Colon cancer screening gaps exist in Washington. What can we do to change that?

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Colon cancer screening gaps exist in Washington. What can we do to change that?

For colorectal cancer, preventative screenings should be easy, affordable, and accessible but on average in Washington state, roughly 4 out of 10 commercially-insured individuals are not receiving these tests. That gap worsens for those covered by Medicaid, Alliance data shows.  

In recognition of colorectal cancer awareness month, the Washington Health Alliance wants to draw focus to this crucial preventative measure we track closely through our Community Checkup

Colon cancer screening is an effective way to detect cancer in its early stages and prevent its development. Studies show that regular screening can significantly reduce the incidence and mortality of colon cancer. In one study by the American Cancer Society, researchers found that colonoscopy screening every 10 years from ages 50 through 75 would reduce colorectal cancer incidence by 62% to 88%.

Figures from our latest 2023 Community Checkup (Link) show that the rate for colon cancer screenings can vary widely between medical groups, among clinics, and by county. The situation is made even worse if someone does not have a primary care provider. For commercially-insured individuals in Washington State, the average rate of colon cancer screenings is 61%.  

Now with the help of the Neighborhood Atlas, also known as the Area Deprivation Index, we can see that someone’s advantage or disadvantage can also directly impact the rate of colon cancer screening 

While the health benefits are clear, colon cancer screenings can also drive cost savings since the treatment of the disease in advanced stages can be high. Numerous studies have shown that the common forms of colon cancer screenings are cost-effective.

So, what can be done to ensure more people get screened for colon cancer?


  • Proactively send patients FIT or other home tests by mail (identify eligible patients using electronic health records) and then remind them via patient portal text if the completed test has not been received.  
  • Notify patients of alternative screening methods such as FIT, Cologuard and Shield. 
  • Remind patients, using patient portal/text messages or hard copy mail about all their outstanding preventive services 
  • Consider equity implications of not completing COL screening and prioritize targeting particular patients as appropriate for gap closure 
  • Actively pull in those “non-compliant” patients – those attributed to them who aren’t seeing regularly 
  • Address barriers to access in their communities to better understand why the overall gap, set a higher target (try 50th percentile nationally to start) and focus on the inequities  

Health Plans:  

  • Mine their data and confirm with Alliance cohort data to close colorectal cancer care gaps. 
  • Notify patients of alternative screening methods such as FIT, Cologuard, and Shield. 
  • Plans can send FIT kits or Cologuard testing to the home for those members unwilling to or unable to come into the office. 
  • Focused collaboration within communities and provider practices to understand inequities and remove barriers for access 
  • Measure their results including the impact of provider payment incentives 

Employers, Union Trusts, and other Health Care Purchasers:  

  • Education and awareness for employees and families, including alternative screening methods like FIT, Cologuard, and Shield. 
  • Expect more from health plans and key providers. 
  • When they are paying for value-based incentives, they require performance guarantees from either plans or providers to achieve results. 
  • Provide health plans with enhanced eligibility data to better allow for location analysis and race, ethnicity and language considerations for members.  
  • Consider covering all colon cancer screening tests, including blood-based tests like Shield.  

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