Report in English with a Dutch summary (KCE reports 45A)

138 Screening for Colorectal Cancer: Appendices KCE reports vol.45
7.12 USA
The Familial Cancer Program is a state-wide service providing a comprehensive
service to families with a history of breast, ovarian, colorectal and other related
cancer syndromes 578. The program, run by genetic services of Western
Australia incorporates counselling, education, genetic testing and management
for individuals/families with a history of cancer
Currently there is no national screening program in the USA. A recent study of
the Centers for Disease Control and prevention (CDC) demonstrated that
approximately 41,8 million average-risk people aged 50 or older have not been
screened for colorectal cancer according to national guidelines. The U.S. health
care system has enough capacity to conduct widespread screening of the
unscreened population, using FOBT and diagnostic colonoscopy for those with
a positive FOBT. Currently, 18 states require coverage of colorectal cancer
screening tests 579. A few other states require that they be offered or available
throughout Medicare Supplemental policies. Many states refer to the guidelines
of the American cancer society and from the age of 50 years onward, individuals
without family history or hereditary risk should have five different screening
options:
Annual FOBT test with their GP. If the test is positive, the
follow up should be a colonoscopy
Flexible sigmoidoscopy every 5 years
Annual FOBT + sigmoidoscopy every 5 years
Double contrast barium enema every 5-10 years
Colonoscopy every 7 to 10 years
To increase colorectal cancer screening, in August 2005, the CDC awarded
cooperative agreements to five sites to establish colorectal cancer screening
demonstration programs for low-income U.S. men and women aged >50 years
who have inadequate or no health insurance coverage for colorectal cancer
screening. Screening services in these programs are expected to begin by early
April 2006.
The demonstration program sites are:
Statewide: Nebraska Department of Health and Human
Services 580 : primary screening with gFOBT; colonoscopy for
high risk persons and for follow-up of positive gFOBT with a
focus on African American population
County-based: the Research Foundation of SUNY at Stony
Brook, New York (Suffolk County): primary screening with
colonoscopy
County-based: Seattle and King County, Washington (Seattle
and King County): primary screening with gFOBT; colonoscopy
for high risk persons and for follow up of positive gFOBT with a
focus on American Indian population
City-based: Missouri Department of Health and Senior Services
(St. Louis): primary screening with gFOBT; colonoscopy for high
risk persons and for follow-up of positive gFOBT with a focus on
African American population