Preventing Breast, Cervical, and Colorectal Cancer Deaths

Assessing the Impact of Increased Screening

Krishna P. Sharma, PhD; Scott D. Grosse, PhD; Michael V. Maciosek, PhD; Djenaba Joseph, MD, MPH; Kakoli Roy, PhD; Lisa C. Richardson, MD, MPH; Harold Jaffe, MD

Disclosures

Prev Chronic Dis. 2020;17(10):e123 

In This Article

Abstract and Introduction

Abstract

Introduction: The US Preventive Services Task Force (USPSTF) recommends select preventive clinical services, including cancer screening. However, screening for cancers remains underutilized in the United States. The Centers for Disease Control and Prevention leads initiatives to increase breast, cervical, and colorectal cancer (CRC) screening. We assessed the number of avoidable deaths from increased screening, according to USPSTF recommendations, for CRC and female breast and cervical cancers.

Methods: We used model-based estimates of avoidable deaths for the lifetime of single-year age cohorts under the current and increased use of screening scenarios (data year 2016; analysis, 2018). We calculated prevented cancer deaths for each 1% increase in screening uptake and extrapolated to current level of screening (2016), current level plus 10 percentage points, and increasing screening to 90% and 100% of the eligible population.

Results: Increased use of screening from current levels to 100% would prevent an additional 2,821 deaths from breast cancer, 6,834 deaths from cervical cancer, and 35,530 deaths from CRC over a lifetime of the respective single-year cohort. Increasing use of CRC screening would prevent approximately 8.5 times as many deaths as the equivalent increase in use of breast cancer screening (women only), although twice as many people (men and women) would have to be screened for CRC.

Conclusions: A large number of deaths could be avoided by increasing breast, cervical, and CRC screening. Public health programs incorporating strategies shown to be effective can help increase screening rates.

Introduction

The US Preventive Services Task Force (USPSTF) recommends select clinical preventive services with "A" and "B" recommendation grades for the eligible population. A grade "A" recommendation reflects high certainty of substantial net benefit from a service; grade "B" reflects high certainty of moderate benefit or moderate certainty of substantial benefit. USPSTF recommendations include routine screening for female breast cancer in women aged 50 to 74 years, cervical cancer in women aged 21 to 65 years, and colorectal cancer (CRC) in men and women aged 50 to 75 years.[1] Most private health plans cover these services without copays or deductibles. However, insurance coverage does not ensure uptake of recommended services, and many preventive services remain underutilized.[2]

To increase the use of these services, the US Department of Health and Human Services supports various programs and initiatives.[3] For example, 2 cancer control programs at the Centers for Disease Control and Prevention (CDC), the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and the Colorectal Cancer Control Program (CRCCP), seek to increase screening use among low-income, medically underserved populations.[4,5] Despite the availability of screening services and better treatment outcomes, a large number of patients still die of these cancers. In 2016, the number of deaths from female breast cancer was 41,487; from cervical cancer, 4,188; and from CRC, 52,286.[6] In 2016, the self-reported screening rates for female breast and cervical cancers were 78.3% and 79.9%, respectively, and the self-reported screening rate for CRC was 67.7%.[7]

In this article, we assess the number of potential deaths that could be prevented by increasing screening for female breast and cervical cancers and for CRC according to USPSTF recommendations. The report is motivated by the need to increase the use of evidence-based interventions that reduce the rates of illness and death from cancer.

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