WASHINGTON – Several dozen organizations have joined together to help increase colorectal cancer screening rates to 80% of all Americans by 2018, citing the success of campaigns over the past decade that led to a 30% decline in incidence in individuals over age 50.
The National Colorectal Cancer Roundtable is leading the 80% by 2018 effort, saying that 1 in 3 adults between the ages of 50 and 75 years, or 23 million Americans, are not getting recommended screening.
Colorectal cancer is the third-leading cause of cancer death in the United States. In 2014, there will be an estimated 136,830 new diagnoses and 50,310 deaths. Sixty percent of the cases and 70% of the deaths are in those over age 65.
"Our goal today is absolutely clear: to eliminate colorectal cancer as a major public health threat," said Dr. Howard Koh, assistant secretary for health at the Health and Human Services department. HHS will be part of the campaign, along with state health departments; patient advocates; the American Association of Retired Persons (AARP); the American Cancer Society (ACS); and physician organizations, including the American College of Gastroenterology, the American College of Radiology, and the American Society for Gastrointestinal Endoscopy.
Dr. Howard Koh
Dr. Koh spoke at a March 17 briefing sponsored by the ACS, which also published an analysis that day showing a decline in colorectal cancer incidence and mortality for most age groups, but for older Americans, in particular.
The study was published online in CA: A Cancer Journal for Clinicians, and was based on data from the Centers for Disease Control and Prevention’s National Center for Health Statistics; the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program; and the CDC’s National Program of Cancer Registries.
Overall, the incidence of colorectal cancer decreased by an average 3.4% per year from 2001 to 2010. The biggest declines were in people aged 50 years or older – at 3.9% per year, or a 30% decline over that decade. For people over age 65, the decline has been particularly notable—3.6% a year from 2001 to 2008 and 7.2% a year during 2008-2010.
The authors attribute that decline to a growth in screening. In 2000, 19% of Americans aged 50-75 years received some kind of screen. By 2010, the number had jumped to 55%.
"In other words, we are making real progress," said John R. Seffrin, chief executive officer of the ACS, at the briefing.
Some of the screening increase was due to Medicare coverage of all screening methods, including the fecal occult blood test, colonoscopy, and sigmoidoscopy. Sixty-four percent of Americans over age 65 had a screening test in 2010, compared with 55% of those in the 50- to 64-year-old group not covered by Medicare. Screening rates are highest in well-educated Americans who have health insurance, and in whites. Only a quarter of recent immigrants – those in the United States less than 10 years – were screened, compared with 62% of non-Hispanic whites. And only 18% of the uninsured had a screening exam in 2010, compared with 62% of those with insurance.
Just having insurance does not guarantee that screening will be cost-free, even though it is covered under Medicare and is an essential benefit under policies covered by the Affordable Care Act.
If polyps are found and removed, however, Medicare patients and others with private insurance often find themselves facing large copayments or lack of coverage for subsequent screenings. Gastroenterologists want to see an end to that "postpolypectomy surprise," said Dr. Ronald Vender, immediate past president of the American College of Gastroenterology, at the briefing.
The Removing Barriers to Colorectal Cancer Screening Act (H.R. 1070), which would cover any of those subsequent costs, was introduced in Congress in March 2013.
There are still major disparities in colorectal cancer incidence and mortality rates. Incidence and mortality rates are 30-40% higher in men than women. Incidence and mortality are highest in African Americans and lowest among Asian Pacific Islanders. From 2006 to 2010, the incidence in blacks was 25% higher than in whites and 50% higher than in Asian Pacific Islanders. Mortality rates are 50% higher for blacks than for whites, at 29.4 per 100,000. The higher incidence and mortality in blacks may be due to a lower socioeconomic status, but there are also other factors at play, said the authors, noting that rates are higher even for blacks in the same socioeconomic status as white peers.
Survival rates do not vary substantially by sex, according to the paper. While 5-year survival rates are relatively high – at 65% – only 40% of patients are diagnosed when the disease is localized. The 5-year survival at that stage is 90%.