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

Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). 

The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. 

(c) 2008 -2014 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 CPT or other codes contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2013 American Medical Association. LOINC(R) copyright 2004-2013 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2013 International Health Terminology Standards Development Organisation. ICD-10 copyright 2013 World Health Organization. All Rights Reserved.

These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications.

THE MEASURES 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

An estimated 142,570 men and women were diagnosed with colon cancer in 2010. In the same year, 51,370 were estimated to have died from the disease, making colorectal cancer the third leading cause of cancer death in the United States (American Cancer Society 2010). 

Screening for colorectal cancer is extremely important as there are no signs or symptoms of the cancer in the early stages. If the disease is caught in its earliest stages, it has a five-year survival rate of 91%; however, the disease is often not caught this early. While screening is extremely effective in detecting colorectal cancer, it remains underutilized (American Cancer Society 2010). 

Fecal occult blood tests, colonoscopy, and flexible sigmoidoscopy are shown to be effective screening methods (United States Preventive Services Task Force, 2008). Colorectal screening of individuals with no symptoms can identify polyps whose removal can prevent more than 90% of colorectal cancers (Rozen 2004). 

Studies have shown that the cost-effectiveness of colorectal cancer screening is $40,000 per life year gained, which is similar to the cost-effectiveness of mammography for breast cancer screening (Hawk and Levin 2005).

The United States Preventive Services Task Force (2008): 

[1] The USPSTF recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults, beginning at age 50 years and continuing until age 75 years (A recommendation). 
[2] The USPSTF concludes that the evidence is insufficient to assess the benefits and harms of computed tomographic (CT) colonography and fecal DNA testing as screening modalities for colorectal cancer (I statement). 

The American Cancer Society, The American College of Radiology, and the U.S. Multi-Society Task Force on Colorectal Cancer (Levin et al. 2008): 

Tests that Detect Adenomatous Polyps and Cancer
[1] Colonoscopy (every 10 years) 
[2] Flexible sigmoidoscopy (every 5 years) 
[3] Double contrast barium enema (DCBE) (every 5 years)
[4] Computed tomographic colonography (CTC) (every 5 years) 

Tests that Primarily Detect Cancer: 
[1] Guaiac fecal occult blood test (gFOBT) with high sensitivity for cancer (annually) 
[2] Fecal immunochemical test (FIT) with high sensitivity for cancer (annually) 
[3] Stool DNA (sDNA) with high sensitivity for cancer (interval uncertain) 

Modalities not approved: 
[1] Single digital rectal examination fecal occult blood test (FOBT) has a poor sensitivity for CRC and should not be performed as a primary screening method 
[2] Studies evaluating virtual colonoscopy and fecal DNA testing for CRC screening have yielded conflicting results and therefore cannot be recommended

Higher score indicates better quality

Levin, B. D.A. Lieberman, B. McFarland, K.S. Andrews, D. Brooks, J. Bond, C. Dash, F.M. Giardiello, S. Glick, D. Johnson, C.D. Johnson, T.R. Levin, P.J. Pickhardt, D.K. Rex, R.A. Smith, A. Thorson, S.J. Winawer. 2008. “Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology.” CA Cancer J Clin 58(3):130-60.

US Preventive Services Task Force (USPSTF). 2008. “Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement.” Ann Intern Med 149(9):627-37.

American Cancer Society. 2010. Cancer Facts & Figures 2010. Atlanta: American Cancer Society.

Hawk, E.T., and Levin, B. 2005. Colorectal cancer prevention. J Clin Oncol 23:378-388.

Rozen, P. 2004. Cancer of the gastrointestinal tract: early detection or early prevention? Eur J Cancer Prev 13(1):71-5.

None

None

TBD

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

Equals Initial Patient Population

Patients with a diagnosis or past history of total colectomy or colorectal cancer

Patients with one or more screenings for colorectal cancer. Appropriate screenings are defined by any one of the following criteria below: 
- 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

Not Applicable

None

Not Applicable

Not Applicable

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