MONTANA CANCER SCREENING PROGRAM BY ANNIE CASTILLO, MD, MEDICAL ONCOLOGY

Montana Cancer Screening Program
JANUARY 10, 2011
The Montana Cancer Screening Program (MCSP) has now expanded to include colorectal cancer (CRC) screening to eligible men and women in Montana. Formerly known as the Montana Breast and Cervical Health Program (MBCHP), the program began in 1993 when the Montana Department of Public Health and Human Services received a grant from the Centers for Disease Control and Prevention to form and develop the MBCHP.

The goal was to establish coalitions between healthcare professionals, community members and the target population of low income, uninsured or underinsured women for breast and cervical cancer screening. Barriers to screening were identified and a plan was developed to reduce those barriers. The MBCHP was awarded a comprehensive screening grant in 1996 from the CDC to focus on the delivery of comprehensive breast and cervical cancer screening services.

This program has provided education and screening to women who may not have undergone these very important tests to detect cancer. In recent years, additional resources through the Montana Breast and Cervical Cancer Treatment Program (MBCCTP/Medicaid) have become available for coverage of clinic visits, laboratory and radiologic testing, and treatment (surgery, radiation, chemotherapy and hormonal therapy) of persons diagnosed with breast or cervical cancer who have undergone screening through MCSP.

The Montana Cancer Screening Program now provides education and screening for colorectal cancer for eligible persons. The candidates must meet all of the following criteria men or women age 50-64 who are at average risk for colon cancer, are uninsured or underinsured, and have a gross family income at or below 200% of the current Federal Poverty Level Scale. An exception to the age criteria for eligibility is those persons age 40-49 with a family history of CRC or adenomatous polyps.

Men and women who are enrolled in the MCHP are eligible to receive the following services on an annual basis or as indicated:
1. High sensitivity fecal occult blood test (FOBT)
2. High sensitivity fecal immunochemical test (FIT)
3. Colonoscopy (including office visit, bowel prep, standard anesthesia, biopsy/polypectomy and pathology fees)

“Average risk” is defined as one who has no personal or family history of colorectal cancer or adenomatous polyps, no history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease), and no history of a genetic syndrome such as Familial Adenomatous Polyposis (FAP) or hereditary nonpolyposis colorectal cancer (HNPCC).

Those at “increased risk” may also be eligible: those with a personal history of adenomatous polyps or colorectal cancer, family history of colorectal cancer or adenomatous polyps (colonoscopy only).
Those at “high risk” are not eligible: those with a genetic diagnosis FAP or HNPCC, clinical diagnosis of or suspicion of FAP or HNPCC or history of inflammatory bowel disease. These persons require genetic counseling and more expanded clinical services which are beyond the scope of the program.

Those persons with significant gastrointestinal symptoms are not eligible. Those symptoms may include but are not limited to gastrointestinal bleeding (not proven to be due to hemorrhoids), prolonged changes in bowel function, persistent abdominal pain, symptoms of bowel obstruction and unintentional weight loss of 10%. Remember: “screening” is testing performed in the absence of symptoms.

If the screening process reveals cancer, the person will be referred to appropriate facility outside of the program. At this time, the program does not cover treatment or follow-up of colorectal cancer. However, a future goal is to have services covered similar to those available for breast and cervical cancer treatment and follow-up.

For more information, enrollment forms, please visit the MCSP website at www.dphhs.mt.gov/PHSD/cancer-control or call 1-888-803-9343.
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