Guidelines and Recommendations for U.S. Colorectal Cancer Screening Industry
The United States Preventive Services Task Force (USPSTF) recommends screenings for Colorectal Cancer starting at age 50 for adults of average risk and continuing until age 75. This recommendation is rated as a Grade A, which means there is high certainty that the net benefit is substantial. Screenings can identify precancerous polyps or early-stage cancer so they can be treated before they progress. The goal is to reduce illness and death from colorectal cancer through early detection and removal of polyps.
The various screening options endorsed by the USPSTF include annual high-sensitivity fecal occult blood tests, sigmoidoscopy every 5 years plus high-sensitivity fecal occult blood tests every 3 years, colonoscopy every 10 years, or computed tomographic colonography every 5 years. For people at higher risk, such as those with a family history of colon cancer or ulcerative colitis, screening may need to start prior to age 50 and involve shorter intervals between tests.
Availability and Types of Screening Tests
There are several different types of screening tests that can be used to detect colorectal cancer early:
– High-Sensitivity Fecal Occult Blood Test (FOBT): This non-invasive test checks for hidden (occult) blood in the stool, which can be an early sign of cancer or polyps. Patients receive test kits to collect stool samples at home and return by mail for laboratory testing.
– Fecal Immunochemical Test (FIT): Similar to the FOBT but uses antibodies to detect human hemoglobin specifically and may be more accurate. Also done using home collection kits.
– Flexible Sigmoidoscopy: The doctor inserts a lighted scope into the lower third of the colon to check for polyps or cancer. Requires a bowel preparation and confirmation colonoscopy if anything abnormal is found.
– Colonoscopy: Considered the “gold standard” as the entire colon is examined. The doctor uses a long, thin, flexible tube with a camera to view the inside of the colon. Biopsies and removal of polyps can be done during the procedure if anything suspicious is seen. Requires bowel prep prior.
– CT Colonography (Virtual Colonoscopy): Special x-rays of the colon and rectum are taken but without inserting instruments. Can detect polyps and cancer but follow-up colonoscopy will still be needed if any growths are seen on the CT scan images.
Screening Trends and Awareness Campaigns
Even with widely available screening options, national screening rates remain below the Healthy People 2020 target of 70.5 percent for colorectal cancer screening based on the most recent guidelines. Barriers include lack of physician recommendations, patient misconceptions, inadequate health insurance, and inability to take time off from work.
Numerous organizations and advocacy groups are working to increase public awareness of the importance of colorectal cancer screening through educational campaigns. For example, the Centers for Disease Control and Prevention promotes screening through its “80% by 2018” initiative which aims to get 80% of eligible adults to be screened for colon cancer. The American Cancer Society, American College of Gastroenterology, and Colon Cancer Alliance also fund advertising, web pages, and community health programs about risk factors and available screening tests.
Celebrity endorsements have helped raise awareness levels as well. Former baseball player Lance Armstrong founded the LIVESTRONG Foundation after surviving colon cancer himself and speaking publicly about his diagnosis and treatment journey. After the loss of Supreme Court Justice Ruth Bader Ginsburg to colorectal cancer in 2020, her family helped launch an educational campaign to honor her legacy and encourage more people to get screened.
Staged Approach to Boost Rates
Public health experts recognize that some patients may be deterred by the most invasive screening options like colonoscopy, which require uncomfortable bowel prep and involve medical risks however small. This has led to a strategy of using less daunting tests like fecal immunochemical tests first as a preliminary screening to detect blood in the stool.
Those who test positive on the FIT would then complete a follow-up colonoscopy to evaluate any suspicious findings. The sequential multi-step approach may be more acceptable or suitable for some individuals compared to immediately starting with colonoscopy. If adopted widely, it has the potential to significantly expand screening rates across diverse patient populations and socioeconomic groups. Early detection through multiple testing modalities is critical for reducing mortality from this largely preventable cancer.
Disparities in U.S. Colorectal Cancer Screening Industry and Outcomes
Despite the focused efforts of advocacy campaigns, disparities in colorectal cancer screening persist among certain groups. Those living in poorer, rural areas without adequate access to health care facilities have screening rates far below the national targets. Racial and ethnic minorities also face barriers like lack of health insurance coverage, language barriers, and competing priorities that have hindered participation.
As a result, minorities also experience worse outcomes compared to whites. Even when diagnosed at the same disease stage, African Americans have a higher mortality rate from colorectal cancer than non-Hispanic whites. Closing these gaps requires culturally sensitive education, provision of low-cost or free screening resources, and policies to expand insurance coverage to underserved communities at highest risk. Telehealth and community outreach programs can help widen availability of cancer screening in hard-to-reach areas.
In Summary, nationwide data shows modest improvements in colorectal cancer screening rates over time but more work is still needed to optimize use of recommended screening tools and address socioeconomic barriers limiting access. Public funding, organized screening campaigns, and innovative multi-step testing approaches hold promise to achieve the Healthy People 2020 objectives and reduce colorectal cancer burden.
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1.Source: CoherentMI, Public sources, Desk research
2.We have leveraged AI tools to mine information and compile it