CRC Awareness Roundup: Lower screening age, effort to break stigma in Black community

For the entirety of March, the gastroenterology community has celebrated National Colorectal Cancer Awareness Month to encourage individuals to learn more about the highly preventable cancer and to increase screening.

Thus far in 2023, there have been major shifts in CRC screening, beginning with CMS lowering the minimum age for screening to 45 under Medicaid Part B and research found artificial intelligence may offset time-related decline in colonoscopy quality.

Additionally, the Association of Black Gastroenterologists and Hepatologists partnered with James Casey — patient advocate, saxophonist and member of the Trey Anastasio Band — to host a virtual event to help facilitate dialogue within the Black community about colorectal cancer.

Healio has closely followed the latest research on CRC and the importance of colonoscopies. Want to see what you may have missed so far? We have compiled a list of the latest news and research on colonoscopies.

CMS lowers CRC screening coverage age, requires new modifier for follow-up colonoscopy

CMS has announced expanded coverage for specific CRC screening tests by lowering the minimum age to include individuals aged 45 years and older under Medicare Part B.

“CMS is expanding coverage for colonoscopy for all Americans at age 45 instead of age 50. This is a welcome change, as it aligns with evidence-based guidelines by the United States Preventive Services Taskforce,” Shazia Siddique, MD, MSHP, assistant professor of medicine at the University of Pennsylvania and director of research at the Center for Healthcare Improvement and Patient Safety, told Healio. “Thanks to the Affordable Care Act, screening colonoscopies are essentially free for Americans, and now this is extended to Americans between ages 45 to 49 as well.” Read more.

AI can offset dwindling adenoma detection for colonoscopies performed later in the day

Although colonoscopies performed later in the day correlated with a decreased adenoma detection rate, researchers reported that artificial intelligence systems may offset time-related decline in colonoscopy quality.

“Time of day has been identified as an indispensable factor related to suboptimal ADR. ... Continuous and repetitive visual stimuli may lead to weaker reliable response and poorer judgement, which jeopardize diagnostic abilities and efficiency,” Zihua Lu, MD, of the department of gastroenterology at Renmin Hospital of Wuhan University, and colleagues wrote in JAMA Network Open. “According to available evidence, the incorporation of AI as an aid for colonoscopy results in a significant increase in ADR. ... However, the extra benefit of AI systems in eliminating the time-related decline of ADR remains unknown.” Read more.

Excess weight increased risk for colorectal cancer, independent of genetic risk

Excess weight, regardless of polygenic risk score, correlated with an increased risk for CRC, according to results from a population-based, case-control study.

“Accumulated evidence has shown that a high BMI, as a proxy for excess body weight, is associated with increased CRC risk,” Xuechen Chen, MMed, of the division of clinical epidemiology and aging research at the German Cancer Research Center, and colleagues wrote in JAMA Network Open. “Polygenic risk scores (PRSs), the combination of multiple single nucleotide variations identified in genome-wide association studies, are increasingly used for CRC risk stratification and also are useful to improve limited statistical power in gene-environmental studies that often suffer from weak effects of single risk loci and harsh penalty of multiple comparison corrections. Read more.

VIDEO: ABGH partners with acclaimed saxophonist to break stigma of CRC in Black community

In a Healio video exclusive, Ugo Iroku, MD, previewed the Association of Black Gastroenterologists and Hepatologists’ upcoming event on early-onset CRC and the disparities in screening and care that Black patients face.

“In 2023, a projected 100,000 Americans will get colon cancer and just under 50,000 Americans will get rectal cancer,” Iroku, a gastroenterologist at Mount Sinai Hospital and Summit Health, said. “Why is it important in the Black community? Black people are 20% more likely to get colorectal cancer and, unfortunately, 40% more likely to die from colorectal cancer.” Watch here.

Q&A: Personalized care, outreach key to boosting CRC screening among Hispanic patients

In 2021, an estimated 16,500 Hispanic men and women were diagnosed with cancer of the colon or rectum and about 4,700 Hispanic individuals died from the disease.

Hispanics represent the largest and one of the fastest growing minority populations in the U.S. and have lower survival from CRC than non-Hispanic whites. Mortality from CRC dropped by 15.1% among non-Hispanic whites from 2000 to 2011 but by only 5.9% among Hispanics. Currently, CRC is the second most common malignancy among Hispanics in the U.S., and low CRC screening rates in this group are a contributor. Read more.

Advanced colorectal neoplasia prevalence remains low 10 years after negative colonoscopy

Researchers reported low prevalence for advanced colorectal neoplasms at screening colonoscopies conducted at least 10 years after a negative index colonoscopy, especially among women younger than 75 years.

“Screening colonoscopy has been shown to reduce colorectal cancer incidence and mortality by enabling detection and removal of precancerous lesions,” Thomas Heisser, MSc, of the division of clinical epidemiology and aging research at the German Cancer Research Center, and colleagues wrote in JAMA Internal Medicine. “However, the available evidence about the optimal screening interval is limited.” Read more.

Exact Sciences backs CMS policy update to waive cost-sharing for follow-up colonoscopy

Exact Sciences announced its support for recent policy changes that aim to increase access to noninvasive CRC screening tests and require Medicare and most insurers to pay for colonoscopy after a positive stool-based test.

The company, which manufactures the stool-based DNA and hemoglobin screening test Cologuard, joined other industry partners and the AGA, the American Cancer Society Cancer Action Network and Fight Colorectal Cancer to advocate for policy updates and eliminate out-of-pocket cost barriers to CRC screening. Read more.

Genescopy encourages colonoscopy with noninvasive CRC screening test

Geneoscopy Inc. announced favorable results from its CRC-PREVENT trial, which assessed noninvasive, stool-based, at-home screening for CRC and advanced adenomas.

Geneoscopy’s stool test uses patented RNA biomarker technology to screen for CRC and advanced adenomas that might indicate a higher risk of developing cancer. Read more.