The AAFP has added its name to the expanding list of health care organizations supporting the "80% by 2018"(nccrt.org) initiative, which was created by the National Colorectal Cancer Roundtable (NCCRT) with the goal of increasing the percentage of adults ages 50 and older who get screened for colorectal cancer to 80 percent by 2018.
On April 18, former AAFP member Richard Wender, M.D., chair of the NCCRT and chief cancer control officer for the American Cancer Society (ACS), visited AAFP headquarters in Leawood, Kan., to explain the initiative and ask for the Academy's support.
Partnering with the AAFP is especially important, said Wender, because family physicians are on the frontline of colorectal cancer screening.
"I think the ACS recognized among all of the organizations very early that our future and success in winning the cancer battle depends on our relationship with the primary care network and communities," he said. "This is because working with primary care organizations is the most effective way to ensure that more people have access to a high-quality, trusted source of primary care."
Julie Wood, M.D., AAFP vice president for health of the public and science and interprofessional activities, was among those who met with Wender and recommended supporting the initiative to the AAFP Board of Directors.
- The AAFP has announced its support for the "80% by 2018" initiative, which aims to increase colorectal cancer screening rates for adults ages 50 and older to 80 percent by 2018.
- According to the National Colorectal Cancer Roundtable (NCCRT), colorectal cancer is the third leading cause of death in men and women in the United States, with 140,000 adults diagnosed with the disease each year.
- About one in three adults between the ages of 50 and 75 in the United States -- about 23 million people -- are not currently getting screened as recommended, according to the NCCRT.
"The (AAFP) fully supports this effort to eliminate colorectal cancer as a major public health issue, understanding how important our reach is as family physicians via the patient-centered medical home," Wood said. "Additionally, this program integrates well with the Academy's population health efforts as we emphasize the importance of health equity and social determinants of health to our members."
The ACS and CDC established the NCCRT in 1997 with the help of public and private organizations and invited individuals to help reduce the incidence of and mortality from colorectal cancer in the United States. Strengthening the initiative's support, Howard Koh, M.D., M.P.H., assistant secretary for health, has made fighting colon cancer a top priority, Wender said.
Why is Screening for Colorectal Cancer Important?
According to the NCCRT, colorectal cancer is the third leading cause of death among both men and women in the United States, with 140,000 adults diagnosed with colorectal cancer each year. But when adults get screened for colorectal cancer, it can be detected at an earlier stage when treatment is most likely to be successful. Moreover, in some cases, the disease can be prevented through detection and removal of precancerous polyps.
Fortunately, colorectal cancer screening rates are on upward trajectory, says a report in the CDC's Morbidity and Mortality Weekly Report,(www.cdc.gov) with overall U.S. screening rates having improved from 54 percent in 2002 to 65 percent in 2010.
Some participating health systems have already achieved 80 percent screening rates, according to the NCCRT. And the state of Massachusetts has achieved a screening rate of more than 76 percent of its eligible population, the highest in the United States.
Who Isn't Getting Screened and What Is the Plan to Reach Them?
The AAFP recommends screening adults for colorectal cancer using fecal occult blood testing, sigmoidoscopy or colonoscopy beginning at age 50 and continuing until age 75. The U.S. Preventive Services Task Force screening recommendation covers this same population.
Yet about one in three adults between the ages of 50 and 75 in the United States -- about 23 million people -- are not currently getting screened as recommended, according to the NCCRT, which recommends several screening test options but acknowledges that "the best test is the one that gets done."
Furthermore, disparities exist among certain subpopulations in the targeted age group, with men, Hispanics, American Indians, rural populations, and those with lower education and income being less likely to be screened appropriately. To address these gaps, Wender encouraged family physicians whose practices serve these groups to consider discussing the reasons for screening with those patients.
Wender highlighted the CDC's Colorectal Cancer Control Program(www.cdc.gov) (CRCCP), which funds 25 states and four tribes to promote and provide colorectal cancer screening, as a successful example of expanding colorectal cancer screening to underserved populations. Since the program's inception in 2009, the CRCCP has provided screening to nearly 20,000 people, finding 2,917 cases of precancerous polyps and 50 cancers.
Ultimately, Wender said, efforts to expand colorectal cancer screening will require collaboration among health care professionals, health systems, communities, businesses, community health centers and government. Spreading the message through a shared effort will allow those involved to reach as many people as possible.
"We're going to create health equity in colon cancer screening and make sure everybody has a chance to be screened," Wender declared. "Walgreens has funded a grant program(pressroom.cancer.org) where we will go to very poor communities, and the (gastrointestinal medical professional) organizations have pledged that they will find (physicians) who will do colonoscopies so that we can build a medical neighborhood around colon screening."
CA: A Cancer Journal for Clinicians: "Developing a Quality Screening Colonoscopy Referral System in Primary Care Practice: A Report from the National Colorectal Cancer Roundtable"(onlinelibrary.wiley.com)
(Dec. 18, 2009)