Tracking and Improving Screening for Colorectal Cancer Intervention

Dear Colleague:

As you may know, we surveyed providers in your office on their colorectal cancer (CRC) screening practices. This was for an intervention that involves your practice along with other practices in the [INSERT HERE: YOUR ORGANIZATION NAME]. We want to alert you that we discovered patterns in some practices that are NOT supported by current guidelines.

Please note:

• Digital rectal exam and in-office stool blood testing is NOT recommended for CRC screening by any guidelines.
• Take-home stool blood testing IS ACCEPTABLE as a CRC screening test. This can be either fecal occult blood testing (FOBT) or fecal immunochemical testing (FIT) annually.
• Patients with any positive at-home stool test should be referred for colonoscopy.

Current guidelines on screening are enclosed.

If you have any questions, please contact [INSERT HERE: CONTACT NAME AND PHONE NUMBER].

2.c-1 Academic Detailing Booster Enclosure

American Cancer Society Guidelines—Colorectal Cancer Screening¹

Beginning at age 50, both men and women at average risk for developing colorectal cancer should use one of the screening tests below. The tests that are designed to find both early cancer and polyps are preferred.

Tests that find polyps and cancer:

• Flexible sigmoidoscopy every 5 years*
• Colonoscopy every 10 years
• Double contrast barium enema every 5 years*
• CT colonography (virtual colonoscopy) every 5 years*

Tests that mainly find cancer

• Fecal occult blood test (FOBT) every year*, **
• Fecal immunochemical test (FIT) every year*, **
• Stool DNA test (sDNA), interval uncertain*

* Colonoscopy should be done if any test results are positive.
** An FOBT or FIT done with a digital rectal exam is NOT adequate for screening. If FOBT or FIT is used as a screening test, use the take-home multisample.

U.S. Preventive Services Task Force Recommendations²

• The USPSTF recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults, beginning at age 50 years and continuing until age 75 years. The risks and benefits of these screening methods vary.
• The USPSTF recommends against routine screening for colorectal cancer in adults ages 76 to 85 years. There may be considerations that support colorectal cancer screening in an individual patient.
• The USPSTF recommends against screening for colorectal cancer in adults older than age 85 years.
• The USPSTF concludes that the evidence is insufficient to assess the benefits and harms of computed tomographic colonography and fecal DNA testing as scolorectal cancer.

1. http://www.cancer.org/docroot/PED/content/PED_2_3X_ACS_Cancer_Detection_Guidelines_36.asp.
2. http://www.uspreventiveservicestaskforce.org/uspstf/uspscolo.htm.

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