Colorectal Cancer Screening

Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer

This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2019 National Committee for Quality Assurance. All Rights Reserved. 

Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2018 American Medical Association. LOINC(R) copyright 2004-2018 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2018 International Health Terminology Standards Development Organisation. ICD-10 copyright 2018 World Health Organization. All Rights Reserved.

The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.
 
Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

None

None

None

Colorectal cancer represents eight percent of all new cancer cases and is the second leading cause of cancer deaths in the United States. In 2018, an estimated 140,250 new cases of colorectal cancer and an estimated 50,630deaths attributed to it. According to the National Cancer Institute, about 4.2 percent of men and women will be diagnosed with colorectal cancer at some point during their lifetimes. For most adults, older age is the most important risk factor for colorectal cancer, although being male and black are also associated with higher incidence and mortality. Colorectal cancer is most frequently diagnosed among people 65 to 74 years old (Noone et al., 2018).

Screening can be effective for finding precancerous lesions (polyps) that could later become malignant, and for detecting early cancers that can be more easily and effectively treated. Precancerous polyps usually take about 10 to 15 years to develop into colorectal cancer, and most can be found and removed before turning into cancer. The five-year relative survival rate for people whose colorectal cancer is found in the early stage before it has spread is about 90 percent (American Cancer Society, 2017).

The U.S. Preventive Services Task Force (2016) recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years. This is a Grade A recommendation (U.S. Preventive Services Task Force, 2016). 
Appropriate screenings are defined by any one of the following:
-Colonoscopy (every 10 years)
-Flexible sigmoidoscopy (every 5 years)
-Fecal occult blood test (annually)
-FIT-DNA (every 3 years)
-Computed tomographic colonography (every 5 years)

Higher score indicates better quality

American Cancer Society. (2017, March). Can colorectal polyps and cancer be found early? Washington, DC: American Cancer Society. Retrieved from https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/detection.html

Noone, A. M., Howlader, N., Krapcho, M., et al. (eds.). (2018). SEER Cancer Statistics Review, 1975-2015. Bethesda, MD: National Cancer Institute. Retrieved from https://seer.cancer.gov/csr/1975_2015/

U.S. Preventive Services Task Force. (2016). Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. JAMA, 315(23), pp. 2564-2575. doi: 10.1001/jama.2016.5989

None

Patient self-report for procedures as well as diagnostic studies should be recorded in "Procedure, Performed" template or "Diagnostic Study, Performed" template in QRDA-1. 

Do not count DRE, FOBT tests performed in an office setting or performed on a sample collected via DRE.

TBD

Patients 50-75 years of age with a visit during the measurement period

Equals Initial Population

Exclude patients whose hospice care overlaps the measurement period.
Patients with a diagnosis or past history of total colectomy or colorectal cancer.
Exclude patients 66 and older who are living long term in an institution for more than 90 days during the measurement period. 

Exclude patients 66 and older with advanced illness and frailty because it is unlikely that patients will benefit from the services being measured.

Patients with one or more screenings for colorectal cancer. Appropriate screenings are defined by any one of the following criteria: 
- Fecal occult blood test (FOBT) during the measurement period 
- Flexible sigmoidoscopy during the measurement period or the four years prior to the measurement period 
- Colonoscopy during the measurement period or the nine years prior to the measurement period
- FIT-DNA during the measurement period or the two years prior to the measurement period 
- CT Colonography during the measurement period or the four years prior to the measurement period

Not Applicable

None

For every patient evaluated by this measure also identify payer, race, ethnicity and sex

None