Overview of Colorectal Cancer

Colorectal cancer, also known as colon cancer or rectal cancer, refers to cancer that develops in the colon or rectum. It is currently the third most common cancer diagnosed in the United States and the third leading cause of cancer-related deaths among men and women in the country. Colorectal cancer often starts as a growth called a polyp that develops on the inside of the colon or rectum. Not all polyps become cancer, but some types of polyps called adenomas have the potential to develop into colorectal cancer over time.

Current U.S. Colorectal Cancer Screening Industry Guidelines

The U.S. Preventive Services Task Force currently recommends that adults between the ages of 45 to 75 years get screened for Colorectal Cancer. Their guidelines state that those at average risk of colorectal cancer should follow one of these screening strategies:

- Guaiac-based fecal occult blood test (gFOBT) or fecal immunochemical test (FIT) every year. These tests can detect blood in the stool, which could be a sign of polyps or cancer.

- Flexible sigmoidoscopy every 5 years combined with FIT every 3 years. Flexible sigmoidoscopy allows the doctor to examine the lower third of the colon.

- Colonoscopy every 10 years. Colonoscopy examines the entire colon and rectum.

- CT colonography (virtual colonoscopy) every 5 years. This noninvasive test uses CT imaging to look for polyps and cancer in the colon.

- Fecal DNA test every 3 years. This relatively new test analyzes stool samples for altered DNA from colon cells which can indicate cancer.

Those at high risk of colorectal cancer due to personal history of polyps or inflammatory bowel disease may need earlier or more frequent screening as recommended by their doctor based on individual risk factors.

Current National Screening Rates

Despite the clear guidelines, colorectal cancer screening rates remain below the target goal of 80% set by Healthy People 2020. According to recent data from the National Cancer Institute and Centers for Disease Control and Prevention:

- Overall colorectal screening rates among adults ages 50 to 75 stood at 65.1% in 2018, falling short of the 80% goal.

- Screening rates varied significantly based on income, education, insurance status, and race/ethnicity. Adults with higher incomes or education levels, with health insurance, and who were non-Hispanic white had higher screening rates.

- The breakdown by type of screening test showed a majority, 47.6%, had completed an FOBT in the past year or a sigmoidoscopy in the past 5 years. 32.6% had received a colonoscopy in the past 10 years, the preferred screening method.

- Only about half of those at high risk due to factors like family history or polyps are up-to-date with screening, less than the two-thirds target for high-risk groups.

Barriers to U.S. Colorectal Cancer Screening Industry

Some of the key barriers that have been identified as contributing to low colorectal cancer screening rates include:

Lack of awareness and knowledge about screening: Surveys have found that up to 40% of the target population is unaware that they should be screened or lack knowledge about the available screening options. This underlines the need for public education campaigns.

Fear, embarrassment and perceived discomfort: Fear of the screening procedure, embarrassment, and perception that colonoscopies are painful can deter many individuals from being screened, though modern tech and prep have reduced discomfort levels significantly.

Cost and insurance coverage: While screening is covered by most insurance plans as preventive care, lack of insurance or high out-of-pocket costs continue to be a barrier, especially for those with low incomes. Even having coverage does not always ensure costs are affordable.

Low prioritization by providers: Studies show providers do not always strongly recommend or discuss screening with patients, especially with high-risk groups. Lack of provider referral reduces uptake of lifesaving screening.

In Summary, additional steps are undoubtedly needed to boost screening rates nationwide and close disparity gaps, but gaining community support through education can help address many of the existing barriers. With increased screening, colorectal cancer incidence and mortality rates can be reduced substantially. Continued monitoring will show if ongoing initiatives are able to bring national rates closer to the Healthy People 2020 goal in the coming years.

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