Colon cancer rates are rising among younger Americans, but insurance barriers make screening more difficult

It is estimated that more than 53,000 Americans will die from colorectal cancer this year. Although colorectal cancer is the second leading cause of cancer death in the United States, it is curable if detected early. Detecting a tumor as early as possible can help you get treatment as quickly as possible, giving you the best chance of survival.

In my work as a gastroenterologist, I treat patients from all backgrounds and backgrounds. A growing number of insurance barriers threaten access to timely care. Too often, payers take a long time to determine their coverage, or even deny it outright.

With the alarming increase in colorectal cancer diagnoses among Americans under the age of 50, it is more important than ever that people know their cancer risk and when to get screened.

Here are common questions I and other gastroenterologists receive from patients about colorectal cancer:

What is my risk of colorectal cancer?

Anyone, at any age, can develop colorectal cancer. However, some people may be more susceptible to the disease than others.

For example, people with a family history of colorectal cancer or a personal history of polyps, which are abnormal growths in the tissues of the colon or rectum, may be at higher risk.

Inflammatory bowel diseases like Crohn’s disease and ulcerative colitis may also increase your risk of developing colorectal cancer. Indeed, the chronic inflammation associated with these diseases can promote the development of abnormal growths.

Race and ethnicity can also affect colon cancer risk. Black and Native Americans are much more likely to develop – and die from – colorectal cancer. Although genetics play a role in the development of the disease, much of the risk of colorectal cancer is linked to environmental factors. These include a person’s income level, the types of foods and groceries available in the neighborhood, access to primary care providers and specialists, and a wide variety of other social determinants of health.

Lifestyle factors like smoking, not exercising regularly, and a poor diet can also increase your risk of colon cancer. Researchers have shown that red meat releases chemicals that can cause inflammation, while fiber-rich foods and vegetables can help reduce inflammation. Likewise, a sedentary lifestyle can also increase inflammation. Smoking can cause harmful genetic changes in the cells of the colon.

What are my screening options?

People with colorectal cancer usually have no symptoms until the disease progresses to a later stage. This is why early and regular screening is essential.

The U.S. Preventive Services Task Force recommends that Americans begin regular screenings at age 45. Recognizing that the incidence of colorectal cancer has increased among young adults, the task force lowered the age to 50 in 2021. Screening may begin earlier and occur more frequently for people who are at increased risk of Colon Cancer.

There are different screening methods, and your doctor can recommend procedures based on your risk factors.

Many people choose to have a colonoscopy, a screening test that can also prevent cancer by removing precancerous polyps. This involves using a long, flexible tube with a light and camera on the end to visually inspect the colon for signs of cancer, abnormalities in the colon lining, or growths such than polyps. Ultimately, colonoscopy screening can significantly reduce the incidence and mortality of colorectal cancer.

Other screening strategies include noninvasive stool tests, imaging studies, and a combination of endoscopic visualization and stool tests.

Your doctor can help you select a test that matches your preferences, values, and risk factors. Suggested screening approaches for people at average risk for colon cancer include a colonoscopy every 10 years, stool tests every one to three years, or CT scans every five years for those who cannot have a colonoscopy as an initial screening test. A positive test result for these alternative approaches should be followed by a colonoscopy.

Thanks to systematic screening, one in three deaths from colorectal cancer can be avoided.

Why won’t my health insurance pay for my colonoscopy?

Although colorectal cancer screening is free as a preventive service under the Affordable Care Act, some insurers make it more difficult to access care.

For example, Blue Cross Blue Shield of Massachusetts proposed a 2024 policy that would have deemed the use of anesthesia in endoscopies, colonoscopies and other life-saving procedures as medically unnecessary. This meant that patients would have had to pay out of pocket for the anesthesia needed for colorectal cancer screening, which could create significant financial barriers. The insurance company only reversed course after protests from doctors and patients.

Another worrying trend is the increased reliance on prior authorization, a process used by some health insurers to determine whether they will cover the cost of a medical procedure, service or medication. Insurers may delay or deny coverage for medically necessary care recommended by doctors and medical guidelines because they deem certain health services unnecessary for a patient or too expensive to cover.

In 2023, UnitedHealthcare proposed a policy that would have required all 27 million people on their plan to get insurance approval before they could receive diagnostic or follow-up colonoscopies. Following protests from doctors and patients, the insurer suspended the policy.

UnitedHealthcare also plans to introduce a program in 2024 that could involve prior authorization for colonoscopies. The insurer has released little information about why it believes such requirements are necessary, what services would require prior authorization and how it would protect patients from unnecessary delays and denials.

How can I reduce my risk of colorectal cancer?

If you haven’t already, consider getting screened for colorectal cancer. Talk with your doctor’s office and check with your insurance company to understand what will be covered before your procedure. If you are 45 or older, a colonoscopy can screen for and prevent colorectal cancer.

Young adults can take steps to reduce their risk of colon cancer by adopting healthy eating and lifestyle behaviors. Being aware of your personal risk factors and seeing a doctor if you experience symptoms – such as changes in bowel habits, rectal bleeding, abdominal pain or unexplained weight loss – can help you discuss screening options with your health care provider.

If you’ve already had a colonoscopy and had polyps removed, make sure you know when you need to return for a follow-up colonoscopy. It could save your life.