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Hands holding a small at-home colorectal cancer screening test

Simple at-home tests called FIT kits are a noninvasive way to keep up on recommended screenings for colorectal cancer. 

A Course Reset on Colorectal Cancer Screening

Threat of COVID-19 infection kept millions of Americans from getting routine cancer screenings early in the pandemic. But research indicates screenings still lagged by the beginning of 2021, especially colonoscopies.

A study published in the journal Cancer, which included more than 700 cancer facilities nationwide, found by January 2021 most of those surveyed had not seen screenings rebound to prepandemic levels. Colonoscopies dropped by nearly half compared to 2019.

At the same time, new cancer diagnoses dropped 13% to 23%, depending on the type, because fewer cases were being detected.

To help get some Texans back on track and improve health outcomes, Blue Cross and Blue Shield of Texas (BCBSTX) offered to send some eligible individual plan members free at-home colorectal cancer screening tests, fecal immunochemical test (FIT) kits, one of the least invasive and effective screenings used to find polyps or colorectal cancer.

“We can actually prevent cancer from occurring through early screening. We’ve got some catching up to do.”

Colorectal cancer is the third most common cancer diagnosed in the United States, according to the American Cancer Society. It’s the second most common cause of cancer deaths for men and women combined and expected to cause more than 52,500 deaths this year.

For years, BCBSTX has offered FIT kits to targeted member populations to screen themselves for colorectal cancer and return them for analysis. After the COVID-19 outbreak forced most Texans to stay home in 2020, BCBSTX increased efforts to send FIT kits to members and encourage home testing.

With a FIT kit, a stick or brush is used to collect a small stool sample, which is returned to a doctor or lab where the sample is checked for blood — an early sign of colorectal cancer. A colonoscopy is recommended as a follow-up test if a FIT detects blood.

In 2021, the company sent kits to 33,375 BCBSTX individual plan members who were at least 45 years old and had not had a colonoscopy. Results were shared only with the participating members and the primary care provider they identified.

Of the 5,432 members who performed the tests and returned them for analysis, 304 had abnormal results and were encouraged to schedule follow-up colonoscopies.

“Colorectal cancer screening should be on the to do list for everyone,” says Dr. Mark Chassay, BCBSTX vice president and chief medical officer. “We can actually prevent cancer from occurring through early screening. We’ve got some catching up to do.”

Pandemic impacts cancer diagnoses

BCBSTX claims data suggests the pandemic may have affected screening rates for several cancers. However, company leaders do not anticipate a surge in cancer diagnoses despite a screening lag.

Diagnoses for at least four cancer categories — colorectal, cervical, prostate and breast — plunged almost immediately after the pandemic was declared in 2020. However, diagnoses rates for all four increased as communities eased COVID-19 restrictions and doctor’s offices and clinics reopened to treat more patients.

Dr. Mitch Magee, oncology medical director for BCBSTX, says the swift rebound indicates short COVID-related delays didn’t substantially prohibit members from seeking care and probably won’t dramatically affect their treatment. He says research published in the Annals of Thoracic Surgery indicates treatment delays up to three months for some lung cancers did not significantly affect five-year survival rates.

“A delay of a month is not going to make a big difference in the stage of cancer at diagnosis or treatment going forward,” says Magee, a thoracic surgeon. “Delays are bad, but long delays are worse.”

In 2021, BCBSTX helped close some gaps by helping 201 BCBSTX members throughout the state receive mammograms at mobile breast cancer screening events.

“We need to ensure that individuals know that it is safe to return to care to understand what are the things that should be at the top of their priority list based upon their age, family history and other risk factors for screening,” Chassay says.



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