At Work With the CDC

Colorectal Cancer:
With Awareness Comes Prevention

By Andrew Kardon, Managing Editor
The Business and Health Institute

Katie Couric had no problems getting screened for colon cancer on national TV three years ago, but it will take more than the admirable efforts of the "Today Show" co-anchor— whose husband died of the disease — to have a real impact on the over-50 crowd.

Colorectal cancer is currently the second leading cause of cancer-related deaths in the United States. In fact, 147,500 new cases and 57,100 deaths are expected in 2003.¹ The lifetime risk for having colorectal cancer diagnosed is six percent.² At least a third of those deaths could be prevented by timely screening, but half of Americans at-risk are simply not getting the appropriate procedures.

Why bother with screening?

Screening measures reduce colorectal cancer incidence and mortality by detecting early disease and removing precancerous lesions.³ In other words: Screening saves lives. Plain and simple. Over the years, there have been small increases in the self-reported use of colorectal cancer tests, but screening rates still remain low.

On the economic side, screening can also save serious health care dollars. Cancer treatment in the U.S. consumes over $40 billion per year, about 12 percent of total health care expenditures. Colorectal cancer treatment costs over $6.5 billion per year and, among malignancies, is second only to breast cancer at $6.6 billion.

The U.S. Preventive Services Task Force recommends routine cancer screening for U.S. adults over 50 years old, with one or more of the following:

• An annual home fecal occult blood testing (FOBT)
• A sigmoidoscopy every five years
• A colonoscopy every 10 years
• A double contrast barium enema every five years ³

Evaluating trends for the over-50 crowd

To estimate rates and evaluate trends for colorectal cancer test use among Americans over 50, CDC analyzed data from the 2001 Behavioral Risk Factor Surveillance System (BRFSS) on the use of the Task Force’s screening recommendations and compared 2001’s data with those for 1997 and 1999.

Covering all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, and Guam, the 2001 BRFSS included participants over the age of 50. Respondents were asked whether they ever had an FOBT, sigmoidoscopy or colonoscopy, and when these tests were last performed. For the CDC report, both sigmoidoscopy and colonoscopy are described as "lower endoscopy."

In 2001, an estimated 45 percent of adults over 50 ever had FOBT, and 47 percent ever had a lower endoscopy. An estimated 24 percent had FOBT within 12 months; 43 percent had lower endoscopy within 10 years; and 53 percent had one or both tests within the periods described. The percentages varied geographically, with the midwest generally reporting under 50 percent, the East and West Coast at 50 to 60 percent, and the Northeast states at more than 60 percent.

The findings in the report indicate that rates for colorectal cancer test use among U.S. adults rose only a few points over the course of four years, and the percentages most likely overestimate usage. That’s partly because the BRFSS can’t differentiate tests used specifically for screening from those performed for diagnostic purposes. Also, people who received sigmoidoscopy outside the recommended 5-year screening interval, but within 10 years, were considered compliant with screening guidelines. As a result, colorectal cancer screening rates are probably lower than the estimates in this report.

What can you do?

With colorectal cancer test rates much lower than breast and cervical cancer test rates,⁴ there’s a clear need for increased public awareness. This shortfall also warrants increased health care provider awareness and supportive health care systems that emphasize and ensure accessibility to colorectal cancer screening. In July 2001, Medicare reimbursement was approved for colonoscopy screening for persons with average risk for colorectal cancer; a measure that might increase future screening rates.

With March being "National Colorectal Cancer Awareness Month," the CDC launched its annual "Screen for Life: A National Colorectal Cancer Awareness Campaign" ( http://www.cdc.gov/cancer/screenforlife ), which encourages people over 50 to discuss screening for colorectal cancer with their doctor and to select appropriate test(s). The site includes links to the latest screening guidelines, state data, national data, fact sheets, promotional information and more.

For health-care providers, CDC has also produced an education program, "A Call to Action: Prevention and Early Detection of Colorectal Cancer" ( http://www.cdc.gov/cancer/colorctl/calltoaction ), designed to raise health-care providers' awareness and knowledge about prevention and early detection. The 49-slide presentation hopes to also improve primary care providers' knowledge regarding the research, education, and screening issues surrounding colorectal cancer, as well as provide tools to aid providers in assisting their patients in selecting a colorectal cancer screening option.

Acknowledgement:

This column is based on information originally reported in the Morbidity and Mortality Weekly Report by Lori A. Pollack, MD, EIS Officer, Laura Seeff, MD, Marion Nadel, PhD, and Donald Blackman PhD, who all work in the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention in Atlanta, Georgia.

References

1. American Cancer Society. Cancer facts and figures, 2003. Atlanta, Georgia: American Cancer Society, 2003; publication no. 5008.03.

2 Ries LAG, Eisner MP, Kosary CL, et al., eds. SEER cancer statistics review, 1973— 1999. Bethesda, Maryland: National Cancer Institute, 2002. Available at http://seer.cancer.gov/csr/1973_1999 .

3 Pignone M, Rich M, Teutsch S, Berg AO, Lohr KN. Screening for colorectal cancer in adults at average risk: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2002;137:132— 41.

4. Seeff L, Shapiro J, Nadel M. Are we doing enough to screen for colorectal cancer? Findings from the 1999 Behavioral Risk Factor Surveillance System. J Fam Prac 2002;51:761— 6.

Be sure to check out previous "At Work With the CDC" columns in our archive.

Resources:

Screen for Life: A National Colorectal Cancer Awareness Campaignhttp://www.cdc.gov/cancer/screenforlife

A Call to Action: Prevention and Early Detection of Colorectal Cancerhttp://www.cdc.gov/cancer/colorctl/calltoaction

Centers for Disease Control and Preventionhttp://www.cdc.gov/

American Cancer Societyhttp://www.cancer.org/

National Cancer Institute http://www.nci.nih.gov/

Morbidity and Mortality Weekly Reporthttp://www.cdc.gov/mmwr/

More Business and Health Articles on This Topic:

Cancer Control: More Reasons for Hope (Living, Coping, and Working With Cancer)

Finding the value in health screening (Feb. 01, 1997)

Andrew Kardon. Colorectal Cancer: With Awareness Comes Prevention.

Business and Health

2003;3.