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Colorectal Cancer Control: Where Have We Been and Where Should We Go Next?

Colorectal cancer (CRC) is the second leading cause of cancer death in the United States, but it does not have to be. Screening prevents CRC by finding precancerous lesions so they can be removed before they become cancerous. Screening can also detect CRC early and, when CRC is localized, 5-year survival is over 90%, with many patients cured. Five-year survival for late-stage CRC, however, is less than 20%. 1 Colorectal cancer screening rates have been steadily increasing in the United States, yet only 62% of age-eligible adults are up-to-date for CRC screening. 2 Rates are lower among low-income (47%), uninsured (25%), African American (59%), Asian (52%), Native American (48%), and Hispanic (47%) populations. 2 These rates fall short of the 70% and 80% targets for Healthy People 2020 and National Colorectal Cancer Round Table. Net health care costs in the first year after CRC diagnosis range from $36 000 for stage I to $74 000 for stage IV disease. 3 Colorectal cancer survivors also experience high out-of-pocket costs and lost productivity. 4 In short, optimal and equitable CRC screening would improve health outcomes and produce cost-savings. 5