UNIVERSITY PARK – For nonsmokers, colorectal cancer is the No. 1 cause of cancer death in the United States. For 2008, there will be an estimated 145,000 new cases and 55,000 deaths due to colorectal cancer. According to the American Cancer Society, colorectal cancer is estimated to have claimed the lives of 2,730 Pennsylvanians in 2007. For unknown reasons, Pennsylvanians are diagnosed with and succumb to colorectal cancer at rates above the national average.
Colorectal cancer is ideally suited for screening as it is both common and lethal. In addition, there is a long “preclinical” phase (without symptoms) in that the majority of colorectal cancers arise from pre-existing polyps. These precancerous polyps can be removed noninvasively by colonoscopy.
The goals of colorectal cancer screening are to detect early cancers which can be cured by surgery and to prevent cancers by removing precancerous polyps.
The evidence which recommends routine colorectal cancer screening in asymptomatic individuals is overwhelming. Recommendations in support of colorectal cancer screening have been adopted separately by the U.S. Preventative Services Task Force, the Joint Expert Panel of the American Cancer Society, and the U.S. Multi-Society Task Force on Colorectal Cancer. The routine screening of asymptomatic average risk individuals, male and female, beginning at age 50 years of age is recommended. In addition to saving lives and preventing cancer, colorectal cancer screening has been found to be both cost effective and safe.
An advantage to colorectal cancer screening by colonoscopy is that the entire large bowel can safely be examined and precancerous polyps removed at the same setting. If a 50-year-old individual with no family history of colorectal cancer has a normal screening colonoscopy, another examination is not needed for 10 years.
The alternative to screening for colorectal cancer is to not screen. Before routine screening, the majority of patients diagnosed with colorectal cancer had advanced disease. These patients required surgeries in combination with chemotherapy and occasionally radiation therapy. It was not until the 1990s that chemotherapy after surgical resection in patients with advanced disease were shown to have a small, but significant, survival advantage compared to individuals who did not receive chemotherapy. In this decade, newer chemotherapy agents and “biologic” therapies have become available, again, with a small, but significant, survival advantage for those with advanced disease. However, these advances in the treatment of advanced colorectal cancer come at significant cost. These newer agents used in combination can cost up to $30,000 for an eight-week course of therapy.
In patients with advanced stage disease, chemotherapy is usually continued indefinitely. Although these newer chemotherapy regimens have been shown to improve disease-free interval and prolong survival, they do not cure the disease.
It has been estimated that yearly, approximately 32,000 individuals in the United States will receive a diagnosis of colorectal cancer with metastasis, and recurrent metastatic disease will develop in another 24,000 individuals. The cost for an eight-week course of initial therapy for these 56,000 individuals will be approximately $1.2 billion. These cost estimates are exclusively for drugs and do not cover the cost of administration, supervision or supportive medications.
The alternative is to screen all individuals for colorectal cancer which will detect early curable cancers and remove precancerous polyps. Recent statistics for Pennsylvania show that only 51 percent of individuals receive proper screening. The Pennsylvania Division of the American Cancer Society has set a goal to increase to 75 percent the proportion of people age 50 and older who have colorectal cancer screening consistent with the American Cancer Society guidelines by 2015. This improvement in colorectal cancer screening will reduce the incidence rate of colorectal cancer by 40 percent and reduce the death rate by 50 percent by the year 2015.
Many have worked with the Pennsylvania Legislature to remove barriers to colorectal cancer screening. Not all insurance carriers provide for colorectal cancer screening as outlined by the American Cancer Society. Some insurance plans cover some but not all of the recommended screening tests for colorectal cancer. Senate Bill 146 will ensure Pennsylvanians that colorectal cancer screening, according to the guidelines of the American Cancer Society, are mandated for health insurance carriers. This bill currently is being deliberated in the Senate Banking and Insurance Committee.
It has been shown for breast cancer that placing insurance barriers between individuals and the care their physicians wish to provide, results in fewer women being screened. The same is true for colorectal cancer, which is why passing this bill will increase screening for colorectal cancer and significantly reduce the burden of this deadly disease for Pennsylvanians. The evidence is stronger than ever that colorectal cancer screening is effective for preventing colorectal cancer, detecting early cancer, saving lives and decreasing costs.