In early January 2019, the U.S. Preventive Services Task Force (USPSTF) released their Draft Research Plan for Colorectal Cancer: Screening, March 2021. The goal of the proposed research is to help guide the USPSTF’s review of screening research and approaches in preparation to update screening recommendations. The draft was open for public comment period, which expired on January 30, 2019.
Dear USPSTF Review Committee,
Fight Colorectal Cancer (Fight CRC), with key members of our Medical Advisory Board, appreciates the opportunity to submit the following comments to USPSTF regarding the Draft Research Plan for Colorectal Cancer: Screening, March 2021. Fight Colorectal Cancer (Fight CRC) is the leading national colorectal cancer advocacy non-profit organization. We offer support for patients and caregivers, and we serve as a resource for advocates, policymakers, and medical professionals. Additionally, we lead efforts to increase and improve research for colorectal cancer, for all stages, and throughout the cancer continuum.
As advocates in the colorectal cancer community, Fight CRC has seen the increase in early-age onset cases and has been passionate about both building awareness of this trend among the public, while engaging in research efforts to understand more and mitigating the increased incidence in young adults.
Through our work with the American Cancer Society (ACS), Memorial Sloan Kettering in the United States, and Erasmus University in the Netherlands, Fight CRC participated in the development of the manuscript “Colorectal Cancer Screening Initiation before the age of 50 years: A Microsimulation Analysis” which was accepted into Cancer in July 2018. Fight CRC and the task force group recognized the need to develop a modeling study that reassessed the age at which colorectal cancer screening should begin and end for the average-risk population, discovering that a more appropriate age to begin screening is 45 years of age. Fight CRC is working with diligence to further the research in this area.
Fight CRC believes in fully disclosing all potential conflicts of interest. As an organization, we have received sponsorships and/or educational grants from companies who have an interest in novel screening methods for colorectal cancer including Exact Sciences; Quest Diagnostics; Epigenomics; Clinical Genomics; and Medtronics. Neither these companies nor any of our corporate supporters have influenced our comments on this issue.
After review of the recommendations by our Medical Advisory Board and our staff, we would like to highlight the following responses regarding the USPSTF Draft Research Plan:
- Consider the feasibility of adding major known colorectal cancer risk factors (such as BMI and smoking status) as well as age, race, and sex to the commissioned modeling studies.
- Compare the screening strategies by incidence, use incidence endpoints in addition to mortality.
- Use current incidence and mortality data in the modeling studies, and consider real-world data and data from diverse settings.
Include not only compliance with the first step in screening such as FIT or FIT/DNA or mSeptin 9 but also the compliance with the colonoscopy for those that are positive.
- Assess each screening test on its own merits rather than grouping together.
- Consider a broader array of harms for each screening test, including over surveillance and test volume.
- Account for patient screening test preferences and individual barriers to screening methods.
- Consider comparing screening strategies rather than screening tests.
- Include the recent modeling done for the ACS in the literature review.
Thank you for the opportunity to provide comments to this proposed research plan.
Fight CRC reviewed the USPSTF thoroughly with its medical advisory board members, governing board leadership, and senior staff. These comments are based on ongoing input from stakeholders and review amongst diverse perspectives. The comments are reflective of Fight CRC in its entirety, not a single individual.