Calls for expanded research on racial disparities in CRC screening and death rates
Washington, DC – The Digestive Health Physicians Association (DHPA) voiced its support for the final recommendation by the U.S. Preventive Services Task Force (USPSTF) that Americans begin screening for colorectal cancer at the age of 45, an update of 2016 guidelines that had recommended that adults without risk factors for colorectal cancer (CRC) should begin screening at age 50 and continue periodically until 75.
In the USPSTF final recommendation, CRC screening for adults aged 50-75 years remains an A grade recommendation, and screening in adults aged 45-49 receives a B grade recommendation. A recommendation with a B grade indicates that “there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.”
“The USPSTF recommendation provides an opportunity to screen 20 million additional Americans for colorectal cancer, which could prevent thousands of people from dying from the disease,” said Dr. James Weber, president of DHPA. “The most effective way to prevent colorectal cancer is detecting and removing pre-cancerous polyps and providing screening colonoscopy at age 45 will help saves lives.”
Dr. Scott Ketover, DHPA chair of health policy agrees with the USPSTF recommendation that more studies are needed to evaluate the direct effectiveness of screening with sDNA-FIT on colorectal cancer mortality outcomes as well as more studies that report outcomes for patients who receive abnormal sDNA-FIT results, but subsequently negative colonoscopy results.
“Colonoscopy is the only screening method that both detects and prevents colorectal cancer,” said Dr. Ketover. “Physicians should offer stool-based tests in accordance with guidelines set forth by the gastroenterology societies, and there needs to be appropriate follow-up to ensure that patients who have positive stool-based tests receive colonoscopy.”
USPSTF observed in its new recommendations that “Positive results on stool-based tests require follow-up with colonoscopy for the screening benefits to be achieved.”
In 2017, the U.S. Multi-Society Task Force on Colorectal Cancer (MSTF), comprised of the American Gastroenterological Association (AGA), the American College of Gastroenterology (ACG) and the American Society for Gastrointestinal Endoscopy (ASGE), ranked screening options in three tiers based on performance features, costs, and practical considerations. The MSTF recommends offering colonoscopy first with annual fecal immunohistochemical testing (FIT) offered to patients who decline colonoscopy, followed by second-tier tests such as sDNA-FIT, CT Colonography and flexible sigmoidoscopy for patients who decline FIT.
DHPA supports the USPSTF’s recommendation that more research is needed to understand the factors that contribute to increased colorectal cancer incidence and mortality in Black adults, such as access to and availability of care and characteristics of systems providing health care. Black Americans have lower screening rates and are more likely than white Americans to have late-stage disease at the time of diagnosis.
Dr. Aja McCutchen, DHPA chair of diversity, equity and inclusion, said that this research should be expanded to examine all communities of color.
“Racial disparities in colorectal cancer are largely driven by socioeconomic status and differences in access to early detection and treatment,” said Dr. McCutchen. “Colorectal cancer screening initiatives in communities of color will become increasingly important as aging Americans become a larger proportion of the population and we transition to a majority-minority nation over the next few decades.”
The Digestive Health Physicians Association® (DHPA®) is a trade association of 99 independent gastroenterology (GI) physician practices across the country with the aim of promoting and preserving accessible, high quality and cost-efficient care in the independent GI medical practice setting. DHPA’s member practices include more than 2300 gastroenterologists and other physician specialists who provide care for approximately three million people annually.