The incidence of colorectal cancer has fallen a dramatic 30 percent over the past decade in people aged 50 and older, with the largest drop occurring among those aged 65 and older, according to a report published Monday in CA: A Cancer Journal for Clinicians.
The majority of that decline is being credited to an increase in the number of older Americans undergoing preventive screening, which enables physicians to spot growths or changes in the colon and rectum — and successfully treat them — before they become cancer.
As both the study and a companion report by the American Cancer Society (ACS) point out, preventive screening has almost tripled among American adults aged 50 to 75 in recent years. The rate climbed from 19 percent in 2000 to 55 percent in 2010. Among people aged 65 and older, the screening rate was even higher in 2010: 64 percent.
The authors of the ACS report suggest that this higher uptake of screening at age 65 is due to Medicare, which provides universal coverage for the procedures.
Minnesota’s screening rate for adults aged 50 and older was an impressive 70.7 percent in 2010, according to the ACS report. That’s the ninth highest ranking among all 50 states.
Most (52 percent of the national number) of those older Americans who had been screened for colorectal cancer in 2010 underwent either a colonoscopy within the past 10 years or a sigmoidoscopy exam within the past five years, coupled with an at-home stool test every three to five years. The rest were screened with annual at-home stool tests.
The ACS endorses all three screening methods.
Still a leading killer
Death rates for colorectal cancer have also been falling — and at an increasingly faster rate, according to the new statistics. The rates decreased by about 3 percent per year in both men and women from 2001 to 2010, which compares with 2 percent decrease per year during the 1990s.
Yet, despite this positive trend, colorectal cancer remains the third most commonly diagnosed cancer and the third leading cause of cancer-related death in both men and women in the United States. The authors of the two new reports estimate that 136,830 Americans will be diagnosed with colorectal cancer in 2014, and 50,310 will die from the disease.
This year in Minnesota, colorectal cancer will be newly diagnosed in an estimated 2,240 adults, and an estimated 780 will die from the disease.
The reports contain other troubling news about colorectal cancer. The risk of the disease among blacks is 25 percent higher than among whites and 50 percent higher than among Asian-Americans. Experts attribute these differences to both genetics and socioeconomic factors, which can significantly reduce access to screening.
In addition, during the past decade the colorectal cancer rates have risen by 1.1 percent a year among people younger than age 50. The experts cite rising obesity rates and poor eating habits — two risk factors for colorectal cancer — as possible explanations for that increase among younger adults.
A new and ambitious goal
Today, the National Colorectal Cancer Roundtable, a coalition of public and private organizations brought together by the American Cancer Society and the Centers for Disease Control and Prevention, is launching its “80% by 2018” initiative, in which it hopes to have 80 percent of all Americans aged 50 and older being regularly screened for colorectal cancer by 2018.
That’s an ambitious goal, but it’s one that should be easier to reach under the Affordable Care Act (ACA). The law requires all health insurance policies to cover colorectal-cancer screening tests without co-pays or other out-of-pocket expenses. (If a screening test finds something suspicious, however, all subsequent tests will require co-payments by the patient, as the tests will no longer be considered preventive procedures.)
The ACA’s coverage of colorectal-cancer screening is good news for people aged 50 to 64, who are at higher risk for colorectal cancer but who don’t qualify for Medicare.
“These continuing drops in incidence and mortality show the lifesaving potential of colon cancer screening; a potential that an estimated 23 million Americans between ages 50 and 75 are not benefiting from because they are not up to date on screening,” said Dr. Richard C. Wender, the ACA’s chief cancer control officer, in a statement released with the two new reports.
“Sustaining this hopeful trend will require concrete efforts to make sure all patients, particularly those who are economically disenfranchised, have access to screening and to the best care available,” he added.