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Press Briefing Transcript

CDC Media Availability on Vital Signs Report on Cancer Screening

Friday, July 2, 2010 – 1:30pm ET

Operator: Welcome, and thank you for standing by. At this time, all participants will be on a listen-only mode. During the question-and-answer session, please press star and 1 on your touch-tone telephone. You will be prompted to record your name in order to be entered. Today's conference is being recorded. If you any objections, you may disconnect at this time. I would like to turn the call over to Glen Nowak. Sir, you may proceed.

Glen Nowak: Thank you. And thank you all for joining us on this Friday before a holiday to talk about a new report that CDC will be issuing on the first Tuesday of every month. It's "CDC Vital Signs," and this "Vital Signs" report today focuses on colorectal and breast cancer screening. And before I turn this media availability over to Dr. Thomas Frieden and Dr. Marcus Plescia, who's the director of CDC's Division of Cancer Prevention and Control, I want to just note a couple things about "CDC Vital Signs." One is it will be coming out, we expect, the first Tuesday of every month. We expect that we will be sending this to an embargo copy of the materials to the media on the Monday before that, and the materials would be embargo until 12:00 noon on Tuesday. This is a little bit unusual, because for us, July 5th is a federal holiday, and as a result, we sent these materials out today, and we will also be updating some of the materials later this afternoon. So, I would say look for a slightly updated version of the press release. We found some things we want to correct and we'll be sending that out, and we may speak to that in this call. It has to do with estimates and Dr. Frieden will probably touch upon that in his remarks. But going forward, you can expect to see the "Vital Signs" the first Tuesday of every month. You can expect the materials on an embargoed basis the Monday before that and we will probably be holding media availabilities or telebriefings with our "CDC Vital Signs" report. With that, I will turn the phone over to Dr. Thomas Frieden, who will talk about this "vital signs" effort and the "vital signs" report that we are issuing this week or next week.

Thomas Frieden: Good afternoon, everybody, and welcome. Hope you all have a wonderful and safe holiday weekend. This really is the inaugural issue of a new program to get the most important health information out in a way that makes clear how we're doing. Just as your own personal physician would monitor your blood pressure and other vital signs, these are the most important indicators of how we as a country are doing. We'll be covering over the year cancer prevention, obesity, tobacco use, alcohol use, access to health care, HIV/AIDS, motor vehicle safety, healthcare-associated infections, cardiovascular health, teen pregnancy along with infant mortality, asthma and food safety. And in each area, we have a large burden of disease, we have a lot of things that we can do to make a difference, prevent illness, prevent injury, prevent death, save money, drive down our health care costs, and we have a lot of variability. Are we making progress? Are we not? Are we making progress in some areas geographically or demographically over the country?

So, starting with colon cancer and breast cancer. Colon cancer. More Americans who don't smoke are killed by colon cancer each year than from any other cancer. And colon cancer is largely preventable. Most deaths from colon cancer could be prevented by screening technologies that are availability today. And this is something that is really only a recognition over the past few years and we're encouraged by a significant increase in colon cancer screening rates over recent years. So the MMWR, which you have the advance copy of, in figure 2 shows a steady increase in overall screening rates from around 50% over a six-year period of time to a significant increase. You can also see that there's been a big change in colon cancer screening, decreased use of fecal blood screening and increased use of lower endoscopy. At CDC, as with the general recommendations, any screening is good, and the overall increase is the main message there. Nevertheless, there is a lot more progress that we could make with colon cancer screening. There are more than 20 million Americans between the age of 50 and 75 who need to be screened who may have cancer growing within them who, if they were screened, could have it taken out before it spreads or take a growth out before it became cancerous who have not been screened. And we're confident that this number will continue to increase. It has been increasing. And changes in our health reimbursement system, including the withdrawal of co-payments for recommended screening programs such as colon cancer screening will, we think, make a difference. We know, as you can see from the "Vital Signs" summary, that there's a big difference in coverage for people in access or proportion screening for people who have or don't have coverage and at different levels of economic status. So, a lot more progress can be made, but a lot of progress has been made with colon cancer. And in terms of cancers, some of the numbers are complex because they have to do with models, but the bottom line is, more than 20 million people need to be screened. And if they were, that would save thousands of deaths per year. In terms of mammography, moving from colon cancer to breast cancer, we've seen really a leveling off or plateauing of breast cancer screening rates and quite a bit of variability around the country in the level of screening, higher in the – on the coasts, lower in the middle to a general extent. And we know that there was a much lower rate of screening in women who are uninsured and in certain racial and ethnic groups and by educational status and income as well as by geographically, and we know that mammography does prevent breast cancer and prevent the spread of breast cancer and saves lives, so we want to see that continue to increase. I'd like to turn it over to Dr. Marcus Plescia, who's the director of our program before we open it up for questions.

Marcus Plescia: Good afternoon. I'll just summarize a couple of the main findings from this report and then talk for a couple of minutes about the activities CDC is engaged in to try to have an impact on this issue. I think the two key elements that Dr. Frieden has gone over that stand out in his report are the low utilization rates for what are highly effective screening tests for colorectal cancer and then the persistence of a number of disparities, disparities in screening use based on race/ethnicity, disparities based on insurance and lack of insurance, and disparities based across geographic regions. CDC has been—has known—we have all known for some time that the utilization rates for colorectal screening are low. CDC has responded by launching demonstration programs to implement evidence-based interventions at the community level and to define best practices. In 2009, we increased our efforts by funding 22 states and 4 tribal areas to implement population-based programs to improve colorectal cancer screening across the nation. CDC programs have also contributed significantly to the national improvements that we've seen in mammography screening, particularly in underserved populations. Over the last two decades, CDC has provided funding to every state to provide screening services for uninsured women. Since 1991, this has resulted in over 8.8 million exams being provided to women who lack insurance. Moving forward into the future, CDC hopes to take advantage of opportunities to further expand our population-based approaches to improving cancer screening, and this approach will include a wide range of strategies, including improved surveillance, targeted outreach, patient navigation and health care systems change, particularly health care systems change that help the health care system take a much more systemic approach to screening interventions.

Thomas Frieden: all right, and just before I open it for questions, I would like to note that although the "Vital Signs" publication and the MMWR that you got are final and we don't anticipate any changes, the press release has two lines in it which will be changed in the final updated version, which will come around in about an hour. First, the headline, the second line of the headline, where it says "more than 30,000 people" – that estimate is in the literature, but there are various estimates and we'll just change that to "thousands of people." And in about the middle of the page, in the second quotation from me, we'll just delete the second line, which talks about the number of lives saved. I don't want to get into – there is some academic debate about exactly how many, and it involves modeling, and we'd rather stick with the basic numbers that we're certain are accurate. We know that many, many lives could be saved, particularly with an increase in colon cancer screening. More than a third of Americans who need to be screened haven't been screened. And at that, I'll open it up for questions. Or operator, I guess, needs to open it up for questions.

Operator: Thank you. At this time, if you would like to ask a question, please press star 1 on your touch-tone telephone. You will be prompted to record your name in order to be introduced. That's star and 1. Our first question comes from Mike Stobbe from Associated Press. Your line is open.

Mike Stobbe: Hi, doctor. Thanks for taking the question. Two questions, actually. Regarding the increase in colorectal cancer screening, we've heard and read about the Couric effect? I was wondering if that was still in play or if that was enough years ago that that's no longer an influence on increased screening. And my second question was about the breast cancer screening holding around 81 percent. Is it possible that that's as high as it's going to go? Is there just a certain level above which that a certain proportion of humans just won't do the – won't get screening?

Thomas Frieden: Well, in terms of your first question, the Couric effect is real. It's been demonstrated through the data. And for those not familiar, when Katie Couric publicized the importance of colon cancer and had an on-air colonoscopy, there was a bump in the number of people who had a colonoscopy, and that bump continued to rise. So, I think that has contributed to the increase. In terms of – I don't think there is a ceiling effect for cancer screening. No one wants to get cancer. And if you look at the barriers to cancer screening, it's access, sometimes it's health care systems. We've seen many health care systems around the country that have been able to greatly increase screening rates and screening efficiency through the use of things like registries and patient navigators, patient investigation, systemic follow-up, process improvements in colonoscopy, which result in the ability to complete comprehensive and systemic colonoscopy on a larger number of people in the same period of time with the same infrastructure. So, I don't think we've gotten to a plateau. We have further to go. And public education, such as Katie Couric did with her work, can have a major role.

Operator: Our next question comes from Maggie Fox from Reuters. Your line is open.

Maggie Fox: I wanted to ask about that 30,000 number, which is now disappearing. If you just go with a vague thousand, we're going to have to put a number somewhere, so we're going to have to look up the 30,000 number. Is there any way that we can have something from you that we can put in that's clearer than just thousands?

Thomas Frieden: What we do know is that last year, or the most recent year that data's available, 2006, more than 50,000 people died from colon cancer. What is debated is exactly how many of those would be prevented by colon cancer screening getting to as high as as plausibly expected. You can argue for 10,000, you can argue for 15,000, you can argue for 30,000. I think most people would indicate some of those cases are beyond the age at which we would recommend screening, but whether they would occur if we screened in that age group is not known, and there are people who over the age of 75 get screened. So, I think we can certainly say more than 10,000 very comfortably. Whether it's 10,000 or 20,000 or 30,000, I think for every individual who dies of preventable deaths from colon cancer, it's one too many.

Maggie Fox: Thank you.

Marcus Plescia: We should also note that in previous significant reductions that we've seen in colorectal cancer mortality, particularly the reductions from 1975 to 2000, we are now having pretty good estimates. Probably about half of that reduction came from improvements in screenings. So, we do think there's the potential with that 53,000 number to have an even bigger impact. It's just as Dr. Frieden said, we're not sure if there are some people in that number who just wouldn't benefit from screening.

Operator: Our next question will come from Lisa Stark with ABC news.

Lisa Stark: Thank you so much for taking my question. I know this is a little bit out of the scope of the reports, but I'm wondering, do you have any estimates on what it would cost to have this additional screening, what the health care cost is of that, if you had the numbers of people doing them, the mammograms and the colon screening that you would like?

Glen Nowak: I'll turn it first over to Marcus and have him answer that question.

Marcus Plescia: Yeah, so, some of the cost-saving estimates are difficult because some of the up-front costs of screening are fairly significant, particularly for tests like colorectal cancer, and then we tend to not see the savings until further on. We do have studies that look at the cost per life saved of colorectal cancer, and I can't quote that number right now, but I do know that that number generally meets what we see as the standard for what is considered a reasonable practice economically.

Thomas Frieden: Colon cancer screening can be done by a couple of different means that have different pros and cons, but they're all effective at reducing colon cancer and reducing colon cancer deaths. What we often look at is the cost per life saved, and colon cancer screening does quite well in that regard. I think all of us would be willing to see our system spend a few thousand dollars to save a life, and that's in at least one of the estimates. That's the kind of range that we're talking about for year of life saved.

Glen Nowak: Operator, next question?

Operator: Our next question comes from Nick Mulcahy from Medscape. Your line is open.

Nick Mulcahy: Yeah, hi, this is Nick Mulcahy from Medscape. I have a few questions starting with housekeeping. When does the embargo lift on this? As of right now, I see on the press release it says something about Tuesday at –

Glen Nowak: Tuesday at 12:00 noon. And the reason – we would normally, as I mentioned early in the call, we would normally be sending these materials out on a Monday, but Monday is a federal holiday for us, so we wanted to make sure the media got these, versus getting them on a Tuesday morning.

Nick Mulcahy: Okay. Here's a question about colorectal cancer screening. The occult blood test costs pennies. The scope costs thousands. What's the difference in terms of their ability to detect something and why aren't you championing the one that costs pennies? Especially, correct me if I'm wrong, I think it just leads you on to get a scope, but it's like a first, like, cruder test. Wouldn't it be cost-effective and sensible to be championing that test?

Marcus Plescia: This is Marcus Plescia. They're both effective tests, they are both recommended by the U.S. Preventive Services Task Force. The issue with the occult blood testing is, you're right, although the tests are relatively inexpensive, many of those tests that come back positive have to go on, and that individual has to have a colonoscopy to follow up a test. And in the cases of colonoscopies, many of those turn out to be negative. So, it's little misleading when you look at the cost of the occult blood testing, it's small, but when you add in the cost for all the follow-ups, some of the projections suggest that you really come up with a fairly similar cost.

Thomas Frieden: Particularly since the occult blood testing is annual, which may require follow-ups and doctor visits and colonoscopy maybe every ten years. So, it's not such a clear-cut case, and we want to give both patients and physicians options and also address the different context that people get care in. There are some areas of the country where there is ample capacity for colonoscopy screening. There's others where it would be challenging to offer that to everyone.

Nick Mulcahy: I have a question also about breast cancer. Can I ask a second question?

Glen Nowak: Sure.

Nick Mulcahy: Okay. I've never seen the rate of participation in mammography at 80 percent. I thought it was like 70 percent, and then I sort of remember the Komen organization, you know, raising a red flag maybe a year or two ago because it had dropped down to 66 percent, just kind of like this vague memory here. So, then when I saw 80 percent rate of participation – can you define what that means exactly and then where that number comes from? And is it higher than we've seen ten years ago, two years ago or et cetera? Can you just give some context for that number?

Glen Nowak: Sure. This is Glen. I'll have Dr. Plescia start.

Marcus Plescia: Yeah, there are a variety of different ways of tracking breast cancer screening rates. We have taken our data from the Behavioral Risk Factor Surveillance Survey. The main reason we use that survey is it's a very large survey that's done in every state. So, this is the only survey that provides us with state-specific data. Now, some of the rates that you've seen may have come from the Health Interview Survey.

Nick Mulcahy: Yes, that's right.

Marcus Plescia: It's a very different methodology used with that survey. We do tend to see lower rates with that. What's important with this is the surveillance tests of what we're interested in is trends, and the trends hold true, regardless of which survey you're using, and the trends for mammography are going up. Gone up a little bit recently, at least.

Nick Mulcahy: So, the whole Komen scare, I really do remember them getting all over the press, carrying on, you know, talk shows on the morning, talking about a drop in participation in breast cancer screening. That was just a blip?

Marcus Plescia: Well, there was a little bit of a downturn a couple of years ago, but those rates have come back up in both of the survey methodologies.

Nick Mulcahy: Okay, thank you.

Marcus Plescia: There was a great deal of concern about that. We took that very seriously.

Nick Mulcahy: Okay.

Glen Nowak: And I think the other key point is regardless of which method, both methods show a large number of people still need to be screened. Operator, are there any other questions?

Operator: At this time, I am showing no further questions.

Thomas Frieden: Okay. Thank you all very much. We appreciate you tuning in, and tune in next month for obesity. But I do just want to reiterate that too many Americans die from cancer. It's the second leading cause of death in this country, and actually, the leading cause of early death in this country. Many of those deaths could be prevented. Some of them by things we're not talking about here – smoking cessation for lung cancer are a leading cause of death, but the leading cause of death in nonsmokers is colon cancer, and the leading cause of death in the second leading cause of cancer death in women is breast cancer, and we have much further to go with screening for both of those entities.

Glen Nowak: Thank you all and have a good Fourth of July weekend.

Operator: Thank you. That does conclude today's conference call. You may disconnect at this time. And thank you for participating.

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