Cancer Screening - Colorectal Cancer Screening

Why Is This Important?

Of cancers that affect both men and women, colorectal cancer is the second leading cause of new cancer cases and cancer deaths in New Mexico. Colorectal cancer screening can significantly reduce colorectal cancer mortality through early detection, when treatment tends to be most effective. Colorectal cancer screening can also actually prevent colorectal cancer by detecting and removing polyps in the colon or rectum that could become cancers in the future.

Definition

Estimated percentage of New Mexican adults ages 50-75 years who are current with colorectal cancer screening recommendations. An individual is considered current if they have had a take-home fecal immunochemical test (FIT) or high-sensitivity fecal occult blood test (FOBT) within the past year, and/or a flexible sigmoidoscopy within the past 5 years with a take-home FIT/FOBT within the past 3 years, and/or a colonoscopy within the past ten years. The colorectal cancer screening questions are only administered in the BRFSS in even-numbered years.

Data Sources

• Behavioral Risk Factor Surveillance System Survey Data, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, together with New Mexico Department of Health, Injury and Behavioral Epidemiology Bureau.
  (https://www.nmhealth.org/about/erd/ibeb/brfss/)
• U.S. data source: Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System (BRFSS) Prevalence and Trends Data.
  (https://www.cdc.gov/brfss/brfssprevalence)

How the Measure is Calculated

How Are We Doing?

The percent of New Mexican adults ages 50-75 years who are current for colorectal cancer screening has increased over the past decade.

How Do We Compare With the U.S.?

Comparable rates for current with colorectal cancer screening recommendations are only available for 2014 at this time. In 2014, a lower percentage of New Mexicans reported being current with colorectal cancer screening recommendations compared to the United States overall.

What Is Being Done?

A goal of the New Mexico Department of Health Comprehensive Cancer Control Program is to reduce the burden of colorectal cancer in New Mexico by promoting evidence-based public health initiatives designed to increase the overall rate of New Mexicans ages 50-75 years who are appropriately screened for colorectal cancer.

Evidence-based Practices

The New Mexico Department of Health Comprehensive Cancer Program supports health care providers and health systems across the state in using evidence-based interventions such as patient reminders, risk assessment tools, reducing structural barriers (e.g., expanding clinic hours), provider reminder and recall systems, and provider assessment and feedback on performance. All of these activities have been shown to increase colorectal cancer screening rates and are recommended by The Guide to Community Preventive Services, a collection of evidence-based findings of the Community Preventive Services Task Force, established by the U.S. Department of Health and Human Services.

Other Objectives

New Mexico Cancer Plan 2012-2017 Objectives: By 2017, increase by 15% the proportion of NM men and women ages 50 through 75 who are up-to-date with colorectal cancer screening, from a 2010 baseline of 59.8% to 68.8%.

More Resources

New Mexico Department of Health Comprehensive Cancer Program (http://archive.cancernm.org/ccp/) U.S. Preventive Services Task Force Recommendations website (https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/colorectal-cancer-screening2?ds=1&s=colorectal cancer) Centers for Disease Control and Prevention (https://www.cdc.gov/cancer/colorectal/basic_info/risk_factors.htm) The Community Guide to Preventive Services (https://www.thecommunityguide.org/findings/cancer-screening-multicomponent-interventions-colorectal-cancer)

Health Program Information

In June 2016, the U.S. Preventive Services Task Force (USPSTF) released its updated recommendation, which continue to recommend screening average risk adults ages 50-75 years for colorectal cancer. The updated recommendation addressed some of the same screening methods endorsed by the previous (2008) USPSTF recommendation, including annual testing with a take-home kit using either a high-sensitivity guaiac-based fecal occult blood test (FOBT) or fecal immunochemical test (FIT), or having a colonoscopy every ten years. The updated recommendation also reviewed evidence for methods of screening not previously endorsed, including flexible sigmoidoscopy every ten years plus annual FIT; CT colonography or flexible sigmoidoscopy every five years; or testing every one or three years with a FIT-DNA test. Of note, the USPSTF found no head-to-head studies demonstrating that any of these screening strategies are more effective than others, although they have varying levels of evidence supporting their effectiveness, as well as different strengths and limitations. Unlike its previous recommendations for colorectal cancer screening, the USPSTF's updated recommendation does not endorse a specific list of screening options. Rather, it notes that the risks and benefits of these screening methods vary considerably in terms of frequency, cost, availability, single-test accuracy, convenience, and potential serious complication - leaving it up to clinicians and patients to use this information to choose a screening method. A modeling study included in the updated 2016 U.S. Preventive Services Task Force recommendations predicted that using any one of the following four screening strategies will have a comparable balance of life-years gained, potential harmful complications, and screening burden, assuming 100% adherence: annual FIT; flexible sigmoidoscopy every ten years plus annual FIT; CT colonography every five years, or colonoscopy every ten years. Before 2010, the BRFSS did not differentiate between sigmoidoscopy and colonoscopy when asking respondents about colorectal cancer screening. Therefore, in 2002-2008 an individual was considered current with colorectal cancer screening recommendations if they had either a take-home FIT or high-sensitivity FOBT within the past year, and/or a flexible sigmoidoscopy within the past 5 years with a take-home FIT or high-sensitivity FOBT within the past 3 years, and/or a colonoscopy within the past 10 years.