Colorectal Cancer Screening

Abstract

Colorectal cancer (CRC) screening is endorsed as an effective preventive health service because it reduces morbidity and mortality from CRC. Regular screening with stool blood tests or sigmoidoscopy facilitates earlier detection of CRC and lowers mortality; screening colonoscopy may also decrease CRC incidence through early detection and removal of precancerous polyps. Most professional organizations recommend that screening begin at age 50 years for those at average risk, and in the United States, about 60% of age-eligible adults are up-to-date with screening. Importantly, prevalence of CRC screening differs by race/ethnicity, educational attainment, and insurance status, with marked disparities in screening among racial/ethnicity minorities and the uninsured. Recent CRC screening interventions have focused on mailed outreach, patient navigation, and offering a choice of screening test, and many studies have been conducted in large, integrated healthcare systems or federally qualified health centers. In these settings, mailed outreach and patient navigation, particularly in the context of multicomponent interventions, increased CRC screening (e.g., absolute increase of 28% across trials of mailed outreach). Moving forward, CRC screening interventions must include more than one-time screening and involve a series of coordinated steps, from initial screening to diagnostic evaluation to treatment of any detected lesions. Patient navigation and mailed outreach have been the most extensively tested interventions for increasing screening. Patient navigation appears to have a similar impact on follow-up of abnormal test results. Broad implementation of either of these strategies may bring the current screening prevalence of 60% closer to the national goal of 80%.