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Colorectal cancer screening rates vary significantly among states, counties
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Screening rates for colorectal cancer varied significantly at the state and county level, according to a model-based study.
The highest screening rates occurred in Massachusetts and the lowest in Wyoming. Screening rates also varied significantly by race and ethnicity.
“In 2014, nearly 140,000 Americans were diagnosed with colorectal cancer, and over 50,000 Americans died [of] the disease,” Zahava Berkowitz, MSPH, MSc, statistician at the CDC, said in a press release. “Routine screening for colorectal cancer, starting at age 50 [years], saves lives. However, more than 30% of adults have not had recommended colorectal cancer screening.”
Berkowitz and colleagues used data from the CDC’s Behavioral Risk Factor Surveillance System to estimate the number of adults undergoing screening and to examine geographic patterns in the U.S. at a county level. The researchers studied data from 251,360 respondents from the CDC database, in addition to population estimates from the U.S. Census Bureau for all 3,142 counties.
To be current with screening recommendations, individuals must have completed one of the following:
- colonoscopy during the past 10 years;
- fecal occult blood testing during the past year; or
- sigmoidoscopy during the past 5 years concurrent with fecal occult blood testing during the past 3 years.
Among adults aged 50 to 75 years, 67.3% (95% CI, 66.83-67.71) were current with colorectal cancer screening.
Screening rates varied by ethnicity, with 69.2% of non-Hispanic whites being current compared with 56.8% of Hispanics.
Sixty-four percent of the studied population had undergone colonoscopy within the last 10 years, making it the most common method for screening.
Massachusetts had the highest prevalence of screening among the states at 75%, whereas Wyoming had the lowest colorectal rates at 58.9%.
Connecticut had the lowest variability in screening rates among its counties (3.6%) compared with South Dakota, which had the highest variability (28.6%). Texas, Alaska, North Dakota and New Mexico also had more than 20% variability among their counties.
Because a model generated the study data, results were estimates, which may have limited the findings.
“The predicted percentages might be more appropriate for program planning than for program evaluation,” Berkowitz said in the release. “Additionally, our estimates might have overestimated areas with extremely lower colorectal cancer screening rates and underestimated areas with extremely high colorectal cancer screenings rates. Lastly, the questions used in the survey did not indicate whether the tests were performed for screening or diagnostic/treatment purposes; the results, therefore, indicate a measure of colorectal cancer test use for any reason.” – by Cassie Homer
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Each year in the U.S., approximately 50,000 people die of colorectal cancer. Although there are efforts to increase awareness about diet, lifestyle and recommended screening for early detection, too many people are not getting screened. This lack of screening results in not detecting colorectal cancer while it is curable, so the disease continues to grow and eventually spreads and becomes incurable. Colorectal cancer is preventable or curable through early detection — for example by screening colonoscopy.
It is clear there is variation in colorectal screening between states. Data provided in the manuscript suggest that collecting information at the county level shows additional variation in colorectal cancer screening, and this should help guide education and outreach efforts.
This is particularly relevant in light of the stated goal from the National Colorectal Cancer Roundtable to increase screening to 80% by 2018; such a milestone would decrease colorectal cancer by 200,000 within 2 decades. We are not there yet, and data within the manuscript can point the way to geographic areas where more effort is needed.
There are many factors — including biologic factors — and it is likely that an even higher resolution approach might be fruitful, as has been applied at the neighborhood level by Lynch and colleagues.
Overall, as prevention is much easier than treatment of advanced colorectal cancer, continued efforts to increase screening are likely to be fruitful.
Reference:
Lynch SM, et al. Cancer Epidemiol Biomarkers Prev. 2017;doi: 10.1158/1055-9965.EPI-16-0554.
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