U.S. Colorectal Cancer Screening Capacity Exists, Although Actual Rates Remain Low

By Lori Solomon, Editor, Diagnostic Testing & Emerging Technologies

The United States has the screening capacity to meet colorectal screening goals, but this capacity has so far not translated into increased screening rates, according to a study published online ahead of print in the journal Cancer. The researchers say that capacity is “sufficient” to screen 80 percent of recommended adults with fecal immunochemical testing (FIT), colonoscopy, or a mix of tests.

In 2014, a national campaign was launched to increase colorectal cancer screening rates in the United States to 80 percent of adults aged 50 to 75 years by 2018. Current estimates suggest, though, that just over half of this target population is up-to-date with screening—a rate that has remained relatively stagnant in recent years.

Last month the United States Preventive Services Task Force recommended seven methods of colorectal cancer screening—stool-based tests (guaiac-based fecal occult blood testing or FIT test annually or FIT-DNA, multitargeted stool DNA test every one to three years) or use of direct visualization tests less frequently (colonoscopy every 10 years; flexible sigmoidoscopy alone every five years or sigmoidoscopy every 10 years with FIT annually).

The U.S. Centers for Disease Control and Prevention researchers used mathematical modeling (the Microsimulation Screening Analysis-Colon model) to estimate the number of colonoscopies or FIT tests that would be necessary every year to screen for colorectal cancer for 80 percent of adults in the recommended age group. They also assessed survey data from facilities that perform colonoscopies, participating in the 2012 Survey of Endoscopic Capacity.

The researchers found that between 5.1 million and 13 million colonoscopies would need to be conducted per year, depending on which screening test was used first, to meet screening goals. For example, if FIT testing was used as the primary screening test for a national screening program started in 2014, by 2024, approximately 47 million FIT procedures and 5.1 million colonoscopies would be needed annually to screen the eligible population. If colonoscopies were the primary screening test, approximately 11 million to 13 million colonoscopies would be needed annually to screen the eligible population.

The related survey showed that 15 million colonoscopies were performed in the U.S. in 2012, but that the U.S. health care system had the capacity in 2012 to perform another 10.5 million colonoscopies annually. The researchers add that future studies need to assess geographic distribution and possible variation in screening capacity.