Colorectal Cancer Screening: The Best Test Is the One That Gets Done

Marcus Plescia, MD, MPH


February 12, 2014

Editorial Collaboration

Medscape &

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Thank you for this important opportunity to share ways that we can save lives by helping more people to be tested for colorectal cancer. The disturbing fact is that despite research showing that colorectal cancer screening tests save lives, screening rates remain too low. Why? Here are 2 reasons.

1. Research shows that people are not being told by their doctors and healthcare providers that they have a choice of colorectal cancer tests. Studies also reveal that those who are able to choose the test that they prefer are more likely to have the test done.

2. Among adults who were screened as recommended by the United States Preventive Services Task Force (USPSTF), colonoscopy was by far the most common screening test (62%). Use of the other USPSTF-recommended tests was much lower. Those tests are:

Fecal occult blood test (FOBT) or fecal immunochemical test (FIT), with 10% usage; and

Sigmoidoscopy, now seldom done (< 1%).

We know that about 1 in 3 adults aged 50-75 years have not been tested for colorectal cancer as recommended by USPSTF. So, CDC encourages healthcare providers to take the initiative and specifically set aside time to speak with these patients about colorectal cancer screening. Their patients need to know that they should be tested for colorectal cancer and that they have a choice of tests.

Currently, almost 23 million adults are not being screened for colorectal cancer with any test. Essentially, testing saves lives, but only if people are tested. We have to remember that colorectal cancer is the second leading cancer killer among men and women in the United States, after lung cancer. Colorectal cancer screening needs to increase among US adults, and greater use of all recommended tests could help increase screening rates and reduce deaths.

CDC has learned that the majority of states with higher overall colorectal cancer screening rates also had relatively higher use of FOBT and colonoscopy. So, CDC believes that a more organized, more inclusive approach can increase colorectal cancer screening rates and save more lives.

For example, healthcare systems and providers could:

Offer recommended test options, with advice about each;

Expand the use of organized screening systems that identify people eligible for screening;

Reach out to people in their homes or community settings;

Make sure that patients complete the tests; and,

Follow up on abnormal tests.

Additionally, public health agencies could accelerate progress in colorectal cancer screening by developing ways to organize screenings, such as:

Using databases to track and improve cancer screening activities across communities;

Distributing fecal occult blood testing kits at flu clinics; and

Using communication, and outreach activities in communities with low colorectal cancer screening rates.

Thank you for listening. Please visit for more information.

Marcus Plescia, MD, MPH, is the Director of the Division of Cancer Prevention and Control at the Centers for Disease Control and Prevention (CDC). He is responsible for providing leadership and direction for all scientific, policy, and programmatic issues related to 4 national programs: the Colorectal Cancer Control Program, the National Breast and Cervical Cancer Early Detection Program, the National Comprehensive Cancer Control Program, and the National Program of Cancer Registries. He oversees a well-developed research agenda that includes the national Cancer Prevention and Control Research Network.

Before coming to CDC in 2009, Dr. Plescia served for 6 years as Chronic Disease Director at the North Carolina Division of Public Health. He directed the program policy, planning, and evaluation efforts for 12 public health programs and the State Center for Health Statistics. Under his leadership, the North Carolina cancer screening programs were expanded to reach more underserved adults. Public-health-focused legislation on tobacco, cancer, and obesity was passed, including a state law banning smoking in all restaurants and bars.

Dr. Plescia's research interests have focused on community health and health disparities. His publications focus on the application or evaluation of public health programs, with an emphasis on primary prevention and policy. During his 9-year tenure on the family medicine faculty at Carolinas Healthcare System, he received an 8-year, $7 million grant from CDC to implement a community-oriented primary care project that addressed racial and ethnic disparities.

Dr. Plescia received his medical degree, Master of Public Health, and Bachelor of Science from the University of North Carolina at Chapel Hill. He trained in family medicine at the Montefiore Residency Program in Social Medicine in the Bronx, New York, and started practice in a federally qualified health center there, where he also lead a team providing care to the homeless. Dr. Plescia continues to practice family medicine through the Indian Health Service and holds an academic appointment as associate professor in the UNC Department of Family Medicine.