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NIH State-of-the-Science Conference assesses use, quality of CRC screening, makes recommendations for improvements

Friday, June 04 2010 | Comments

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What's This? The colorectal cancer (CRC) screening rate among adults aged 50 years or older in the United States has increased steadily--from 20% to 30% in 1997 to nearly 55% in 2008--but CRC screening is still both underused and misused in this country, according to a recent National Institutes of Health (NIH) State-of-the-Science Conference Statement.

In February, the National Cancer Institute and the NIH Office of Medical Applications of Research convened a State-of-the-Science Conference to provide a comprehensive assessment of CRC screening and surveillance among U.S. populations with an average risk of CRC. The conference statement, which was prepared by an independent panel of health care professionals and public representatives, summarized current barriers to effective CRC screening and outlined proposed solutions to improve CRC screening quality and appropriateness of use.

Primarily, the panel noted, the 2 most important factors associated with CRC screening are having insurance and having access to a usual source of health care, and important correlates of screening include income and education level. To improve CRC screening rates nationwide, the group suggested, strategies need to be developed to eliminate financial barriers to screening and follow-up.

The panel also recommended implementation of interventions that have been shown to increase CRC screening rates, such as patient reminders and 1-on-1 patient interactions with health care providers, educators, and navigators.

In addition to increasing CRC screening rates, there is a need to ensure that CRC screening is used appropriately. The group noted that there are cases of overuse (ie, screening patients who are unlikely to benefit from prevention or early detection, such as those with limited life expectancy, or performing colonoscopies more frequently than recommended by guidelines) as well as misuse (eg, fecal occult blood test screening with in-office stool samples rather than with the recommended at-home technique).

Current approaches to monitoring CRC screening in the United States, such as population-based surveys and reviews of administrative datasets and electronic medical records, do not adequately assess rates of screening or appropriateness of use, the panel added. The group recommended expansion and analysis of existing data sources, such as the Clinical Outcomes Research Initiative endoscopy database, and/or creation of a CRC screening registry similar to the Breast Cancer Surveillance Consortium.

The panel concluded that additional research is necessary to develop an infrastructure that can adequately track CRC screening quality and quantity; to better understand factors that influence CRC screening rates and interventions designed to improve these rates, particularly in underserved populations; and to better assess the current and projected demand for CRC screening in communities as well as the capacity required to meet it. (Steinwachs D, et al. Ann Intern Med 2010;152:663-667.)

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