National Institutes of Health Panel: Reduce Colorectal Cancer Deaths by Striking Down Barriers to Screening

Abstract

A National Institutes of Health (NIH) state-of-the-science panel that convened February 4–5, 2010, identified ways to further increase the use and quality of colorectal cancer screening in the United States. The 13-member conference panel included experts in the fields of cancer surveillance, health services research, community-based research, informed decision making, access to care, health care policy, health communication, health economics, health disparities, epidemiology, statistics, thoracic radiology, internal medicine, gastroenterology, public health, end-of-life care, and a public representative. Colorectal cancer is the third most common cancer and the second leading cause of cancer-related deaths in the United States. Despite evidence and guidelines supporting the value of screening for this disease, rates of screening for colorectal cancer are consistently lower than those for other types of cancer, particularly breast and cervical. “We recognize that some may find colorectal cancer screening tests to be unpleasant and time-consuming. However, we also know that recommended screening strategies reduce colorectal cancer deaths,” said Donald Steinwachs, PhD, panel chair, and professor and director of the Health Services Research and Development Center at The Johns Hopkins University. “We need to find ways to encourage more people to get these important tests.” The panel found that the most important factors associated with being screened are having insurance coverage and access to a regular health care provider. Their recommendations highlighted the need to remove out-of-pocket costs for screening tests. Given the variety of tests available, the panel emphasized that informed decisions incorporating personal preferences may help reluctant individuals determine which test's combined attributes—invasiveness, frequency, and required preparation—are preferable to them, helping them to 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. Noting differences in screening rates across racial and ethnic groups, socioeconomic status, and geographic location, the panel emphasized the need for strategies that target specific subgroups. For example, compared with non-Hispanic whites, Hispanics are less likely to be screened. The panel also noted that if efforts to increase utilization are successful, there will be a greater demand for colorectal cancer screening services. Available capacity involves not only facilities and appropriately trained providers, but also support for informed decision making, resources to coordinate screening services and communicate results effectively, and enhanced monitoring practices to ensure that positive results are followed up with colonoscopy. Depending on the scale of increase in screening rates, there may be a need to increase local and national capacity. In addition to increasing first-time screening rates, the panel also identified the need to ensure that individuals return for subsequent testing at recommended intervals. A variety of colorectal cancer screening tests are available and different guidelines recommend them at different intervals. The panel's state-of-the-science statement, which incorporates comments received during a subsequent public session, is available at http://consensus.nih.gov. A list of the panel members and their institutional affiliations is included in the conference statement.