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Press Briefing Transcript

Vital Signs Telebriefing on Colorectal Cancer Screening

Tuesday, November 5, 2013 at 12:00 noon E.T.

OPERATOR: Welcome. And thank you for standing by. I'd like to inform our parties that your lines have been placed in a listen-only mode until the question and answer session of today's call.  Today's conference is also being recorded.  If you have any objections, you may disconnect at this time. I would now like to turn the meeting over to your host, Mr. Tom Skinner. Sir, you may begin. 

TOM SKINNER: Thank you, Calvin, and thank you all for joining us today for the release of another CDC Vital Signs. This one is on colorectal cancer screening tests used in the United States, year 2012. We're joined today by the director of the CDC, Dr. Tom Frieden, who will provide some opening remarks, and then he will be joined by Dr. Marcus Plescia, last name is spelled p-l-e-s-c-i-a, who is the director of CDC's division of cancer prevention and control.  He will join Dr. Frieden and help answer your questions. So at this time I’d like to turn the call over to Dr. Frieden. 

TOM FRIEDEN: Good afternoon, everyone.  Thank you all for joining us for this month's Vital Signs report.  Each month we focus on the latest data about a critical health issue facing the country and what can be done about it. This month we're addressing the really disturbing fact that despite research that shows that colorectal cancer screening saves lives, screening rates remain far too low.  In fact, about one in three adults aged 50 to 75 have not been screened as recommended by the U.S. Preventive Services Task Force. That translates to 23 million people, 23 million people who are at risk from preventable colon cancer. Now, colon cancer is the second leading cancer killer among both men and women, and, in fact, it's the leading killer of nonsmokers in this country.  It kills about 50,000 people a year, and there's a bottom line to today's briefing. Not only are levels of screening too low, but we know that because screening works, because screening can prevent cancer or detect it at an early stage when treatment is highly effective, we know that we can increase colorectal cancer testing. There are different test options for people that are affected. The bottom line is, the best test is the test that gets done.

Now, many people have heard about colonoscopy, which is one test, and we're delighted to have seen the big increase in colonoscopy screening in recent years. There's another test option called FOBT or FIT test. That's an at-home test that's done, and as far as all of the scientific evidence shows, it's equivalent to colonoscopy in saving lives when used correctly. Now, colon cancer is something that I have a particular concern about.  I personally have a strong family history of colon cancer.  I was first screened for it at 40, again at age 50, when I had multiple polyps, which were removed.  I'm now polyp free. But colon cancer is something that you should not take for granted, something that you should not avoid thinking about. It's important to get tested. We want adults age 50 and older to get screened for colon cancer because that saves lives. Now, the two most commonly used tests are colonoscopy, and a fecal occult blood test or a fecal immunochemical test, FOBT or FIT. Colonoscopy can detect cancer early and it can find precancerous polyps so they can be removed before they turn into cancer. An FOBT or FIT test is a simple at-home test that can detect cancer early by finding blood in the stool. Studies show that when people are given more choices, they're more likely to get screened. That's a key bottom line. More choices will lead to more progress. So there is an opportunity to further increase colorectal screening and save more lives.  We encourage health care providers to talk with their patients about colon cancer screening and about the choice of tests. 

This Vital Signs report includes colorectal cancer screening data for all 50 states, from CDC's 2012 BRFSS. And those findings are really quite striking. We find that although overall the rate is about 65, 66 percent, there's a plus/minus ten percent in different states in the U.S. So where you live, unfortunately, determines far too much whether you're going to get screened for and get your colon cancer prevented. All way up to 76 percent in the highest performing state, and all the way down to 56 percent – a 20 percentage point difference – in the lowest performing states. Now, as I mentioned, about 23 million adults are not getting screened for colon cancer with any test, and the great majority of them have never been screened. That's the number who are not up to date but an overwhelming majority of those who are not up to date in fact have never been screened. Among people who have been screened as recommended, by far, colonoscopy is now the most common screening test, about 62 percent. Use of other tests was much lower, about ten percent, while flexible sigmoidoscopy combined with fecal screening tests is now less than one percent. We've learned that most states with higher overall screening rates also had a relatively higher use of both fecal tests and colonoscopy, and we believe that there are key approaches that can result in increased screening rates, more cancer prevented, more lives saved. For example, health care systems can expand the use of organized screening systems to identify everyone eligible for screening. They can reach out to people in their homes by, for example, mailing out a reminder or an actual test, or in a community setting, and carefully monitor patient's adherence to completing the test as well as following up on any abnormal test. Also, we think there are lots of things that the public health community can do by increasing communication, outreach, and other ways of informing people of the importance of colorectal cancer screening. CDC provides funding to 25 states and four tribes across the U.S. to increase colorectal cancer screening rates in men and women aged 50 and above.

The bottom line is that colorectal cancer screening saves lives. There are effective options in addition to colonoscopy. We encourage health care providers to talk with their patients about getting tested and about the choice of tests. Through the Affordable Care Act, more Americans will have access to health coverage, and preventive services such as colorectal screening tests will be available at no cost to the patient. The bottom line here is, again, that the best test is the test that gets done. So thanks for joining us today. The issue of colon cancer prevention is really important. And we look forward to answering your questions. 

TOM SKINNER: Calvin, I believe we're ready for questions, please. 

OPERATOR: Thank you, sir. At this time if you would like to ask the question, please press star one on your telephone keypad.  Please record your name at the prompt.  Again, that is star one to ask a question. Jonathan Serrie, with Fox News. Your line is open. 

JONATHAN SERRIE: Thank you. Good morning, Dr. Frieden. The report and you suggest that no screening strategy has been shown to be superior than the others when you weigh the risks and benefits, but if you could hypothetically eliminate noncompliance as a factor, would there be a preferred method or are these still equally good screening strategies? 

TOM FRIEDEN: Well, there are some scientific studies that are still under way comparing one screening strategy with another. And remember that they're not completely unrelated. So just to back up a bit -- if someone has a strong family history of colon cancer or has polyps or a personal history of a disease such as inflammatory bowel disease, then colonoscopy is clearly preferred.  However, for everyone else, and that's the great majority of people, there is no proven benefit of one versus the other approach. Many people who undergo a home stool blood test, if they are found to have stool in their blood, will undergo a colonoscopy. So I think for either situation it is really important to ensure that there's follow-up. Even if you have a colonoscopy and have polyps removed, it's important to have a repeat colonoscopy. So both the at-home stool blood test and colonoscopy saves lives.  Again, bottom line, best test is the test that gets done. 


OPERATOR: Our next question comes from Mike Stobbe with Associated Press. Your line is open. 

MIKE STOBBE: Hi. Thank you for taking the question.  I just want to make sure I had this right.  So this report says that there was -- that it was 65 percent in 2012 which was about the same as 2010.  When was the last time that there was no significant increase according to BRFSS data? Was it 2002 or was it earlier than that? 

TOM FRIEDEN: That's a little bit of a complex question. The methodology of the BRFSS changed between those two studies. And we began correcting for things like cell phone only households and other correction factors that make it impossible for us to have a valid fact comparison with earlier BRFSS studies. So while it does appear that there may be a slowing of the increase in colorectal cancer screening, we're not able to say that from this data because we can't give longitudinal data from the BRFSS. 

MIKE STOBBE: Okay. Setting that aside, could you tell me when was the last time that there wasn't an increase in the annual -- the biannual rate? 

TOM FRIEDEN: Dr. Plescia, do you have that offhand, or if not--? 

MARCUS PLESCIA: Yeah, there's been consistent -- there's been consistent increases in the biannual rate since 2002. Prior to that, I think our data is not, again, not as comparable because of some of the changes in the methodology. We've been seeing colorectal cancer screening rates go up gradually for the last decade. 

MIKE STOBBE: Thank you. 

TOM SKINNER: Next question, Calvin, please. 

OPERATOR:  Thank you. Once again, if you would like to ask a question, please press star one on your telephone keypad. Our next question comes from Betsy McKay. Your line is open. 

BETSY MCKAY: Okay, thanks. Yeah, I found it interesting that colonoscopies have increased, the rate has increased, but the other tests have decreased over the past ten years. I wondered if you could -- either of you could talk about why that is, and do you think -- how do you think that might change going forward, you know, will coverage of preventive screenings under the ACA change that, will doctors or insurers encourage the less expensive, less invasive tests for the majority of the population that -- or the part of the population that doesn't have a strong family history or other factors that would call for a colonoscopy? 

TOM FRIEDEN: I’ll make one point and then turn it over to Dr. Plescia to answer beyond that and add anything more if there's anything I want to add.  One point I want to make clear is that even though an individual does a blood test or fit test is much less expensive than an individual colonoscopy.  If you look at the screening technologies, there's not necessarily a big difference in the overall cost.  The stool blood test needs to be done every year, so that increases the cost as opposed to an every ten-year or maybe every five-year colonoscopies.  And any positives need to be followed up with colonoscopy.  So it's not clear if it's saving money to do one or the other but it is clear that doing either saves lives. Dr. Plescia? 

MARCUS PLESCIA: Yeah.  The fact that -- we think it's fantastic that we see are seeing rates go up and we think it's great that people are participating in more and more often in colonoscopy.  What is a little concerning to us is that we're not seeing that uptake in fecal blood test, the test that you can do at home.  And we're concerned about that because, you know, it's good for people to have options and it's a very different kind of test.  And we actually know from other studies that if you explain the two tests to people and ask which one they would like to have done, anywhere from 25 percent to 50 percent of people would opt for the -- for the FOBT, the test that you can take and do at home.  So the fact that we're only seeing 10 percent leads us to believe we need to do things to make sure people know that test is an option as well.  Now, there is some data that suggests that a lot of physicians feel that colonoscopy is really the superior test and they're tending to offer that to their patients more often.  And that really is not accurate and a lot of the reason that we published this particular report is we want to really communicate to clinicians and also to the public that there are two choices out there and they're both very good tests and it's really, as Dr. Frieden said, the best test is the one that gets done. 

TOM SKINNER: Next question, Calvin. 

OPERATOR: Our next question comes from Steven Reinberg with HealthDay.  Your line is open. 

STEVEN REINBERG: Yes.  What are the barriers that are keeping people from -- more people from getting screened? 

 TOM FRIEDEN: Well, when we've asked what are the main barriers of screening, the number one barrier is that the doctor didn't give clear advice to get screened.  So one thing we find is that really people are not being -- are not having the suggestion to get screened by their doctor.  And we know that if you look at the different systems out there, there are systems like the VA, like Kaiser that get to 75 percent, 80, even over 80 percent screening as opposed to the 65 percent that we have nationally.  I think that the health care system can do a lot to increase screening rates.  In fact, some of the key interventions the health care systems can do include focusing on this as a priority, defining their target populations, being specific about what the policies will be having clear protocols, having a management team that's responsible for implementation and systematically tracking how they're doing.  And so the leading risk factor is a health care system that isn't making screening a priority.  But it's also important that individuals learn about the testing options, get the test that's right for them, know their family history, encourage friends and family to get tested.  There are lots of things that can be done.  We also know that not having health insurance greatly reduces the likelihood that someone will get tested.  That's why increasing coverage is another way of saving lives. Dr. Plescia, anything you would like to add? 

MARCUS PLESCIA: I think what Dr. Frieden just said, that it's really, I think, about making getting these tests as easy as possible.  That's why we think giving people a choice of the two tests, you know, some people are not going to participate in testing if it requires colonoscopy.  Sometimes because they can't afford it, sometimes because they just don't want to do that test.  That's why it's so important that there's a second test that they can do as well.  But there's lots of other things that we can do to make testing easier and Dr. Frieden mentioned many of those.  I think that's a big role for public health and many of the public health agencies across the nation. 

TOM SKINNER: Calvin, next question? 

OPERATOR: Thank you.  Next question comes from Michelle Healy with USA Today.  

MICHELLE HEALY: Hi, Dr. Frieden.  Can you please discuss a little bit more about some of the concerns and fears associated with the invasiveness of colonoscopy and the associated risk? 

TOM FRIEDEN: I think one of the things that people are concerned about with colonoscopy is the preparation, quite frankly.  It's unpleasant.  And some people just don't want to go through it.  Some people don't like the idea of the procedure itself.  And that's why for some people at-home tests for blood in stool will be a preferable way to get tested.  One of the things we're emphasizing in today's report is that as per the U.S.  Preventative Services Task Force, either screening mechanism, either screening technique, is equivalent, is acceptable.  So the more choices people have, the more progress we're going to make.  There are-- people may have fears or concerns or just don't want to deal with the colonoscopy.  Dr. Plescia, anything more you would like to add to that? 

MARCUS PLESCIA: No, you know, there is -- colonoscopy is an invasive test so there's a moderate risk but it really is a small risk.  I think the bigger issues are the issues that Dr. Frieden just mentioned. 

TOM SKINNER: Next question, Calvin? 

OPERATOR: I’m showing no further questions at this time. 

TOM SKINNER: Okay.  Do you want to instruct callers one more time on how to ask a question and we'll pause and then if there are no further questions, we'll have Dr.  Frieden conclude our call. 

OPERATOR: Certainly.  Once again, if you would like to ask a question, please press star 1 on your telephone keypad.  Star 1 to ask a question. 

TOM FRIEDEN: Okay.  Well, assume that we're not going to have more questions --


TOM SKINNER: I’m sorry? 

OPERATOR:  We do have a couple of questions.  Next question comes from Maureen McKinney with Modern Healthcare.  Your line is open. 

MAUREEN MCKINNEY: Hi.  Thanks so much for taking my question.  I wanted to know, can you tell me a little bit more about how people access these at-home tests and is it something that they have to be prescribed?  What's the availability of those tests and are there -- are there any sort of initiative that, you know, try to make them more available to people or is that sort of thing or is it something they only get at their doctor?  I know sometimes you said they can be sent out but I wanted to know is the provider the only person that can get that or can people go and get them themselves? 

MARCUS PLESCIA: So in most situations, to get the fecal colon blood testing, you need to get it from your doctor.  This is one of the things we mentioned that we think we can do more work to make this easier and look at other ways to make these tests more available.  For the people in the Veterans Administration, the tests are automatically given out whenever you go in to see a doctor at the VA.  A number of the managed care companies in the United States have started to move towards using these tests.  And those programs you will receive the test in the mail automatically.  They send them to everybody who is eligible for -- for colorectal cancer screening.  And then there's also been a limited number of cases where they began offering the take-home tests at health fairs and the most interesting one is now in some places when you go to get your flu shot you also might be offered the cards there, as well.  So, you know, these are some early attempts but this is the kind of thing that I think that if we were much more aggressive about and, you know, it's a matter of making it easy for the people to participate in the tests.  This is what we would like to see more of. 

TOM SKINNER:  Next question, Calvin? 

OPERATOR:  Our next question comes from Ryan Jaslow with 

RYAN JASLOW: Oh yes. Thank you so much.  I notice the report looks specifically at adults over 50, is there a reason to believe that some of the younger, more high-risk adults with family histories are falling through the screening gaps, as well? 

TOM FRIEDEN: Dr. Plescia?

MARCUS PLESCIA: The data is not entirely clear on that.  There is some concern that in some patients who have particularly high risk for colon cancer perhaps the screening age should be moved to a younger age.  Perhaps have people start screening at age 45 or even younger.  But at the present time there's no specific recommendations from the U.S. Preventive Services Task Force on that.  So for the purposes of this particular analysis and study, we were just looking at patients who were older than the age of 50. 

RYAN JASLOW: Thank you. 

TOM SKINNER: Calvin, if there's no more questions we'll have Dr. Frieden conclude our call. 

TOM FRIEDEN: Thank you all very much -- sorry?  Go ahead. 

OPERATOR: Sorry.  I'm show nothing further questions. 

TOM FRIEDEN:  Thank you very much.  Thank you all for joining this call.  Again, colon cancer is an important problem.  It kills more nonsmokers in this country than any other cancer.  And unlike some other cancers, actually the vast majority of colon cancers are preventable with technologies that we have today.  The main two screening tests being used for colon cancer screening are colonoscopy and at-home test to check for blood in the stool.  Either of those tests are equivalent in preventing colon cancer and saving lives as per our best information today.  That's why we're encouraging patients and their providers to recognize that colon cancer screening is important, there's still more than 20 million Americans who haven't been screened or aren't up to date with their screening, and the test that is done is the test that is best for you.  So if you haven't been screened or haven't been screened recently, if you're 50 to 75 or under 50 with a very strong family history, by all means, see your provider about getting screened.  It could really save your life.  Thank you all very much. 

TOM SKINNER: Thank you, Dr. Frieden.  And, Calvin, this concludes our call.  Reporters who have additional questions or need additional information may call the CDC office at 404-639-3286.  Thank you. 

OPERATOR: That concludes today's conference.  You may disconnect at this time.  Thank you for your participation.  


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