Colorectal Cancer and the Importance of Screening

February 26, 2021

Colorectal cancer (cancer of the colon and rectum) is the third most common cancer in men and women and the second leading cause of cancer death in men and women combined in the United States.[1] There has been a decline in colorectal cancer incidence and deaths in most adults over the last several decades due to improvements in early detection and treatment, increased uptake of screening, and changes in risk factors. Unfortunately, progress in colorectal cancer is slowing and screening rates remain low compared to other cancer screenings. In 2021, it is estimated that 149,500 people in the U.S. will be diagnosed with colorectal cancer, and an estimated 52,980 will die from the disease.[1]CRC Risk Factors

Screening for Colorectal Cancer

Nearly all colorectal cancers are preventable. Colorectal cancer begins as an abnormal precancerous growth, known as a polyp. If the polyp is detected during the screening process, the entire polyp is removed, stopping it from becoming cancerous. Regular screening is the most effective way of detecting precancerous growths and early colorectal cancer. Cancers that are found at an early stage can be treated more easily, and lead to greater survival.[2]

The American Cancer Society (ACS) updated their colorectal cancer guidelines in 2018 and now recommend one of the following stool or structural screening exams starting at age 45 (rather than 50) for average risk individuals: [3]

  • Highly sensitive guaiac-based fecal occult blood test (gFOBT) every year*
  • Highly sensitive fecal immunochemical test (FIT) every year*
  • Multi-targeted stool DNA (MT-sDNA) test every 3 years*
  • Colonoscopy every 10 years
  • Flexible sigmoidoscopy every 5 years
  • CT colonography (virtual colonoscopy) every 5 years
    * If any of these tests show a positive (suspicious) finding, a colonoscopy should be performed in order to complete the screening process.

Trends in Screening Incidence

  • Less than 70 percent of individuals 50 to 75 years old report being screened for colorectal cancer.[4]  This means that about 1 in 3 adults aged 50 to 75 years are not getting tested as recommended.
  • Barriers often cited to colorectal cancer screening uptake are affordability, lack of a family history or symptoms, feelings of embarrassment or fear, and no recommendation from a health professional.
  • Disparities in screening rates for colorectal cancer exist among uninsured adults; those without a high school diploma; those between the ages of 50-55; those in rural communities; and those of Hispanic, Asian, and American Indian/Alaska Native descent.[2]

Benefits of Screening – Getting screened early can save lives  

  • Ninety percent of all individuals diagnosed with colorectal cancer at a local (early) stage are still alive 5 years later. Unfortunately, only 38 percent of all colorectal cancers are diagnosed at a local stage, partly due to the underutilization of screening.[1]
  • Most colorectal deaths in the U.S. are attributable to not getting screened – this means that thousands of colorectal cancer death could be avoided if people are screened according to ACS recommendations.[5]

Improving Access to Screening

  • Colorectal Cancer Control Program (CRCCP) – The Centers for Disease Control and Prevention’s (CDC) CRCCP focuses on improving screening rates among high-need populations aged 50 –75 years using evidence-based interventions in partnership with health systems.[6] Unfortunately, only 20 state health departments, eight universities, and two tribal organization receive CDC funding due to limited funds.[6] The CRCCP is an essential program in the fight against cancer, as it raises awareness among men and women on the importance of getting screened; provides evidence-based, population-level interventions to achieve greater colorectal cancer screening rates; and provides a limited number of screening services to at-risk populations.
  • 80 Percent in Every Community – ACS, ACS CAN, and thousands of other organizations across the nation are committed to eliminating colorectal cancer as a major public health problem. The goal of the campaign is to get 80 percent of eligible adults regularly screened for colorectal cancer through partnerships, collective action, and the pooling of resources. The 80 Percent in Every Community campaign coordinates efforts that address barriers (financial, operational, policy, etc.) related to improving screening rates. Through collaborative efforts among lawmakers; health care providers; health systems; and community and business leaders, this challenging yet achievable goal can be reached.

ACS CAN’s Position

ACS CAN supports several initiatives aimed at increasing colorectal cancer screening rates, including:

  • Appropriating funds to invest in state and federal colorectal cancer screening and control programs. Programs should raise public awareness about colorectal cancer screening and improve access to screening, including patient navigation and treatment services. Programs should use evidence-based patient and provider interventions to promote screening and reduce barriers to eligible adults.
  • Ensure coverage without cost-sharing for colonoscopies after a positive stool screening exam as recommended by the American Cancer Society colorectal cancer guidelines.
  • Ensure coverage of colorectal cancer screenings beginning at age 45, as recommended by the American Cancer Society colorectal cancer guidelines.
  • Evidence-based educational efforts to improve uptake of preventive services, particularly in disparate populations.
  • Join the 80 percent in every community movement! Learn more at: http://nccrt.org/80-in-every-community/

[1] American Cancer Society. Cancer Prevention & Early Detection Facts & Figures 2019-2020. Atlanta: American Cancer Society; 2019.

[2] American Cancer Society. Cancer Facts and Figures 2021. Atlanta: American Cancer Society; 2021

[3] Wolf A, Fontham E., Church TR, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018;68:250-81.

[4] Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data [online]. 2019. [accessed February 03, 2021]. URL: https://www.cdc.gov/brfss/brfssprevalence/.

[5] Meester RGS, Doubeni CA, Lansdorp-Vogelaar I, et al. Colorectal Cancer Deaths Attributable to Nonuse of Screening in the United States. Annals of epidemiology. 2015;25(3):208-213.e1. doi:10.1016/j.annepidem.2014.11.011.

[6] Centers for Disease Control and Prevention. Colorectal Cancer Control Program: About the program. Updated June 24, 2020. Accessed February 3, 2021. https://www.cdc.gov/cancer/crccp/about.htm.