Impact of Delayed Screening

Colorectal cancer (CRC) is the most preventable yet least prevented form of cancer.1 Earlier detection and treatment of colorectal cancer greatly improves the odds of survival, which is why colorectal cancer screening guidelines recommend screening patients beginning from age 45.2-7 Detecting colorectal cancer early, even as a precancerous growth, is important for increasing survival.7

Colorectal cancer (CRC) is “the most preventable, yet least prevented form of cancer”1

In the US, the five-year survival rates are 91% for stages I/II2,a,b and only 14% for stage IV2,b

Current CRC screening guidelines recommend screening in all average risk patients ≥45 years of age3-6

Early Detection of CRC Improves Survival

What is the goal of CRC screening?7

  • Detect disease in asymptomatic individuals8
  • Detect and remove precancerous growths
  • Detect disease at an earlier stage when treatment is more successful
  • Reduce colorectal cancer incidence and mortality
  • Increase survival
The five-year survival rates of cancer in US are 91% for stages 1 and 2, and only 14% for stage 4

In the US, the five-year survival rates are 91% for stages I/II2,a,b and only 14% for stage IV2b

Colorectal Cancer 5-year Relative Survival (%) by Stage at Diagnosis, All Ages, 2012-2018, US2

Bar graph compares the colorectal cancer five-year relative survival percentage by stage of diagnosis. The survival percentage for all stages is 65%, localized is 91%, regional is 73%, and distant is 14%.

The evolution of colorectal adenoma to early CRC typically takes more than 10 years, providing an important opportunity for screening and early detection9,10

Higher Rates of Screening Are Associated With a Reduction in CRC Incidence and Mortality11

▼25.5%

Reduction in cancer incidence
From 95.8 to 71.4 cases/100,000 (P<0.01)

▼54.2%

Reduction in cancer mortality
From 30.9 to 14.7 deaths/100,000 (P<0.01)


The study was performed using a dynamic cohort of Kaiser Permanente Northern California (KPNC) health plan members, aged 51-75 years, from 2000-2015. KPNC is an integrated healthcare delivery organization that serves approximately 4.0 million members in urban, suburban, and semirural regions throughout California. The primary outcome was the influence of organized screening on screening up-to-date status, CRC incidence, and CRC-specific mortality. Limitations include that the observational design precludes confirming a direct causal link between the increases in screening and the decreases in CRC outcomes.

Earlier Screening’s Impact on the 50-54 Age Group

  • Lowering the CRC screening age to 45 years is likely to have an impact on CRC incidence and mortality in the group aged 50-54 years4
  • Incidence in this age group is currently increasing, in contrast to the declining incidence in all age groups after age 54 years4

ONLY 46%

screening prevalence in those aged 50-54 years12


Current CRC Screening Guidelines Recommend Screening In All Average Risk Patients ≥45 Years Of Age3-6

Data supporting these recommendations suggest an increase in CRC incidence in individuals aged 40-49 years that is double that of individuals aged 50-54 years (1.3% vs 0.5% increase per year from 2008 to 2017) and an increase in CRC mortality in adults younger than 50 years since 2005.4

Despite clear CRC screening recommendations, screening rates are well below the nationwide target7,13; thus, important opportunities for screening and early detection are being missed.

Average 5-Year Survival Rate by Stage at Diagnosis14

Distant metasteses (late stage) Regional metasteses Localized tumors (early stage)
Pancreas 3 15 44
Ovary 31 74 93
Uterine cervix 17 59 92
Colorectum 14 73 91
Non-Hodgkin lymphoma 67 77 86
Urinary bladder 8 39 70
Lung and brochus 7 34 61
Esophageal 6 26 47
Liver and bile duct 3 13 36

Figure adapted from Seigel, 202414

“...more than 80% [of cancers] are detected by signs or symptoms of patients, which means cancers are already advanced. I would like to see that reversed, so that 80% of cancers are screen-detected and only 20% by signs or symptoms.”15,16

— Bert Vogelstein, MD, Professor of Oncology, Johns Hopkins

Survival rates dramatically improve when cancer is diagnosed early and confined to the organ of origin.17

Related Topics

Footnotes

  1. Rates are based on cases diagnosed from 2012 to 2018, all followed through 2019.2
  2. Per American Joint Committee on Cancer's (AJCC) staging system: Localized = stage I, IIa , IIb. Regional = stage IIc and III. Distant = stage IV.18

List of definitions

AJCC: American Joint Committee on Cancer; CRC: colorectal cancer; KPNC: Kaiser Permanente Northern California; US: United States.


References

  1. Itzkowitz SH. Incremental advances in excremental cancer detection tests. J Natl Cancer Inst. 2009;101(18):1225-1227.
  2. American Cancer Society. Colorectal Cancer Facts and Figures 2023-2025. Accessed November 9, 2023. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2023.pdf
  3. Davidson KW, Barry MJ, Mangione CM, et al. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(19):1965-1977.
  4. Wolf AMD, Fontham ETH, Church TR, et al. Colorectal cancer screening for average risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018;68(4):250-281.
  5. Shaukat AK, Kahi CJ, Burke CA, et al. ACG clinical guidelines: colorectal cancer screening 2021. Am J Gastroenterol. 2021;116(3):458-479.
  6. Patel SG, May FP, Anderson JC, et al. Updates on age to start and stop colorectal cancer screening: recommendations from the U.S. Multi Society Task Force on colorectal cancer. Gastroenterol. 2022;162(1):285-299.
  7. American Cancer Society. Colorectal Cancer Facts & Figures 2020-2022. Accessed July 13, 2023. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2020-2022.pdf
  8. National Cancer Institute. Asymptomatic Multi-Cancer Detection: Advancing Cancer Screening to Save Lives. Accessed September 1, 2023. https://www.cancer.gov/research/annual-plan/scientific-topics/asymptomatic-multi-cancer-detection
  9. Rex DK, Boland CR, Dominitz JA, et al. Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi Society Task Force on colorectal cancer. Am J Gastroenterol. 2017;112(7):1016-1030.
  10. Winawer SJ, Fletcher RH, Miller L, et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterol. 1997;112(2):594-642.
  11. Levin TR, Corley DA, Jensen CD, et al. Effects of organized colorectal cancer screening on cancer incidence and mortality in a large community based population. Gastroenterol. 2018;155(5):1383-1391.
  12. Siegel RL, Wagle NS, Cercek A, et al. Colorectal cancer statistics, 2023. CA Cancer J Clin. 2023;73(3):233-254.
  13. National Colorectal Cancer Roundtable. 80% In Every Community. Accessed February 26, 2023. http://nccrt.org/
  14. Siegel RL, Miller KD, Wagle NS, et al. Cancer statistics, 2023. CA Cancer J Clin. 2023;73:17-48.
  15. Exact Sciences Corporation. Leadership Connections with Kevin Conroy Interview with Dr. Bert Vogelstein. Internal Presentation. April 2022. Madison, WI. Accessed September 9, 2022.
  16. Late stage cancer detection in the USA is costing lives. Lancet. 2010;376(9756):1873.
  17. Kakushadze Z, Raghubanshi R, Yu W. Estimating cost savings from early cancer diagnosis. Data. 2017;2(3):30.
  18. American Cancer Society. Colorectal Cancer Stages. Accessed September 01, 2023. https://www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-staging/staged.html#how-is-the-stage-determined