An Updated Look at Colorectal Carcinoma Incidence and Stage Disease in Virginia and the U.S

Abstract

Purpose: National coverage for Medicare screening of high risk and average risk colorectal carcinoma (CRC) individuals began in 1998 and 2001. The first insurance mandate on a state level that required colonoscopy as the preferred strategy for CRC screening began in Virginia in July of 2000. This study correlates yearly trends of incidence and stage of disease at time of diagnosis with screening mandates. Methods: The most current available data on CRC incidence, and stage of disease at time of diagnosis were evaluated from the American Cancer Society (ACS), Virginia Cancer Registry (VCR), and National Cancer Institute's (NCI) registries. Yearly differences of new cases, incidence, and stage of disease were compared. Results: Compared to values from the year 2001, when Medicare coverage began for CRC screening of average risk individuals, the diagnoses of CRC in the U.S. increased yearly by an average of 12,833 cases See Table 1. This is a 12% increase in the incidence of CRC diagnosis with a yearly trend showing positive correlation (P < 0.05,r2 = 0.8167). This trend was evident with a 17.6% increase in male CRC incidence and a 9.6% increase in female incidence. These values are compared to 1997–1999 where incidence rates in the U.S. were on average 2,866 less per year. In VA an average increase of 682 cases was seen from 2004–2007 See Table 2. In 2005, there was a 25% increase in number of cases localized (r2 = 0.791), and a 23.6% decrease in incidence of regional CRC diagnosed (r2 = 0.753).Table: Virginia Colorectal Cancer Incidence 2001—2005.Table: U.S. Colorectal Cancer Incidence 2001–2007.Conclusion: Analysis of databases from the ACS, VCR, and NCI shows a definitive relationship between CRC screening mandates allowing screening colonoscopy and the reported incidence of CRC. More cases of CRC are being diagnosed since Medicare and state legislative (VA) coverage have been established. A clear positive correlation for detection of cancer at earlier stages can be documented. The data suggests that legislative mandates for CRC screening effectively increase early detection. The long term benefit of polyp recognition/resection will likely only amplify this early evidence of a beneficial effect.