Enhancing guideline-appropriate use of colorectal cancer screening in the United States

Despite guidelines from major expert groups that recommend screening asymptomatic, average-risk adults for colorectal cancer (CRC), national data document underuse of CRC screening among adults aged 50-75. The National Health Interview Survey shows that the proportion of average-risk adults ages 50-75 who were up-to-date with colorectal cancer screening by having home FOBT in the past year, sigmoidoscopy in the past 5 years, or colonoscopy in the past 10 years increased from 39% in 2000 to 55% in 2008. Screening rates increased over this time period for most population subgroups, but not for individuals who had no usual source of care, no physician visits in the past year, or who lacked health insurance coverage.

Evidence from primary care physicians also suggests that many are not following guidelines in their provision of CRC screening. Data from nationally-representative provider surveys conducted in 2000 and 2007 show that many primary care physicians recommend CRC screening for average-risk patients at inappropriate starting ages and screening intervals. Other important quality concerns are use of in-office instead of home FOBT, and failure to follow up positive FOBTs with total colon examination.

An independent panel convened by the National Institutes of Health in February 2010 considered these data as well a detailed evidence report and expert testimony during a three-day State of the Science conference, and concluded that six priority areas must be addressed in order to achieve higher and guideline-appropriate rates of CRC screening in the United States. The priority areas will be discussed during the presentation.