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 doctor who would typically make referrals for screenings such as a colonoscopy, keeping up with the recommendations may be difficult. Living in a rural area can add to the challenge. Primary care doctors may be tens of miles away. Facilities that can perform a colonoscopy may be a drive away, too. Plus, the procedure requires a day off of work, sedation and a ride home to recover.
In 2016, Premera Blue Cross (Premera) noticed that some of its members in rural Alaska hadn’t received recommended colorectal cancer screening. Understanding the challenges of living in rural areas, the health plan decided it had to find a way to minimize barriers to receiving this important preventive care.
An alternative to colonoscopies
The good news is that there are alternatives to colonoscopies. 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. FITs look for blood in the stool. A sample that’s positive for blood could indicate the early stages of colon cancer (or colorectal cancer).
So Premera mailed 4000 FIT kits to customers in Alaska who appeared to be overdue for screening. Each FIT kit came with a postage-prepaid envelope. Twenty-five percent of recipients returned a sample.
A Premera nurse reached out to those with positive test results to schedule follow up screening.
Expanding at-home colorectal cancer screening
Building on the success of the rural Alaska program, Premera expanded it to customers in rural Washington, focusing on those who hadn’t listed a primary care provider. The health plan made follow up calls to recipients, confirming they’d received the kits and reminding them about the importance of sending in their sample. The results, so far, are promising:
Safe screening during a global pandemic
Premera has expanded at-home screening with FIT kits for all of its customers now, given social distancing protocols as a result of COVID-19.
Expanding screening now is essential
Catching the early symptoms of 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 who live in rural areas—are delaying screenings past the recommended age.
Premera Blue Cross is a licensee of the Blue Cross Blue Shield Association, an association of 36 independent, locally operated Blue Cross and Blue Shield Companies.