Cancers Diagnosed at Late-Stages Despite Available Screening Tests
Almost half of the colorectal and cervical cancer cases and a third of the breast cancer cases in the United States are diagnosed at late-stages of the diseases when treatment is more difficult, according to a new report released today by the Centers for Disease and Control and Prevention. The report, "Surveillance of Screening-Detected Cancers (Colon and Rectum, Breast, and Cervix) — United States, 2004-2006," is published as a Surveillance Summary in the Morbidity and Mortality Weekly Report.
In this first report to highlight the nationwide incidence of late-stage cancer diagnosis and cancer screening prevalence, the incidence rates of late-stage cancers differed by age, race/ethnicity, and state.
"This report causes concern because so many preventable cancers are not being diagnosed when treatment is most effective," said Marcus Plescia, MD, MPH, Director, Division of Cancer Prevention and Control. "More work is needed to widely implement evidence-based cancer screening tests which may lead to early detection and, ultimately, an increase in the number of lives saved."
Researchers examined stage-specific cancer incidence rates and screening prevalence for breast, cervical and colorectal cancer by demographic characteristics in states. National data on new cancer cases were obtained from cancer registries affiliated with the CDC National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. State-level cancer screening data were obtained from the CDC Behavioral Risk Factor Surveillance System.
Authors of the report noted that differences in late-stage cancer diagnoses may be partially explained by differences in screening rates in locations and among different demographic groups. The U.S. Preventive Services Task Force recommends the following evidence-based population-based cancer screenings:
Men and women aged 50-75 years, at average risk for colorectal cancer, should get screened with any of the three tests: a fecal occult blood test every year, a flexible sigmoidoscopy every five years, or a colonoscopy every 10 years.
Women aged 50-74 years should be screened with mammography every two years.
Screening for cervical cancer with the Pap test should begin for women within three years of beginning sexual activity or at age 21 (whichever comes first). Furthermore, women should be screened annually with three consecutive normal Pap tests and then at least every three years up to age 64 years.
Significant findings of the study include:
Demographic incidence rates
Incidence rates of late-stage colorectal cancer increased with age and were highest among black men and women.
Incidence rates of late-stage breast cancer were highest among women aged 70-79 years and black women.
Incidence rates of late-stage cervical cancer were highest among women aged 50-79 years and Hispanic women.
State incidence rates
Late-stage colon and rectum incidence rates ranged from 51.0 to 86.5, and were highest in Connecticut, Delaware, Illinois, Iowa, Kentucky, Louisiana, Maine, Nebraska, New Jersey, and Pennsylvania.
Late-stage breast cancer incidence rates ranged from 92.2 to 132.1, and were highest in Alabama, the District of Columbia, Kansas, Louisiana, Mississippi, New Jersey, Oklahoma, Pennsylvania, Tennessee, and Washington.
Late-stage cervical cancer incidence rates ranged from 3.0 to 8.3, and were highest in Arkansas, the District of Columbia, Illinois, Kentucky, Louisiana, Mississippi, Nevada, New Mexico, and Oklahoma.
The Affordable Care Act provides coverage of these recommended cancer screening tests by eliminating financial barriers such as co-pays which is an important first step to increasing the numbers of persons who receive these services.
Colorectal cancer is the second leading cause of cancer deaths in the United States, after lung cancer. In 2006, more than 139,000 new cases of colorectal cancer were diagnosed and more than 53,000 people died from this disease. Colorectal cancer screening tests can find precancerous polyps so they can be removed before they turn into cancer, thus preventing the disease. In addition, screening can detect colorectal cancer at an early stage when treatment can be very effective.
Each year, approximately 12,000 women in the United States are diagnosed with cervical cancer. However, it is the easiest gynecologic cancer to prevent with regular screening tests and follow-up. Cervical cancer screening can detect precancerous lesions so they can be removed before they turn into cancer.
In 2006, more than 191,000 women were diagnosed with invasive breast cancer and more than 40,000 died from the disease. Mammograms are the best method to detect breast cancer before it is big enough to feel or cause symptoms, and it is easier to treat.
CDC Efforts to Increase Cancer Screening
CDC's Colorectal Cancer Control Program funds 25 states and 4 tribal organizations across the U.S. to increase rates of colorectal cancer screening among men and women 50 years of age and older through population-based approaches such as policy and health systems change, outreach, case management, and selective provision of direct screening services.
The CDC National Breast and Cervical Cancer Early Detection Program provides access to breast and cervical cancer screening services to low-income, uninsured, and underserved women in 50 states, the District of Columbia, five territories, and 12 tribes.
For more information about CDC's efforts to prevent cancer, visit www.cdc.gov/cancer.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES