HJAR Mar/Apr 2022

HEALTHCARE JOURNAL OF ARKANSAS I  MAR / APR 2022 41 Joseph W. Thompson, MD, MPH President and Chief Executive Officer Arkansas Center for Health Improvement driving this disparity are that Black people are less likely thanWhite people to receive colorectal cancer screenings and are less likely to receive follow-up colonoscopies after screenings that yield positive or ab- normal results. 3 Recognizing the importance of colorectal cancer screenings, theArkansas General As- sembly enacted Act 779 of 2021, which was sponsored by Sen. Missy Irvin and passed overwhelmingly with bipartisan support. The Act lowered the age range for covered colorectal cancer preventive screenings from 50 and above to 45 and above, effective Jan. 1 of this year, and aligns with the U.S. Pre- ventive Services Task Force’s 2021 updated guidance on colorectal cancer screenings. ForArkansans in that age group, colorec- tal cancer screenings must be covered under Medicare, Medicaid, and commercial indi- vidual and group health insurance plans, including those covering Medicaid expan- sion beneficiaries and the state and public school employee health benefit plan. The new Arkansas law also prohibits cost sharing for the completion of screen- ing through a follow-up colonoscopy. On Jan. 10, the U.S. Department of Labor issued guidance clarifying that all Americans in employer-sponsored or individual market health plans are protected from cost shar- ing for follow-up colonoscopies. This is an important change for Arkansas. According to a 2021 report by the Arkansas Center for Health Improvement and Fight Colorectal Cancer, among Arkansas patients ages 50 to 75 enrolled in Medicare, commercial in- surance, or Medicaid, three out of five who received a positive or abnormal colorectal cancer screening result were exposed to cost sharing for a follow-up colonoscopy. 4 Adherence to screening recommenda- tions has been made less onerous by ad- vances in screening tools, particularly stool- based tests, that have made the tests easier to administer, less expensive, and less in- vasive than traditional procedures such as colonoscopies. Tests are now available that can be administered in an outpatient setting or a patient’s home, including the fecal im- munochemical test, or FIT; the high-sensi- tivity guaiac-based fecal occult blood test, or gFOBT; and the multitarget stool DNAtest -of which only one, Cologuard, has received approval from the Food and DrugAdminis- tration at this writing. Early detection is crucial in reducing deaths from colorectal cancer. In 2017, there were 1,528 cases diagnosed in Arkansas, of which about 58% were late-stage. Among those Arkansans ages 45 to 49 who had a colorectal cancer diagnosis, about 71% had a late-stage diagnosis, which suggests that the change in the national screening rec- ommendation to include people as young as 45 could have a substantial impact on early detection. 4 Unfortunately, screening for colorectal cancer remains low compared to screening for breast and cervical cancers. Barriers to screening include patient fear, lack of appro- priate insurance coverage, absence of a pri- mary source of healthcare, failure of provid- ers to provide screening recommendations, lack of transportation, language barriers, and lack of information about available re- sources or recommendations. These barriers may be prevalent in populations that tradi- tionally lack socioeconomic and educational resources, such as low-income communities and communities of color. 3 The expansion of the screening recom- mendation’s age range and efforts to remove financial barriers to screenings and follow- up colonoscopies are welcome changes that should save lives, but policymakers must continue working to address the many bar- riers that remain. With the tools we have available, colorectal cancer should be claim- ing far fewer lives than it is. n REFERENCES 1 Centers for Disease Control and Prevention. United States Cancer Statistics: Data Visual- izations. https://gis.cdc.gov/Cancer/USCS/ ?CDC_AA_refVal=https%3A%2F%2Fwww.cdc. gov%2Fcancer%2Fdataviz%2Findex.htm#/ AtAGlance/ 2 National Cancer Institute. State Cancer Pro- files. https://statecancerprofiles.cancer.gov/ recenttrend/index.php#results 3 American Cancer Society. Colorectal Can- cer Facts & Figures 2020-2022. https://www. cancer.org/content/dam/cancer-org/research/ cancer-facts-and-statistics/colorectal-cancer- facts-and-figures/colorectal-cancer-facts-and- figures-2020-2022.pdf 4 Arkansas Center for Health Improvement. Assessment of Colorectal Cancer Screen- ings and Disease Prevalence in Arkansas. 2021. https://achi.net/wp-content/uploads/2021/12/ 211031_Assessment-of-Colorectal-Cancer-in-AR- Report-FINAL.pdf