Takeaway: A White paper by Dr. Thomas Imperiale and colleagues outline practice changes that would improve outcomes related to colorectal cancer screening, namely avoiding an oversimplified "one size fits all" approach. The paper promotes three primary position statements and associated barriers and facilitators to each.
Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the third leading cause of cancer-related death among men and women in the United States. The American Gastroenterological Association’s Center for Gastrointestinal Innovation and Technology convened a consensus conference in December 2018, entitled, “Colorectal Cancer Screening and Surveillance: Role of Emerging Technology and Innovation to Improve Outcomes.” The goal of the conference, which attracted more than 60 experts in screening and related disciplines, including Dr. Imperiale, part of HSR&D’s Center for Health Information and Communication (CHIC) in Indianapolis, IN, was to envision a future in which CRC screening and surveillance are optimized, and to identify barriers to achieving that future. This White Paper originates from that meeting and delineates the priorities and steps needed to improve CRC outcomes, with the goal of minimizing CRC morbidity and mortality.
A one-size-fits-all approach to colorectal cancer (CRC) screening has not and is unlikely to result in increased screening uptake or desired outcomes owing to barriers stemming from behavioral, cultural, and socioeconomic causes, especially when combined with inefficiencies in deployment of screening technologies. Overcoming these barriers will require: 1) efficient utilization of multiple screening modalities to achieve increased uptake; 2) continued development of non-invasive screening tests, with iterative reassessments of how best to integrate new technologies; and 3) improved personal risk assessment to better risk-stratify patients for appropriate screening testing paradigms. Development of structured organized screening programs, rather than solely opportunistic screening driven by provider recommendation, ultimately will be needed to achieve target screening rates and reductions in CRC morbidity and mortality.
Investigators expect the age for starting colorectal cancer screening to drop from 50 years to 45 years of age. Researchers in gastroenterology expect to explore the barriers and facilitators to screening Veterans aged 45-49 years to better understand their needs and preferences for screening. This effort could extend to those Veterans who are 40-44 years of age in case the starting screening age is lowered further in the future, as the risk of CRC is increasing in persons younger than age 50. Further, investigators hope to participate in studies to identify non-invasive ways to monitor older Veterans who have had pre-cancerous polyps, for which colonoscopy is currently the only recommended strategy.
Melson J, Imperiale T, Itzkowitz S, et al. AGA White Paper: Roadmap for the future of colorectal cancer screening in the United States. Clinical Gastroenterology and Hepatology 2020; July 2020;4;S1542-3565(20)30917-4.