In February 2010, the National Institutes of Health (NIH) convened an expert panel that reviewed strategies to increase the use and quality of colorectal cancer screening in the United States. The panel included experts in cancer surveillance, health services and community-based research, informed decision making, health economics, epidemiology, and gastroenterology.
Colorectal cancer is the second leading cause of cancer death in the United States. However, despite evidence and guidelines supporting the value of colorectal screening, the percentage of people screened is consistently lower than the percentage of people screened for other types of cancer, particularly breast and cervical. Although screening rates in the target population of adults over 50 years of age have increased from 20% to 30% in 1997 to nearly 55% in 2008, the NIH suggests that the rates are still too low.
The panel found that the most important factors associated with being screened are access to a regular healthcare provider and the availability of health insurance. The panel’s recommendations also highlighted the need to remove out-of-pocket costs for screening tests, as well as emphasizing the need to implement targeted strategies for specific subgroups that are less likely to be screened, such as Hispanics. In addition to emphasizing the need to increase initial screening rates, the panel also discussed how best to ensure that high-risk patients return for subsequent testing at recommended intervals.
Given the variety of screening tests available, the panel emphasized that informed decisions incorporating personal preferences might help reluctant patients 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.
Recognizing that successful implementation of these efforts will lead to a greater demand; the panel also spoke of the need to increase local and national capacity. This includes more facilities, trained providers, and support for informed decision making, resources to coordinate screening services, and enhanced monitoring practices.
A variety of colorectal screening tests are available and different guidelines recommend them at different intervals. A summary of these is available in the panel’s draft statement at: http://consensus.nih.gov/2010/colorectalmedia.htm.
The panel’s statement is an independent report and is not a policy statement of the NIH or the federal government. The NIH Consensus Development Program was established in 1977 as a mechanism to judge controversial topics in medicine and public health in an unbiased, impartial manner.