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CDC: Expansion of cancer screening requires more organized approach
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The effectiveness of screening programs should lead to an expansion of cancer screening, albeit with more organization, surveillance and collaboration between health care systems and their communities, according to a CDC Grand Rounds report published in Morbidity and Mortality Weekly Report.
Because cancer remains the second leading cause of death in the United States, and 52% of cancer deaths are from cancers that can be identified earlier through current screening options, the CDC outlined uniform ways to improve screening access.
Cheryll C. Thomas, MSPH, of the division of cancer prevention and control within the CDC’s National Center for Chronic Disease Prevention and Health Promotion, and colleagues identified international models of organized cancer screening that could benefit practices in the United States, suggested a way to have organized cancer screening in a managed care setting, and offered means of integrating primary care and public health to improve screening practices.
International and U.S. models
Thomas and colleagues evaluated screening models from the Netherlands and the United Kingdom that may be beneficial in the United States. These programs allow screening recommendations that are made outside of routine medical care settings. Organized systems contact all eligible adults to remind them to undergo screening at appropriate intervals.
These systems use comprehensive data collection and evaluation. This feedback, thus, improves the quality of the screening while limiting breakdowns in the lengthy screening process.
Researchers noted that although women in the United States undergo three to four times more Pap tests than women in the Netherlands — who are recommended to undergo screening every 5 years when aged 35 to 60 years — the decreases in cervical cancer death were comparable in both countries from 1970 to 2010.
Researchers also provided the example of a colorectal screening program in the United Kingdom. The pilot study had 60% participation of invited participants. This participation rate led to the full implementation of the Bowel Cancer Screening Program, which screens adults aged 60 to 69 years every 2 years with guaiac fecal occult blood testing. Follow-up colonoscopies were available for patients with abnormal results. Although general practitioners are not directly involved in conducting the program, they do receive copies of all results for their patients.
The CDC report pointed to colorectal cancer screening at Kaiser Permanente Northern California (KPNC) as an example of organized cancer screening in a managed care setting.
KPNC tracks patients aged 51 to 75 years to monitor their use of colorectal screening. The program mails 13,000 fecal immunochemical test kits weekly to eligible patients, as well as reminders 3 and 6 weeks after the initial mailing. Additionally, patients with positive tests are ensured a timely follow-up colonoscopy.
Overall, the CDC reported that KPNC has improved its Healthcare Effectiveness Data and Information Set (HEDIS) performance measure for CRC screening from 37% in 2005 to 79% in 2012 among patients using commercial insurance and from 41% to 91% in the Medicare population.
Opportunities for improvement
The CDC researchers called on public health leaders to coordinate hospitals, managed care plans and other screening service providers to develop an approach to cancer screening that is both organized and community-wide. Thomas and colleagues suggested the potential to build on the capacities and extensive networks of well-established public health programs to create a population-based approach to enhance the use of screening and target susceptible populations.
Researchers recommended interventions that would include patient reminders and small media combined with enhanced surveillance of screening measures using integrated data from health care providers.
“Effective cancer screening programs that achieve high screening rates depend on patient, provider and health care system factors,” the researchers wrote. “The lessons learned from successful breast, cervical and colorectal screening programs in national and international settings might be used in the development of initiatives to further expand cancer screening.” – by Anthony SanFilippo
Disclosure: The researchers report no relevant financial disclosures.
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