Monitoring Needed for Colorectal Ca Screening

BETHESDA, MD. — Colorectal cancer screening initiatives that use evidence-based interventions to target underscreened populations while encouraging use of the full range of screening options should be implemented to improve the use and quality of colorectal cancer screening, according to findings from a panel convened by the National Institutes of Health.

In a draft “state-of-the-science” statement, the 13-member panel also recommended investing in a variety of quality monitoring methods to make sure that colorectal cancer screening is accompanied by high rates of cancer detection and prevention.

Efforts to further increase screening rates in the target population of adults aged 50 or older, which have risen from 20%–30% in 1997 to 55% in 2008, will need to address financial and geographical barriers to screening as well as appropriate follow-up of the results, the panel advised.

“We are convinced by evidence in the literature that efforts … to tailor strategies will be very important to test because in different communities and in different population subgroups there need to be different strategies tested to try and get high [screening] rates,” panel chairperson Donald M. Steinwachs, Ph.D., said in a press telebriefing that followed the release of the draft statement.

Systems that remind patients to get screened and one-on-one interactions with providers, educators, or patient navigators could help to increase screening, the panel noted. Systems of care that employ these techniques have much higher screening rates than the national average, such as Kaiser Permanente (75% in the Medicare population) and the Veterans Affairs health care system (80%), according to the statement.

The panel also found that a physician's recommendation is the only consistent physician-related factor that has been shown to predict screening.

“The decision on which approach to use is driven by factors like insurance and patient preferences,” said panelist Dr. Leonard E. Egede, professor of medicine in the division of general internal medicine and geriatrics at the Medical University of South Carolina. He noted that when patients have no preference for a particular screening method, most primary care physicians provide fecal occult blood test (FOBT)–based screening (followed by colonoscopy if necessary) or direct access to colonoscopy.

A wide variety of methods with varying screening intervals are available for screening adults aged 50 years and older, including annual FOBT (guaiac or immunochemical), flexible sigmoidoscopy, or double-contrast barium enema every 5 years, and colonoscopy every 10 years. The panel noted that CT colonography is a potentially viable screening option that could be expanded, but it is not currently covered by Medicare.

When colonoscopy overtook FOBT and flexible sigmoidoscopy in 2001 as the most widely used screening method, there was a subsequent decline in the use of flexible sigmoidoscopy. In that same time, double-barium contrast enema fell out of favor and the overall use of occult blood testing declined more gradually, although these stool tests are still widely used in the Veterans Affairs health care system and some managed care systems, according to the statement.

In order to provide colorectal cancer screening to low-income, uninsured, and underinsured populations, the panel noted that the Centers for Disease Control and Prevention recently began the Colorectal Cancer Control Program in 22 states. The program is modeled after the agency's successful breast and cervical cancer screening program, but “its reach so far has been limited,” Dr. Egede said.

Most current sources of information on screening rates, such as population-based surveys and administrative data sets, do not provide enough detail on the use and quality of colorectal cancer screening, according to the statement.

“Monitoring systems exists in some communities and in some health care organizations, but overall, we don't have systems that monitor whether or not people are receiving screening services appropriately and whether or not the quality of the services being rendered are the highest,” said Dr. Steinwachs, director of the Health Services Research and Development Center at Johns Hopkins University, Baltimore.

The panel suggested that a registry analogous to the existing Breast Cancer Surveillance Consortium should be established to monitor the rates of colorectal cancer screening, overuse, quality, and complications.

The statement is available at http://consensus.nih.gov/

BETHESDA, MD. — Colorectal cancer screening initiatives that use evidence-based interventions to target underscreened populations while encouraging use of the full range of screening options should be implemented to improve the use and quality of colorectal cancer screening, according to findings from a panel convened by the National Institutes of Health.

In a draft “state-of-the-science” statement, the 13-member panel also recommended investing in a variety of quality monitoring methods to make sure that colorectal cancer screening is accompanied by high rates of cancer detection and prevention.

Efforts to further increase screening rates in the target population of adults aged 50 or older, which have risen from 20%–30% in 1997 to 55% in 2008, will need to address financial and geographical barriers to screening as well as appropriate follow-up of the results, the panel advised.

“We are convinced by evidence in the literature that efforts … to tailor strategies will be very important to test because in different communities and in different population subgroups there need to be different strategies tested to try and get high [screening] rates,” panel chairperson Donald M. Steinwachs, Ph.D., said in a press telebriefing that followed the release of the draft statement.

Systems that remind patients to get screened and one-on-one interactions with providers, educators, or patient navigators could help to increase screening, the panel noted. Systems of care that employ these techniques have much higher screening rates than the national average, such as Kaiser Permanente (75% in the Medicare population) and the Veterans Affairs health care system (80%), according to the statement.

The panel also found that a physician's recommendation is the only consistent physician-related factor that has been shown to predict screening.

“The decision on which approach to use is driven by factors like insurance and patient preferences,” said panelist Dr. Leonard E. Egede, professor of medicine in the division of general internal medicine and geriatrics at the Medical University of South Carolina. He noted that when patients have no preference for a particular screening method, most primary care physicians provide fecal occult blood test (FOBT)–based screening (followed by colonoscopy if necessary) or direct access to colonoscopy.

A wide variety of methods with varying screening intervals are available for screening adults aged 50 years and older, including annual FOBT (guaiac or immunochemical), flexible sigmoidoscopy, or double-contrast barium enema every 5 years, and colonoscopy every 10 years. The panel noted that CT colonography is a potentially viable screening option that could be expanded, but it is not currently covered by Medicare.

When colonoscopy overtook FOBT and flexible sigmoidoscopy in 2001 as the most widely used screening method, there was a subsequent decline in the use of flexible sigmoidoscopy. In that same time, double-barium contrast enema fell out of favor and the overall use of occult blood testing declined more gradually, although these stool tests are still widely used in the Veterans Affairs health care system and some managed care systems, according to the statement.

In order to provide colorectal cancer screening to low-income, uninsured, and underinsured populations, the panel noted that the Centers for Disease Control and Prevention recently began the Colorectal Cancer Control Program in 22 states. The program is modeled after the agency's successful breast and cervical cancer screening program, but “its reach so far has been limited,” Dr. Egede said.

Most current sources of information on screening rates, such as population-based surveys and administrative data sets, do not provide enough detail on the use and quality of colorectal cancer screening, according to the statement.

“Monitoring systems exists in some communities and in some health care organizations, but overall, we don't have systems that monitor whether or not people are receiving screening services appropriately and whether or not the quality of the services being rendered are the highest,” said Dr. Steinwachs, director of the Health Services Research and Development Center at Johns Hopkins University, Baltimore.

The panel suggested that a registry analogous to the existing Breast Cancer Surveillance Consortium should be established to monitor the rates of colorectal cancer screening, overuse, quality, and complications.

The statement is available at http://consensus.nih.gov/

BETHESDA, MD. — Colorectal cancer screening initiatives that use evidence-based interventions to target underscreened populations while encouraging use of the full range of screening options should be implemented to improve the use and quality of colorectal cancer screening, according to findings from a panel convened by the National Institutes of Health.

In a draft “state-of-the-science” statement, the 13-member panel also recommended investing in a variety of quality monitoring methods to make sure that colorectal cancer screening is accompanied by high rates of cancer detection and prevention.

Efforts to further increase screening rates in the target population of adults aged 50 or older, which have risen from 20%–30% in 1997 to 55% in 2008, will need to address financial and geographical barriers to screening as well as appropriate follow-up of the results, the panel advised.

“We are convinced by evidence in the literature that efforts … to tailor strategies will be very important to test because in different communities and in different population subgroups there need to be different strategies tested to try and get high [screening] rates,” panel chairperson Donald M. Steinwachs, Ph.D., said in a press telebriefing that followed the release of the draft statement.

Systems that remind patients to get screened and one-on-one interactions with providers, educators, or patient navigators could help to increase screening, the panel noted. Systems of care that employ these techniques have much higher screening rates than the national average, such as Kaiser Permanente (75% in the Medicare population) and the Veterans Affairs health care system (80%), according to the statement.

The panel also found that a physician's recommendation is the only consistent physician-related factor that has been shown to predict screening.

“The decision on which approach to use is driven by factors like insurance and patient preferences,” said panelist Dr. Leonard E. Egede, professor of medicine in the division of general internal medicine and geriatrics at the Medical University of South Carolina. He noted that when patients have no preference for a particular screening method, most primary care physicians provide fecal occult blood test (FOBT)–based screening (followed by colonoscopy if necessary) or direct access to colonoscopy.

A wide variety of methods with varying screening intervals are available for screening adults aged 50 years and older, including annual FOBT (guaiac or immunochemical), flexible sigmoidoscopy, or double-contrast barium enema every 5 years, and colonoscopy every 10 years. The panel noted that CT colonography is a potentially viable screening option that could be expanded, but it is not currently covered by Medicare.

When colonoscopy overtook FOBT and flexible sigmoidoscopy in 2001 as the most widely used screening method, there was a subsequent decline in the use of flexible sigmoidoscopy. In that same time, double-barium contrast enema fell out of favor and the overall use of occult blood testing declined more gradually, although these stool tests are still widely used in the Veterans Affairs health care system and some managed care systems, according to the statement.

In order to provide colorectal cancer screening to low-income, uninsured, and underinsured populations, the panel noted that the Centers for Disease Control and Prevention recently began the Colorectal Cancer Control Program in 22 states. The program is modeled after the agency's successful breast and cervical cancer screening program, but “its reach so far has been limited,” Dr. Egede said.

Most current sources of information on screening rates, such as population-based surveys and administrative data sets, do not provide enough detail on the use and quality of colorectal cancer screening, according to the statement.

“Monitoring systems exists in some communities and in some health care organizations, but overall, we don't have systems that monitor whether or not people are receiving screening services appropriately and whether or not the quality of the services being rendered are the highest,” said Dr. Steinwachs, director of the Health Services Research and Development Center at Johns Hopkins University, Baltimore.

The panel suggested that a registry analogous to the existing Breast Cancer Surveillance Consortium should be established to monitor the rates of colorectal cancer screening, overuse, quality, and complications.

The statement is available at http://consensus.nih.gov/