Published Date: Mar 2024


Importance of Early Detection

Colorectal cancer is one of the most commonly diagnosed cancers and a leading cause of cancer deaths in the United States. According to the American Cancer Society, nearly 150,000 new cases of colorectal cancer are diagnosed each year and over 50,000 people die from the disease annually. However, CRC mortality rates have been declining for decades due to increased screening. When detected early through appropriate screening tests, the 5-year survival rate for colorectal cancer is about 90%. This is because colorectal polyps, which are noncancerous and precancerous growths in the colon or rectum, can take many years to develop into colorectal cancer. Regular screening allows polyps to be found and removed before they turn cancerous, preventing future cancers.

Recommended Screening Tests

The U.S. Preventive Services Task Force and professional medical organizations recommend several screening options for average-risk adults aged 50-75. The two major tests are colonoscopy every 10 years and high-sensitivity fecal immunochemical testing (FIT) annually. Colonoscopy allows doctors to directly examine the entire colon and remove any polyps that are found. It is considered the "gold standard" for screening. However, it requires sedation and bowel preparation which can cause discomfort. The FIT test analyzes stool samples for traces of blood and is less invasive but only examines the lower colon and rectum. Screening with either test is shown to save thousands of lives each year by detecting cancers early and removing precancerous polyps.

Increasing Participation Rates

Despite clear evidence of the benefits of colorectal cancer screening, participation rates in the United States remain lower than for other cancers like breast and cervical cancer. According to the CDC, in 2016 overall screening rates were still only around 65% among adults aged 50-75 who should be screened regularly. Rates vary considerably by state and are lowest among minorities, low-income groups, and the uninsured. Experts believe increasing public awareness and expanding access to screening could significantly boost participation. Some health systems are implementing strategies such as reminder systems, patient navigation programs, and access to free screening to encourage patients to get screened as recommended. Widespread adoption of these practices holds promise to further reduce colorectal cancer incidence and mortality across the country.

Barriers to Screening

While screening tests have proven effective, several barriers prevent some adults from getting screened as advised. A major challenge is simply lack of awareness - many at-risk individuals do not realize they need to be screened or underestimate their personal risk. Concerns about the screening tests themselves also play a role. Fear of potential pain or discomfort from a colonoscopy or embarrassment deters some. For lower-income groups, underinsurance or costs associated with copays and missed workdays can pose financial barriers. Access issues including lack of a provider recommendation, transportation difficulties in rural areas, and shortages of endoscopy facilities and resources in some communities further limit screening rates. Overcoming these barriers through education, access improvements, and reducing structural barriers like costs will be crucial to boost participation.

Role of New Screening Options

Developments in screening technology aim to expand options and address some barriers. New noninvasive stool DNA tests such as Cologuard analyze stool samples for certain genes and biomarkers that could indicate colorectal cancer rather than relying solely on blood. Though still undergoing evaluation, these multi-target stool tests are approved to screen for cancer as well as precancerous polyps every 3 years without dietary or medication restrictions which may improve the patient experience. At-home screening tests are also emerging that further reduce barriers like needing to travel to a doctor’s office. CT colonography, also known as a virtual colonoscopy, uses computed tomography to visualize the colon and polyps without the need for sedation or bowel prep. Increased acceptance and availability of these new screening approaches could help drive up screening rates over time particularly among groups currently less likely to complete recommended colonoscopies or stool tests.

Continued Progress Needed

While steady gains in screening rates and declining mortality show progress, achieving full implementation of recommended colorectal cancer screening remains an ongoing challenge in the United States. Experts estimate that doubling current participation to around 90% could reduce new colorectal cancer cases and deaths by over 150,000 by 2030. Addressing barriers through coordinated population health strategies will require a sustained commitment across public health, medical care providers, patient advocacy groups, community organizations, policymakers and plans. Strategies to increase adoption of new screening technologies, strengthen systems to ensure annual tests when recommended, monitor results, and follow up on abnormalities also warrant ongoing support. With concerted efforts, full realization of colorectal cancer screening's potential to prevent cancer and save lives is within reach.