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More than a quarter of adults not current with colorectal cancer screening
Despite increased utilization of colonoscopy, more than a quarter of age-eligible adults in the United States have not undergone recommended colorectal cancer screening, according to findings published in CDC’s Morbidity and Mortality Weekly Report.
“There are more than 20 million adults in this country who haven’t had any recommended screening for colorectal cancer and who may therefore get cancer and die from a preventable tragedy,” Tom Frieden, MD, MPH, director of the CDC, said in a press release. “Screening for colorectal cancer is effective and can save your life.”
Tom Frieden
Researchers analyzed data on adults aged 50 to 75 years who participated in the 2012 Behavioral Risk Factor Surveillance System survey.
The investigators assessed screening practices in accordance with the US Preventive Services Task Force’s 2012 guidelines for colorectal cancer screening, which classified up-to-date screening as:
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a fecal occult blood test within the past year;
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colonoscopy within the past 10 years; or
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sigmoidoscopy within the past 5 years, plus a fecal occult blood test within the past 3 years.
Overall, 65.1% (95% CI, 64.7-65.5) of adults were up to date on screening. Another 7.2% (95% CI, 7-7.5) had undergone prior screening but were not up to date. The remaining 27.7% (95% CI, 27.3-28.1) of survey respondents had never been screened.
The rates of never-screened participants were highest among men, individuals aged 50 to 64 years, participants who lived in non-metropolitan areas, and those who were Hispanic or American Indian/Alaska Native.
Black and non-Hispanic white adults underwent screening at equal rates. However, black adults were more likely to have undergone fecal occult blood testing.
Those who had never undergone screening were more likely to be uninsured (55% vs. 24%) and not have a regular care provider (61% vs. 23.5%) than those who were screened.
Colonoscopy was the most commonly utilized test (61.7%), and at least 53% of the population in every state had undergone colonoscopy. Fecal occult blood testing was the second most commonly utilized screening method (10.4%).
Overall, the percentage of the population that is up to date with colorectal cancer screening increased from 54% in 2002 to 65% in 2010, primarily due to increased utilization of colonoscopy. The CDC wants to increase colorectal cancer screening to 80% by 2014.
“To achieve this goal, aggressive approaches will be needed, including more consistent promotion of both fecal occult blood test and colonoscopy as viable screening options and development of organized, population-based strategies that extend colorectal cancer screening efforts to settings beyond the medical provider’s office,” the researchers wrote.
Perspective
Back to TopColorectal cancer remains the second leading cause of cancer death in the United States, but it doesn’t have to be. It is well known that colorectal cancer screening reduces the mortality from colorectal cancer. Although the majority of the survey’s respondents were up to date with their colon cancer screening, nearly one in three had never been screened. Of those individuals not screened, the majority were discovered to be without health insurance or primary care providers. One of the most important implications of the study is to offer at least one method to further reduce death from colorectal cancer in the United States, and that is to screen more patients by targeting those individuals not currently participating in the health care system.
Although very effective, screening tests for colorectal cancer are limited by their invasiveness and expense (colonoscopy) and/or unpleasant and disagreeable methods (fecal occult blood testing). What is needed is an inexpensive, noninvasive test suitable for determining not only the presence of colorectal cancer, but its precursors — adenomatous polyps. In this way, greater numbers of individuals at risk for the disease could undergo life-saving early intervention.