Blue Shield Association finds that the rates of
risk factors such as Crohn’s disease and ulcerative colitis are on the rise,
particularly among the millennial generation. The research also shows that many Americans—not just those in rural
areas—are delaying screenings past the recommended age.