Capacity 'Not Limiting Factor in CRC Screening Uptake'

Liam Davenport

June 23, 2016

Although healthcare facilities in the United States have the capacity to meet the national goal of screening 80% of adults aged 50 to 75 years for colorectal cancer (CRC) by 2018, at present, the rates are somewhat lower than that, health officials have warned.

As reported by Medscape Medical News, the United States Preventive Services Task Force recently recommended seven methods of screening: colonoscopy, fecal immunochemical testing (FIT) for occult blood, guaiac-based fecal occult blood testing, sigmoidoscopy alone, sigmoidoscopy plus FIT, the FIT-DNA test, and CT colonography.

It was noted that adherence to CRC screening recommendations currently ranges from 58% to 65%, a rate that has remained stagnant during the past 5 years.

A mathematical modeling study carried out by researchers from the Centers for Disease Control and Prevention (CDC) has concluded that the United States has the capacity to conduct the extra screening that is needed to meet the goal of 80%. The CDC estimates that between 5.1 and 13 million colonoscopies will need to be performed annually to meet the screening goal, depending on whether colonoscopy is the primary screening test.

Crucially, Djenaba Joseph, MD, MPH, medical director of the colorectal cancer control program at the CDC, in Atlanta, Georgia, found that 15 million colonoscopies were performed annually in 2012 and that the United States has the capacity to perform more than 10 million additional colonoscopies every year.

Dr Joseph commented in a release: "Colorectal cancer is the second leading cancer killer for men and women in the US, but it doesn't have to be.

"Screening saves lives," she emphasized. "The good news is that our modeling shows that the US healthcare system has the potential to meet our national goal of screening 80% of adults ages 50 to 75."

She urged patients to ask their doctor about screening, "as there are several options now."

The new modeling study was published online May 20 in Cancer.

For the analysis, Dr Joseph and colleagues used the Microsimulation Screening Analysis–Colon model to simulate the uptake of the CRC screening test between 2014 and 2040, beginning with the implementation of the national screening program with FIT or colonoscopy in 2014 and assuming 80% participation.

To estimate the number of colonoscopies that are actually performed in comparison with the number that could be performed, the team used data from the 2012 Survey of Endoscopic Capacity (SECAP).

Using FIT as the primary screening test, approximately 47 million FIT procedures and 5.1 million colonoscopies would need to be performed annually by 2024 with implementation of the national screening program in 2014.

If the screening program used only colonoscopy, the team estimates that approximately 11 to 13 million colonoscopies would need to be performed annually by 2024.

Crucially, analysis of the SECAP data revealed that although an estimated 15 million colonoscopies were performed in 2012, an extra 10.5 million colonoscopies could have been carried out.

Although acknowledging that future studies should take into account the geographical distribution of colonoscopy capacity, the team concludes: "The estimated colonoscopy capacity is sufficient to screen 80% of the eligible US population with FIT, colonoscopy, or a mix of tests."

The study was funded by the CDC. The authors have disclosed no relevant financial relationships.

Cancer. Published online May 20, 2016. Abstract

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