Study Examines the State of Colorectal Cancer and Finds Cause for Optimism, Particularly within the VA Healthcare System
This article provides an overview of the state of colorectal cancer (CRC) in the US and world-wide. Colorectal cancer remains a significant cause of morbidity and mortality in the US and throughout the world. In 2009, approximately 76,000 men and 71,000 women were diagnosed with CRC in the US, and CRC remains the third most common cause of cancer death among men and women. However, the incidence of CRC decreased by 3% in men and 2% in women between 1998 and 2005. The mortality rate is also decreasing in the US: the rate of men dying from CRC decreased by 32% between 1990 and 2005, and the mortality rate in women decreased by 28% between 1991 and 2005. The U.S. is the only country in the world where CRC incidence and mortality rates are reported to be decreasing significantly, but health disparities in cancer screening, treatment, and survival persist.
CRC incidence rates are highest among African Americans compared to other races, and higher among non-Hispanics compared to Hispanics. CRC mortality rates also are higher in African American men and women. In contrast to the health disparities that are evident in the community, when CRC outcomes were studied within an equal-access, integrated healthcare system, such as VA, racial disparities were markedly decreased or absent. Facilitating access to CRC screening is an important tool in eradicating health disparities. In the two decades since the first CRC screening guidelines were released, the prevalence of screening has markedly increased, though still remains less than ideal. The type of screening test used in the US has varied over the last decade, but colonoscopy is becoming the dominant modality. However, VA relies primarily on FOBT testing. From 1998 to 2003, the proportion of screened Veterans undergoing FOBT within VA increased from 82% to 90% compared to that of Veterans receiving screening colonoscopies, which decreased from 6% to 5%. From the perspective of population-based screening, VA is actually more successful than the general population at screening, and has CRC screening rates well above the national average.
Gellad Z and Provenzale D. Colorectal cancer: National and international perspective on the burden of disease and public health impact. Gastroenterology June 2010;138(6):2177-90.
Authors are part of HSR&D’s Center for Health Services Research in Primary Care, Durham, NC.