CDC's Ambitious Goal for Colorectal Cancer Screening

Nick Mulcahy

September 15, 2009

September 15, 2009 — A day before President Barack Obama, in his televised healthcare speech to a joint session of Congress, highlighted screening colonoscopy as exemplary preventive medicine, the Centers for Disease Control and Prevention (CDC) announced a plan to increase colorectal cancer screening among low-income Americans.

The goal is to have 80% of the age 50+ population screened.

The CDC has awarded a total of $22 million to 22 states and 4 tribal organizations to provide colorectal cancer screening services for low-income people, 50 to 64 years of age, who are underinsured or uninsured. The program will run for 5 years and the funding will be renewed annually; if fully appropriated by Congress, the cost will eventually exceed $100 million.

Dr. Laura Seeff

"The goal is to have 80% of the age 50+ population screened by the end of 5 years in the respective states and tribal associations. Currently, about 60% of this population nationally has been screened," Laura Seeff, MD, medical director of CDC's colorectal cancer screening program, told Medscape Oncology. The goal is "ambitious but realistic," given the screening trends in the United States, she added.

"There are many barriers to screening, and socioeconomic status is an important one," Tamir Ben-Menachem, MD, associate professor of medicine and director of endoscopy at the University of Medicine and Dentistry of New Jersey in New Brunswick told Medscape Oncology. The CDC grant addresses this major barrier.

The timing of the announcement of the program and the President's speech was coincidental, added Dr. Seeff, who was surprised and delighted by the mention of colonoscopy screening.

The money for state and tribal health departments for screening will enable individual gastroenterology and oncology practices to be reimbursed when they screen members of the target population.

Clinicians can become part of this publicly funded program.

"Clinicians can become part of this publicly funded program if they have or establish a relationship with their state or tribal department of health," said Dr. Seeff.

The program was warmly welcomed by Dr. Ben-Menachem. "It's a great thing that the CDC is funding this — it's the right thing to do. In this low-income population, the screening rate in probably much lower than 60%," he said.

However, Dr. Ben-Menachem has doubts about the level of participation of private-practice gastroenterologists.

A lot of practices are now booked 6 months ahead for colonoscopy screening.

"For some doctors, this will be a boon; for others, not. A lot of practices are now booked 6 months ahead for colonoscopy screening," he told Medscape Oncology.

Choice of Screening Method

The states receiving 5-year awards are Alabama, Arizona, California, Colorado, Connecticut, Delaware, Florida, Iowa, Maine, Maryland, Massachusetts, Minnesota, Montana, Nebraska, New Hampshire, New Mexico, New York, Oregon, Pennsylvania, South Dakota, Utah, and Washington.

The tribal organizations receiving awards are the Alaska Native Tribal Health Consortium, the Arctic Slope Native Association, the South Puget Intertribal Planning Agency, and the Southcentral Foundation.

The awards range from $358,283 to $1.1 million. The CDC expects awardees to begin screening patients for colorectal cancer within 6 months.

According to Dr. Seeff, the funding is divided into 2 categories: clinical services (screening and diagnostic follow-up care) and everything else. The latter includes data collection and tracking, public education and outreach, provider education, and an evaluation to measure the clinical outcomes, costs, and effectiveness of the program.

The funding does not cover treatment for colorectal cancer, which will be paid by states and tribal associations.

"The program pays for screening and diagnostic care up to the point of a diagnosis, including necessary removal of polyps," said Dr. Seeff.

Awardees can use colonoscopy, sigmoidoscopy, or stool testing (GUAIAC and immunochemistry) to screening patients.

A 33% reduction in mortality in people screened with this tool . . . [is] better than nothing.

A choice of screening method is a key to increasing participation, explained Dr. Ben-Menachem. "Patient preference is important. We need to offer the option of fecal-occult blood testing. No, it's not as effective as colonoscopy, but studies indicate it can provide up to a 33% reduction in mortality in people screened with this tool. That's better than nothing," he said.

According to Dr. Seeff, computed tomography, DNA-based stool testing, and other screening methods are currently not part of the treatment choices, which are based on the newest US Preventive Services Task Force recommendations, reported on by Medscape Oncology.

If any of the other screening methods are eventually approved by the US Preventive Services Task Force, then they will be "rolled into the program," said Dr. Seeff.

President Obama's Endorsement

In his recent healthcare speech, President Obama endorsed screening colonoscopy during his commentary on preventive medicine, the health-insurance industry, and his purposed healthcare plan.

"And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies, because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives," he said, pausing after "colonoscopies" while the audience applauded.

Although not commenting on any health-insurance matters, Drs. Seeff and Ben-Menachem agreed. "Colorectal cancer screening has absolutely been proven to reduce both cancer mortality and incidence," said Dr. Seeff. "More than 90% of colon cancers are totally preventable. Screening saves money," said Dr. Ben-Menachem.

The new CDC program is an outgrowth of an earlier demonstration screening program, which showed that it was feasible to establish screening in a low-income population, said Dr. Seeff. The program is broader in its scope than the CDC's National Breast and Cervical Cancer Detection Program because it includes insured low-income Americans, not just the uninsured, she added.

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