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Cancer Resources > Cancer News > 2004 > December
Colorectal cancer screening failing to reach 41.8 million Americans at average risk
Last Updated: 2004-12-17 12:05:29 -0400 (Reuters Health)
NEW YORK (Reuters Health) - About 60% of Americans aged 50 years and older at average risk for colorectal cancer - some 42 million people - have not yet been screened, researchers report in the December issue of Gastroenterology. A survey of medical practices suggests that restricting initial screenings using fecal occult blood testing (FOBT) may be the most practical way to meet this projected need.
However, practices will need to "intelligently target colonoscopy to those most likely to benefit from it," Dr. Theodore R. Levin proposes in an accompanying editorial. One important measure that should be taken, he suggests, is to avoid excessive, unnecessary surveillance examinations.
Dr. Laura C. Seeff, at the Centers for Disease Control and Prevention (CDC) in Atlanta, and her associates analyzed data from the US Census Bureau and the CDC's National Health Interview Survey to design a model to forecast future needs.
Their results show that 41.8 million people age 50 and older have not been screened for colorectal cancer.
Results from the national Survey of Endoscopic Capacity suggest that an additional 6.7 million flexible sigmoidoscopies and 8.2 million colonoscopies could be performed. If half of that capacity were used for screening, it could take up to 10 years to perform the required number of screening endoscopy.
However, if fecal occult blood testing was used as the initial screen, followed by diagnostic colonoscopy only for those with positive FOBT, screening the entire population could be accomplished within 1 year.
In his editorial, Dr. Levin points out that these estimates "do not take into account the need for repeat screening tests, postpolypectomy surveillance, tests needed to keep the currently screened population up to date on screening, or an increase in the 50 to 80-year-old population during the 10 years of trying to provide universal screening."
He suggests employing less intensive screening for patients younger than 50 to 65 years, using colonoscopy primarily for older patients. Also, to improve screening participation will require investing in more resources, such as endoscopy support staff and sufficient endoscopy room, and increasing the supply of gastroenterologists.
Gastroenterology 2004;127:1661-1677,1841-1843.
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