Colorectal Cancer Deaths Down, But Far Too Few Americans Screened for Colon Cancer

New data revealing decreasing trends in cancer deaths in the United States overall, and in colorectal cancer deaths in particular, highlight the remarkable benefits of colorectal cancer screening tests, but the lifesaving potential of these tests is unrealized for many Americans, according to experts from the American College of Gastroenterology (ACG). Racial minorities, uninsured Americans, and even Medicare patients who should be tested are not being screening appropriately, and other recent studies reveal that they are diagnosed with more advanced cancers compared to patients with private insurance.

The American Cancer Society (ACS) recently reported a continuing decrease in the cancer death rate between 2004 and 2005 (although the actual number of cancer deaths rose by more than 5,000, as the declining rate was no longer enough to overcome the increase in population). Deaths from cancer of the colon and rectum decreased from 1998 to 2004 among both men and women, according to ACS. The report attributes early detection to this sharp decline in colon cancer deaths. Early detection of colorectal cancer, when it is most treatable, directly results in improved survival, exceeding 90% when detected at the earliest stage.

According to ACG President Amy E. Foxx-Orenstein, do, facg, "The good news is that colorectal cancer deaths are down, but marked differences in the experience of colorectal cancer, its impact on quality of life, and death rates are seen between whites and blacks, and between the uninsured, and even those with health coverage under Medicare and Medicaid." According to Dr. Foxx-Orenstein, "The American College of Gastroenterology is committed to national policy changes to improve access to colorectal screening and increased use of these proven prevention strategies, including reversing Medicare's massive cuts to reimbursement for these tests since the benefit was first introduced, as well as to payments in ambulatory surgery centers where many screening tests are performed."

An analysis published in the ACS journal CANCER in January 2008 of over 150,000 Medicare beneficiaries revealed that only 25% received recommended screenings for colorectal cancer since Medicare started to cover preventive screening tests. This finding reflects a significant underuse of proven screening tests among Medicare patients, and echoes other recent findings that Medicaid patients and the uninsured generally are being diagnosed with colorectal cancer at later stages, when the prognosis is far worse.

A study by Halpern et al published in The Lancet Oncology on February 18, 2008, found a correlation between insurance status and stage of cancer diagnosis. According to the Halpern analysis, uninsured patients were two to three times more likely to be diagnosed at late stages (III/IV) than at stage I. The disparity was most pronounced among cancers that could be detected early through screening or symptom assessment including colorectal cancer. The analysis also looked at racial background and found late state diagnosis for 10 of 12 cancers among African-Americans compared to whites.

African-Americans are diagnosed with colorectal cancer at a younger age than other ethnic groups, and African-Americans with colorectal cancer have decreased survival compared with other ethnic groups. Physicians from the ACG in 2005 issued new recommendations to health-care providers to begin colorectal cancer screening in African-Americans at age 45 rather than 50. Colonoscopy is the preferred method of screening for colorectal cancer, and data support the recommendation that African-Americans begin screening at a younger age because of the high incidence of colorectal cancer and a greater prevalence of proximal or right-sided polyps and cancerous lesions in this population. The recommendations were published in the March 2005 issue of The American Journal of Gastroenterology.

For normal-risk individuals, the ACG recommends screening beginning at age 50 (age 45 for African-Americans). The preferred screening test according to the American College of Gastroenterology is colonoscopy every 10 years. An alternative strategy for average-risk individuals is an annual stool test for blood, and a flexible sigmoidoscopic exam every 5 years.

For those with a family history of colorectal cancer, testing should begin at 40 years of age or 10 years younger than the age of the youngest affected relative at the time of colon cancer diagnosis, whichever is earlier. For both average- and high-risk individuals, all potential precancerous polyps should be removed.