July 5, 2011 -- New diagnoses of colorectal cancer as well as deaths from the disease have declined dramatically in recent years, thanks in part to greater emphasis on screening procedures, a government report says.
Colorectal cancer is the second most deadly cancer, but it could fall from that position if more people were screened, the CDC says in a new Vital Signs report.
Disease incidence declined significantly from 2003 to 2007 in 35 states, the CDC says, and mortality dropped in 49 states as well as in Washington, D.C.
The rate of new cases of colorectal cancer fell from 52.3 per 100,000 in 2003 to 45.5 in 2007, the CDC says, resulting in nearly 66,000 fewer new cases of cancer in 2003-2007 compared to 2002. The disease’s death rate dropped from 19 per 100,000 in 2003 to 16.7 in 2007, meaning almost 32,000 fewer people died than expected during the period, compared with 2002.
Screenings on the Increase
Between 2002 and 2010, the percentage of people between 50 and 75 who were adequately screened for colorectal cancer increased from 52.3% to 65.4%, says the CDC. But one in three people 50-75 are not up to date with recommended screenings.
“Colon cancer be prevented, and we are making progress in getting more people screened,” CDC Director Thomas R. Frieden, MD, MPH, says in a news release. “Those who receive these life-saving screening tests can lead longer, healthier, and more productive lives. Saving our nation the health care costs associated with treating colon cancer is an additional benefit.”
The new report estimates that direct medical costs of colorectal cancer was $14 billion in 2010 and says that for every person who died of the disease in 2006, the lost productivity costs were $15.3 billion, or about $288,468 per person who died from colorectal cancer in 2006.
The United States Preventive Services Task Force recommends colon screenings for people starting at age 50, and also that routine screening should continue until age 75.
Various Screening Methods
There are various ways to screen, including fecal occult blood testing, which checks for hidden blood in the stool and samples should be done annually. Other methods are sigmoidoscopy, in which an instrument is snaked through the rectum and lower portion of the colon to look for abnormalities.
In colonoscopy, doctors can use a similar instrument to visualize the entire length of the colon. It can also be used for biopsy and removal of polyps.
The USPSTF recommends this procedure be done every 10 years starting at age 50 until age 75. People with a higher risk of developing colorectal cancer (such as those with inflammatory bowel disease, certain genetic disorders, a personal history of polyps, or close family history of polyps or colorectal cancer) should start screening at a younger age and screening may be more frequent.
Frieden says in a media briefing that he had a colonoscopy at age 40 and no polyps were found, but that four were discovered and removed 10 years later.
Sandra Adamson Fryhofer, MD, clinical associate professor of medicine at Emory University Hospital in Atlanta, tells WebMD that people with average risk for the disease should be screened with a colonoscopy every 10 years, starting at age 50.
“If you have a family history of colon cancer or if you have history of tubular adenoma, a type of polyp, or other condition that predisposes you to colon cancer, like ulcerative colitis, you should be screened more frequently,” she says.
The CDC report used survey data from 2002-2010 from the state level Behavioral Risk Factor Surveillance System that asked about colorectal cancer screening of people aged 50 to 75. Frieden and authors of the new report stress that screening should be increased, and that more screenings would save more lives.
Major Findings of Study
“Colon cancer deaths are down significantly,” Frieden says in a the briefing, “and even more progress is possible. We have seen a remarkable increase in the level of screening.”
Key findings of the report include that:
- Death rates from colorectal cancer between 2003 and 2007 decreased significantly in 49 states and Washington, D.C., with the largest declines in states with some of the highest screening prevalence. Nationally, death rates decreased 3% per year in that same time period.
- In 2007, Washington, D.C. reported the highest death rate from colorectal cancer per 100,000 people, 21.1, compared to Montana and Colorado with the lowest at 14.1.
- Colorectal cancer incidence rates declined significantly in 35 states between 2003 and 2007. In 2007, the highest number of new colorectal cancer cases was reported in North Dakota, where it was 56.9 per 100,000, and lowest in Utah, at 34.3 per 100,000. Overall incidence rates decreased by 3.4% per year from 2003 to 2007.
Other major findings:
- About 22 million people in the U.S. between 50 and 75 have never been screened for colorectal cancer. The CDC says this needs to change and that innovative programs could and should be developed to make screenings available, affordable, and routine for all adults between 50 and 75. Also, screenings should be promoted more by doctors.
- About 50% of the improvement in mortality can be attributed to increased screening, 35% to reductions in risk factors such as smoking and obesity, and 12% can be attributed to improvement treatments.
Despite growing evidence that screening procedures can save lives, not enough Americans are getting screened, the CDC says. Frieden says the “largest risk factor for not being screened is doctors not recommending that patients be screened.”
Findings were published in the Morbidity and Mortality Weekly Report for July 5, 2011.
The CDC says if the Healthy People 2020 target for colorectal screening to 70.5% is met, about 1,000 additional deaths per year can be avoided.
Doctors Need to Promote Screening Procedures
But for many people, more action is needed, the CDC says. More than a third of respondents to federal surveys said they were not up to date with screenings. And one reason, the CDC says, may be that doctors don’t recommend the procedures enough.
CDC says that:
- The Affordable Care Act will reduce financial barriers to screenings by expanding insurance coverage and eliminating co-payments and deductibles.
- Federal, state, and local public health departments can work with health centers to implement ways to remind doctors and patients about the importance of colorectal screening.
- The CDC Colorectal Cancer Control Program funds 25 states and four tribal organizations for the use of population-based approaches to increase screening among men and women aged 50 and older. These approaches include case management and outreach.
The CDC report cites a survey of U.S. and Canada residents found that 31% of people in the United States say they would opt not to be screened for colorectal cancer even when their preferred method of screening was offered.
Doctors should use this knowledge to explain screening options, the CDC report says. Screening options vary from averaging about $71 for fecal blood tests to $1,397 for colonoscopies.
The CDC says implementation of the Affordable Care Act should remove financial barriers to colorectal cancer screening. But even that won’t be enough to significantly improve screenings and outcomes.
The CDC recommends that state health departments look for ways to emphasize and organize more screening programs.