Colorectal cancer screening leveling off, 23M not getting tested

After years of steady increase, colorectal cancer screening rates may be leveling off, according to the Centers for Disease Control and Prevention’s (CDC’s) latest “Vital Signs” report released online Nov. 5. The report found that 23 million people between the ages of 50 and 75 years old are not getting the testing recommended by the United States Preventive Services Task Force (USPSTF).

Colorectal cancer (CRC) is the second leading cause of cancer death in the U.S. for men and women. For those who don’t smoke, CRC is the leading cancer killer.

The USPSTF recommends three CRC screening tests that can effectively save lives: colonoscopy, high-sensitivity fecal occult blood test (FOBT), and sigmoidoscopy. About 90 percent of people live five or more years when colorectal cancer is found early through testing.

People who are less likely to get tested are Hispanics, those 50-64 years old, men, American Indian or Alaska natives, those who don’t live in a city, and people with low education and incomes.

According to the CDC, people primarily aren’t getting screened because their doctors never informed them or they didn’t know that they needed to be screened. Two out of three adults who haven’t been tested for CRC have a regular doctor and health insurance that could pay for the test.

Physicians are heavily relied on to offer CRC tests to patients, but the need for testing should be discussed by nurses and other office staff as well, according to the CDC. Doctors often recommend colonoscopy, which is the preferred method for those with a strong family history of CRC, but all three tests are effective for early cancer detection.

There are no major cost differences between the tests, but time frames vary individually. While the FOBT may be somewhat cheaper, it has to be done every year. Colonoscopies should be performed every ten years, and sigmoidoscopies should be done every five.

Ultimately, “the best test is the test that gets done,” said CDC Director Thomas Frieden during a press briefing.

Through the Affordable Care Act, the federal government is expanding insurance coverage of USPSTF recommended CRC tests at no cost to patients. Further support of patient navigators on a national and local level, as well as improving the delivery of preventive services and using patient reminder systems, are several ways suggested by the CDC to raise screening rates in the future.