Managed Care Outlook

Increased colon cancer screening could save 200,000 lives by 2030


Increasing the colorectal screening rate to 80% would significantly reduce the incidence and mortality from the disease (http://tinyurl.com/colon-cancer-Outlook) and might even prove to be cost-effective.

In 2013, 58% of American in the screening age range of 50 to 75 were screened for colorectal cancer. Less-than-optimal screening rates inspired the National Colorectal Cancer Roundtable to launch the “80% by 2018” campaign. The roundtable, founded by the American Cancer Society and the CDC, is a coalition of about 60 public, private, and voluntary organizations that combat colorectal cancer.

A research team led by Reinier G.S. Meester of the Erasmus University Medical Center in Rotterdam calculated what meeting the 80% screening rate by 2018—and keeping it there—would mean compared with the status quo of a screening rate of about 60%.

Their predictions, reported recently in Cancer, are that incidence would go up initially by 20% because colorectal cancers would be found in Americans who hadn’t been screened. After that, however, it would go down, decreasing by 17% by 2020 and by 22% in 2030.

Colorectal cancer incidence and mortality rates in the U.S. population under two screening scenarios

In the first scenario, the screening rate remains at about 60% from 2013 through 2030. In the second, the screening rate increases from 60% to 80% by 2018 and remains there.

Incidence
Cases per 100,000 population, per year

Mortality
Deaths per 100,000 population, per year

Source: Meester RG et al., Cancer, March 12, 2015

Their mortality-rate crystal ball shows a 19% decrease in colorectal cancer deaths by 2020 from the “80% by 2018” effort, and an impressive 33% decrease by 2030.

Those percentages translate into 277,000 fewer Americans being diagnosed with colorectal cancer from 2013 to 2020, and 203,000 fewer dying from the disease.

Barriers remain, however. “Underscreened individuals tend to have lower educational levels and income and to lack health insurance,” note Meester and his colleagues.

And, truth be told, the cost-cutting benefits of more screening—which weren’t calculated as part of this study—are somewhat speculative. Neither the potential overuse of screening nor the added expense of pushing screening rates all the way up to 80% have been factored into previous analyses adequately.

However, the increasing number of extremely high-priced cancer drugs may enhance the math that favors screening. As treatment costs go up, the avoided costs increase from cancers that are averted because of screening.

“We know from past studies based on Medicare reimbursement rates that screening can be highly cost-effective, or even cost-saving,” Meester tells Managed Care. “In those studies, prevented treatment costs balance or outweigh the screening costs.”

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