Dear USPSTF Review Committee,
Fight Colorectal Cancer, with our Medical Advisory Board, appreciates the opportunity to submit the following comments to USPSTF regarding the Final Recommendation Summary of the Colorectal Cancer Screening Recommendations. Fight Colorectal Cancer (Fight CRC) is a leading national colorectal cancer advocacy non-profit organization. Our mission is to empower survivors to raise their voices, train advocates and educate lawmakers to strive for better policies. 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.
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; Endochoice; Clinical Genomics; and Medtronics. Neither these companies nor any of our corporate supporters have influenced our comments on this issue.
Adults aged 50 to 75 years:
The USPSTF recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years.
Fight CRC Responses:
- We are pleased to see the expansive list of: gFOBT, FIT, FIT-DNA, colonoscopy, CT colonography, flexible sigmoidoscopy and flexible sigmoidoscopy with FIT included as recommended screening modalities. This is particularly exciting as the USPSTF rating of ‘A’ or ‘B’ sets the standard for usage and reimbursement for insurance coverage.
- The revision in strategy to include more screening modalities as covered benefits for those 50-75, has the potential to increase the number of people screened for colorectal cancer.
- While Fight CRC is supportive of the additional screening modalities approved (as there is sufficient data to include as approved screening options), there is varying levels of evidence and data for each test. We would suggest adding, in detail, the prioritization and indications for use, based on the current level of evidence, to help patients make the most informed decision about their care.
- Fight CRC urges USPSTF to encourage and review additional population based research in the newer screening modalities, to further build evidence to help clinicians and consumers determine the best screening option.
Adults aged 76 to 85 years:
The decision to screen for colorectal cancer in adults aged 76 to 85 years should be an individual one, taking into account the patient’s overall health and prior screening history. Adults in this age group who have never been screened for colorectal cancer are more likely to benefit. Screening would be most appropriate among adults who 1) are healthy enough to undergo treatment if colorectal cancer is detected and 2) do not have comorbid conditions that would significantly limit their life expectancy.
Fight CRC Responses:
- In the age group 75 and older, we agree the ‘C’ rating is warranted with allowance of co-morbidity management and previous findings.
Recommendations on Screening Age under 50:
The USPSTF reviewed data about the increasing incidence of CRC in the population under age 50 as well as the increased CRC risk in Blacks and Alaska Native individuals and concluded that the current modeling evidence best supports a starting age of 50 years for the general population.
Fight CRC Responses:
- Fight Colorectal Cancer urges the USPSTF to further explore modeling studies and examine data to help inform if population-based screening for high-risk populations should be implemented at an earlier age than in the average-risk population, particularly as we focus our efforts to screen African American and Native American populations.
- We are also particularly interested in further reevaluation of the modeling studies, specifically looking at those 45-50 years old. We suggest that the USPSTF consider commissioning a specific modeling study using current incidence and mortality data in the 45-50-year-old cohort.
In an effort to reach the national goal of 80% by 2018, Fight CRC submits the above recommendations for consideration; underscoring that while offering more options will potentially allow for greater uptake of screening within the population, providing specific prioritization and detail about each screening test is preferred.
The USPSTF guidance and updates are critical in informing providers, guiding payment and supporting patients to truly be able to access these screening modalities.
We appreciate USPSTF’s leadership in ensuring existing data and any new data derived (e.g. in younger age groups) are critically reviewed and ensure that the recommendations have optimal clarity in the next USPSTF review. We are specifically interested in ensuring the strategies to examine the early-onset (under 50) and the high-risk population data are a priority for USPSTF, as outlined above.
Thank you for the opportunity to provide comments and for listening to our concerns based on our review of these guidelines.
Fight CRC reviewed the USPSTF thoroughly with 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.