The Lancet Student

Screening for Colorectal Cancer: an American experience

This blog was submitted by Andy on 15th August 2012.
Tagged with Colorectal cancer; screening

Travelling to Chicago this summer I, like many other Brits, anticipated a country unable to provide adequate healthcare to those in greatest need. For the most part this is true and it is no more apparent than in the ever-growing field of cancer screening.

Unlike the UK, the US Preventive Services Task Force (USPSTF) recommends routine colonoscopy screening from the age of 50. Although coverage has been extended to beneficiaries of federally funded Medicare programs, uninsured individuals remain unable to access secondary methods of cancer prevention. As a result, vast inequalities in colorectal cancer (CRC) incidence and mortality exist. Experiencing first-hand a lack of CRC prevention at free clinics, and with screening rates in Illinois reaching the seventh lowest nationally, I set out to investigate how uptake could be improved. It was during my research that I discovered a state-wide initiative, employed by the American Cancer Society (ACS), to widen access to colonoscopy screening to over 9,000 uninsured individuals across Illinois. With the program still being piloted, an opportunity presented itself to organise a charity-funded screening program for a volunteer-run clinic I had visited in an area west of Chicago. Considering the time constraints of my trip, achieving this goal seemed overly ambitious. But as a result of the enthusiasm of the local Surgery Centre and the efforts of those running the clinic; the foundations of a referral program have been laid. If the scheme goes ahead it will provide access to CRC prevention to a high-risk population and will contribute to reducing health inequalities in Illinois.

The Affordable Care Act (ACA), recently upheld by the Supreme Court, mandates coverage of various preventative measures including CRC screening. Opponents of healthcare reform claim it is unaffordable and, with expanding public aid programs providing financial support for screening tests to newly eligible recipients, considerable expenditure can be anticipated. However, the benefits of widening access must also be acknowledged. Removing precancerous polyps has shown to be clinically effective in reducing rates of CRC and with Medicare reporting $4 billion in annual payments for CRC treatment costs, there are substantial savings to be made.

Considering the high-risk characteristics of the uninsured, a primary care model targeting low-income populations with early interventions is not only morally right, but makes economical sense. The ACS program pre-empts future demand for CRC screening and establishes links between currently uninsured patients and specialist services. Key to its success will be the role of volunteers whose relationship with often disengaged patients will be vital in ensuring adequate screening uptake. Although volunteer-run clinics supported by local charities and hospitals strive to meet the needs of the uninsured, limited resources are prioritised for diagnostic services. If health inequalities are to be reduced, primary care should be focused on effective preventative interventions tailored to the needs of an under-served population.

Andrew Osborne is a fourth year medical student studying at the University of Sheffield. He is passionate about research, winning a national prize for his work in reproductive medicine. He also volunteers at several community projects including a local playgroup for children with special needs.