摘要：The Affordable Care Act (ACA) mandates that both Medicaid and insurance plans cover life-saving preventive services recommended by the US Preventive Services Task Force, including colorectal cancer (CRC) screening and choice between colonoscopy, flexible sigmoidoscopy, and fecal occult blood testing (FOBT). People who choose FOBT or sigmoidoscopy as their initial test could face high, unexpected, out-of-pocket costs because the mandate does not cover needed follow-up colonoscopies after positive tests. Some people will have no coverage for any CRC screening because of lack of state participation in the ACA or because they do not qualify (e.g., immigrant workers). Existing disparities in CRC screening and mortality will worsen if policies are not corrected to fully cover both initial and follow-up testing. Colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States, 1 but many of these deaths could be averted by screening, which decreases both CRC incidence and mortality by 30% to 60%. 2 The US Preventive Services Task Force strongly recommends CRC screening for adults aged 50 to 75 years by 3 evidence-based methods: annual fecal occult blood testing (FOBT) with either high-sensitivity guaiac or fecal immunochemical tests, flexible sigmoidoscopy every 5 years with interval FOBT, or colonoscopy every 10 years. 3 In large randomized trials, FOBT and sigmoidoscopy reduced CRC incidence and mortality in 2-part screening programs in which initial positive FOBT or sigmoidoscopy was followed by a colonoscopy. Colonoscopy as an initial screening test is supported by observational studies. 2 CRC screening by any of the recommended options is cost-effective, 4,5 and potentially cost saving, because it reduces the number of patients needing advanced CRC treatment. 6 However, to reduce CRC morbidity, mortality, and associated costs, screening must be increased beyond its current rates.
