The National Institutes of Health (NIH) convened a panel Thursday to identify ways to increase the use and quality of colorectal cancer screening in the U.S.
Despite evidence and guidelines supporting the value of screening for this disease, rates of screening for colorectal cancer are consistently lower than those for other types of cancer, particularly breast and cervical, according to the agency. Although the screening rates in the target population of adults over age 50 have increased from 20-30 percent in 1997 to nearly 55 percent in 2008, the panel said that the “rates are still too low.”
"We recognize that some may find colorectal cancer screening tests to be unpleasant and time consuming. However, we also know that recommended screening strategies reduce colorectal cancer deaths," said Donald Steinwachs, MD, panel chair, and director of the Health Services Research and Development Center at the Johns Hopkins University in Baltimore. "We need to find ways to encourage more people to get these important tests."
The panel found that the most important factors associated with being screened are having insurance coverage and access to a regular healthcare provider. Their recommendations highlighted the need to remove out-of-pocket costs for screening tests.
Given the variety of tests available, the panel emphasized that informed decisions incorporating personal preferences may help reluctant individuals determine which test’s combined attributes—invasiveness, frequency and required preparation—are preferable to them, helping them identify and obtain the most palatable test. For example, an individual may choose a more invasive test requiring less frequent follow-up or a less invasive test requiring more frequent follow-up.
Noting differences in screening rates across racial and ethnic groups, socioeconomic status and geographic location, the panel emphasized the need for targeted strategies for specific subgroups. Compared with non-Hispanic whites, Hispanics are less likely to be screened.
The panel also said that if efforts to increase utilization are successful, there will be a greater demand for colorectal cancer screening services. “Available capacity involves not only facilities and appropriately trained providers, but also support for informed decision making, resources to coordinate screening services and communicate results effectively, and enhanced monitoring practices to ensure that positive results are followed up with colonoscopy,” they said.
Depending on the scale of increases in screening rates, there may be a need to increase local and national capacity, the panel cautioned.
In addition to increasing first-time screening rates, the panel also identified the need to ensure that individuals return for subsequent testing at the recommended intervals. A summary of these is available in the panel’s draft statement at http://consensus.nih.gov/2010/colorectalmedia.htm.