It’s Time for a New Option in Colorectal Cancer Screening
Early detection is a critical tool in the fight against colorectal cancer (CRC) and has the power to save lives. We know that CRC is highly treatable if caught early and yet it has consistently been a leading cause of cancer-related deaths for decades. Despite significant advances in screening methods during this time, a staggering 50 million people – approximately one in three eligible Americans – are not up to date with recommended screening. Screening rates have remained stagnant at about 59 percent, well below the National Colorectal Cancer Roundtable’s goal of 80% for eligible individuals.
As a medical oncologist and someone who has been deeply involved in the fight against cancer, particularly CRC, I have witnessed first-hand the consequences of not getting screened – consequences that will only become more widespread as the incidence of CRC continues to grow in younger populations.
There are multiple reasons why people don’t get screened using the existing methods–colonoscopy and stool-based tests–but for many it’s simply because they find the current options too inconvenient or unpleasant. To finally close the persistent – and alarming – CRC screening gap, we need to embrace innovative screening methods that are accurate and have the potential to improve patient adherence.
Adherence to CRC screening is crucial : 75 percent of Americans who die from CRC were behind on their recommended screening. The American Cancer Society, an organization I served with and hold in high regard, has consistently emphasized the importance of patient adherence in its guidelines. This is because the most effective screening test is the one people are willing to complete.
A convenient, non-invasive blood test has tremendous potential to encourage more patients to take action and complete recommended screening for CRC. Recently, a U.S. Food and Drug Administration (FDA) advisory committee panel of experts recommended that a new blood test would be safe and effective for average-risk patients age 45 and older as a primary option for CRC screening.
This test, which can be completed with a simple blood draw during a routine office visit, has been shown to have accuracy within the range of existing non-invasive tests used as primary CRC screening options. Critically, over the past two years this blood test has been available, 90 percent of people who were prescribed the test completed it, clearly demonstrating its ability to motivate more people to be screened for CRC than other methods, which have adherence rates ranging from 28 to 71 percent.
The need for an effective, non-invasive screening test that people will complete has never been more profound than it is today. Three years ago, the United States Preventive Services Task Force updated its guidelines to recommend that all individuals of average risk begin screening at age 45 instead of age 50 – significantly increasing the number of people eligible for screening in this country. In parallel, we have seen a continuing shortage of qualified gastroenterologists, particularly in rural and underserved urban areas. This provider shortage threatens to delay or even prevent patients from accessing procedures like colonoscopy, which can prevent CRC, find CRC, and potentially save lives. Action is needed to offer patients more options to get screened so we can reduce the number of CRC-related deaths.
Today, the FDA is at a crossroads as it prepares to decide whether to approve this new blood test as a primary screening option. As an oncologist and career-long advocate for the power of screening in early detection of colorectal cancer, I urge the FDA to follow the strong recommendation of its advisory committee and approve the blood test so it can take its rightful place alongside other non-invasive CRC screening tests. With more screening choices, we can advance the fight against CRC at its most vulnerable point – early stages – when more lives can be saved.
Len Lichtenfeld, M.D., MACP, is an experienced medical oncologist and independent consultant, with extensive background in cancer care, cancer research, healthcare policy, and physician payment. He is the former chief medical officer at the American Cancer Society and Jasper Health.
