CDC Telebriefing Transcript

CDC Study Finds Colorectal Cancer Screening Rates Remain Low

March 13, 2003

ATT MODERATOR: The call will begin shortly. This is the CDC MMWR Telebriefing. At this time, all participants on the listen-only mode. Later we will conduct a question and answer session, and instructions will be given at that time. If you should require assistance any time during the conference, press '0' then star. I would now like to turn the conference over to Jennifer Morcone. Please go ahead.

CDC MODERATOR: Thank you, Mary. Thank you, everyone for joining us today. Today we'll be discussing an article in the MMWR titled "Colorectal Cancer Test Use Among Persons Aged Over Fifty Years, United States, 2001." On the line today with us as well is Dr. Cynthia Jorgensen, whether is the author of our other MMWR about colorectal cancer, and PSAs and donated a air clay ***. She will not be making opening statements, but can answer some questions if they arise later in the call.

I'd like to make one clarification on the press release everyone received. I want to emphasize something that was made very clear in the article itself, which is that only 53.1 percent of U.S. men and women aged 50 years and older had received colorectal cancer testing within the recommended screening period.

There are several different kinds of tests Dr. Pollack will be talking about today and each has different screening periods. And she will elaborate. Dr. Loria Pollack, you can take it from here. Dr. Pollack?

DR. POLLACK: Thank you very much, Jennifer. My name is Loria Pollack. I'm a physician and medical epidemiologist at the Center for Disease Control's Division of Cancer Prevention and Control.

Currently, colorectal cancer is the second leading cause of cancer-related death in the United States. Screening for colorectal cancer has proven to decrease developing and dying from the disease. Many organizations, including the Center for Disease Control and Prevention, recommend routine colorectal cancer screening for men and women, beginning at age 50.

Our study looked a large health behavior survey to determine the percentage of U.S. adults, age 50 and older, who received colorectal cancer testing within the recommended time period. Before I talk about our results, first let me review the recommendations for colorectal cancer screening.

All men and women over 50 years old should have one or a combination of the following four tests. One, a home blood stool kit, referred to as "Fecal Occult Blood Test," or FOBT. This should be done very year. And/or a sigmoidoscopy every five years. A colonoscopy every ten years. A double-contrast barium enema every five years. Sigmoidoscopy and colonoscopy are both exams that examine the inside of the bowel wall with a flexible equipment called an endoscope. In this report they're referred to as "lower endoscopy." E-N-D-O-S-C-O-P-Y.

Using the behavioral risk factor surveillance system, a large national telephone survey, nearly 88,000 people 50 years and older were asked if they ever had a fecal occult blood test, sigmoidoscopy, colonoscopy, and when they last had these tests. In 2001, 45 percent of adults, aged 50 years and older, reported receiving a fecal occult blood test at least once. And 47 percent have reported a lower endoscopy at least once.

We then looked at whether these tests had been received within the recommended screening periods, which is fecal occult blood testing within one year, or lower endoscopy within ten years. Approximately half, 47 percent of Americans age 50 and older, did not receive these tests within the recommended screening period. When compared to the same behavioral risk factors surveillance system survey from 1997 and 1999, these 2001 rates had increased slightly, but overall, colorectal cancer tests use rate remains low.

Because colorectal cancer screening rates are low, the Center for Disease Control and Prevention has taken action to address this public health issue. For the public, a screening for life campaign encourages men and women to talk to their doctors about getting screened. For health care professionals, a Call to Action is an educational program in colorectal cancer screening. Both of these are available on line.

CDC MODERATOR: Thank you, Dr. Pollack. Mary, we're ready to open for any for any questions the reporters may have.

ATT MODERATOR: Thank you. Ladies and gentlemen, if you wish to ask a question, press a '1' on your touch-tone phone. You will hear a phone indicating you've placed in queue. To press '1' prior to this announcement, we ask that you do so again at this time. You may remove yourself from queue at any time by pressing the pound key, and if you are using a speaker phone, just pick up your handset before pressing the number.

Once again, if you do have a question, press the '1' on your phone at this time.

Our first question comes from the line of Mandy Gardner, from Health [inaudible] News. Please go ahead.

QUESTION: Hello. I have heard several experts in the field of colorectal cancer say that getting everybody screened with the available screening methods is something that would be incredibly expensive, and would take up a lot of resources, and wouldn't be very tactical to do. I'm wondering if you could comment on that, and perhaps talk about efforts to develop other types of tests?

DR. POLLACK: Sure. That's an excellent question concerning the cost it takes to offer colorectal cancer screening to the public. And actually as we said in the report, in this discussion there are four tests. One of them is a quite inexpensive test that costs maybe $20, $30, and that's the fecal occult blood testing, which is a card given by the doctor, the patient brings home and takes a sample of their stool and then returns that the doctor. That's done yearly.

The other two tests, where the endoscope looks inside, is a bit more expensive, but done less often.

So, there have been studies on cost-effectiveness of these. But between the four tests, any of these tests are good. And it's not necessarily the most expensive one is the best test.

QUESTION: Okay. Thank you.

CDC MODERATOR: Mary, next question?

ATT MODERATOR: Thank you. Our next question comes from Jeff Evans from International Medical News Group. Please go ahead.

QUESTION: Hi. I'm wondering if these people in the survey, do most of them see their doctors regularly? And I'm wondering how many doctors are actually offering these tests. Because like if it's not offered and it's not discussed, or if the doctors don't have enough time to discuss all the options, then maybe that's one of the main problems. I'm wondering if you can say something on that, I guess.

DR. POLLACK: Yes. Thank you. That's an important point. The survey did look at whether respondents reported a regular source of health care. And I don't have the number for that. But what I could address is the question about lack of awareness. And this is both on the public end, where people don't realize that this is such a common cancer, and screening is available, but then on the provider end, there are so many chronic disease and prevention issues to discuss, that you're right, time is short, and often that just gets placed on the back burner or not mentioned at all.

So, increasing the screening rates in an effective way involves both the patient and the doctor.

CDC MODERATOR: Okay, next question?

ATT MODERATOR: Thank you. Our next question is from the line of Martha Kerr from Reuter's Health. Please go ahead.

QUESTION: Hi, Dr. Pollack. I'm wondering if you could sort of elaborate on the editorial comment and the MMWR on the fact that the rate in this surveillance survey are possibly over-estimated?

DR. POLLACK: Oh, yes, that's an important point, because what we're saying is the respondents were asked if they had ever received these tests. And the tests could be used as a screening test, or as a test looking for something in particular. We could not differentiate by the way the questions were asked, whether it was for diagnostic or screening purposes. So actually the rates reported include some of those tests for people that might have got it because of a specific problem they were having, not just for screening, which is looking for the disease before if has symptoms.

So, in actuality the screening rates are lower than in this report, and we can't tell how much lower.

QUESTION: Thank you very much.

CDC MODERATOR: Next question?

ATT MODERATOR: If there are any additional questions, please press the '1' on your phone at this time.

And we do have a follow-up from Martha Kerr from Reuter's Health. Please go ahead.

QUESTION: Hi. Just a follow-up on what do you think the significance is of the findings in terms of how reliable they are? Or is there another direction that needs to be gone in? Or are you going in the correct direction?

And do you plan to do anything differently in order to increase screening rates?

DR. POLLACK: Okay. Let's see. About the reliability. I mean, the fact is the rates we have are so low, though. Less than half of the people are getting screened, and I don't think that's a matter of how the test was done. It's such a large survey: 88,000 people across the entire United States, and I don't think it has to do with the methodology. I think that more people need to be screened.

And also that the screening tests are available, and they are readily available. So I think there needs to be, if anything, more of a link in terms of the awareness, and that's where the public Screen for Life campaign comes in, as well as the Call to Action for the health care providers.

CDC MODERATOR: Great. Thank you. And those materials can be found on the website. You can find the campaign materials at www.cdc.gov/cancer/screenforlife. And the provider materials are also there. The URL is a bit long, and it was in the press release today.

Do we have any further questions, Mary? ATT MODERATOR: There are no further questions at this time.

CDC MODERATOR: Dr. Pollack, would you like to make some closing comments?

DR. POLLACK: Thank you. No. I appreciate everybody listening. And I just want to emphasize that although the test use has increased slightly in the past five years, that half of Americans over 50 have not received the colorectal cancer within the screening interval.

THE MODERATOR: Great. Thank you all for joining us today.

[END OF TAPE RECORDING.]

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