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Implementing Colorectal Cancer Screening: Workshop Summary
Implementing COLORECTAL CANCER Screening
WORKSHOP SUMMARY
Margie Patlak, Christine Micheel, and Robert German, Rapporteurs
National Cancer Policy Forum
INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu
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Implementing Colorectal Cancer Screening: Workshop Summary
THE NATIONAL ACADEMIES PRESS
500 Fifth Street, N.W. Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
This study was supported by Contract Nos. HHSN261200611002C, 200-2005-13434 TO #1, HHSP233200700373P, and 223-01-2460 TO #27, between the National Academy of Sciences and the National Cancer Institute, the Centers for Disease Control and Prevention, the Agency for Healthcare Research and Quality, and the Food and Drug Administration, respectively. This study was also supported by the American Cancer Society, the American Society for Clinical Oncology, C-Change, and the Association of American Cancer Institutes. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.
International Standard Book Number-13: 978-0-309-12139-2
International Standard Book Number-10: 0-309-12139-6
Additional copies of this report are available from the
National Academies Press,
500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu.
For more information about the Institute of Medicine, visit the IOM home page at: http://www.iom.edu.
Copyright 2008 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
Suggested citation: IOM (Institute of Medicine). 2008. Implementing colorectal cancer screening: Workshop summary. Washington, DC: The National Academies Press.
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Implementing Colorectal Cancer Screening: Workshop Summary
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
—Goethe
INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES
Advising the Nation. Improving Health.
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Implementing Colorectal Cancer Screening: Workshop Summary
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.
www.national-academies.org
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Implementing Colorectal Cancer Screening: Workshop Summary
WORKSHOP PLANNING COMMITTEE1
RALPH COATES, Ph.D. (Chair), Associate Director for Science in the National Office of Public Health Genomics at the Centers for Disease Control and Prevention
MARY BARTON, M.D., M.P.P., Scientific Director of the United States Preventive Services Task Force,
Agency for Healthcare Research and Quality
TOM KEAN, M.P.H., Executive Director,
C-Change
WILLIAM LAWRENCE, M.D., M.S., Senior Service Fellow in Outcomes Research,
Center for Outcomes and Evidence, Agency for Healthcare Research and Quality
SCOTT RAMSEY, M.D., Ph.D., Full Member,
Fred Hutchinson Cancer Research Center
LAURA SEEFF, M.D., Associate Director for the Office of Colorectal Cancer Programs in the Centers for Disease Control and Prevention’s Division of Cancer Prevention and Control
ED WAGNER, M.D., M.P.H., Director,
MacColl Institute and
Senior Investigator,
Group Health Center for Health Studies
Project Staff
ROGER HERDMAN, M.D., Study Director and Director,
National Cancer Policy Forum and Board on Health Care Services
LAURA LEVIT, J.D., Senior Program Associate
CHRISTINE MICHEEL, Ph.D., Program Officer
MICHAEL PARK, Senior Program Assistant
1
Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.
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Implementing Colorectal Cancer Screening: Workshop Summary
NATIONAL CANCER POLICY FORUM1
HAL MOSES, M.D. (Chair), Director Emeritus,
Vanderbilt-Ingram Cancer Center
PETER B. BACH, M.D., M.A.P.P., Associate Attending Physician,
Memorial Sloan-Kettering Cancer Center
EDWARD BENZ, Jr., M.D., President,
Dana Farber Cancer Institute and
Director,
Harvard Cancer Center, Harvard School of Medicine
THOMAS G. BURISH, Ph.D., Past-Chair,
American Cancer Society Board of Directors and
Provost,
Notre Dame University
BETTY R. FERRELL, Ph.D., R.N., F.A.A.N., Research Scientist,
City of Hope National Medical Center
JOSEPH F. FRAUMENI, Jr., M.D., Director,
Division of Cancer Epidemiology and Genetics, National Cancer Institute
STEPHEN H. FRIEND, M.D., Ph.D., Executive Vice President,
Oncology, Merck & Co., Inc.
PATRICIA A. GANZ, M.D., Professor,
University of California, Los Angeles Schools of Medicine and Public Health, Division of Cancer Prevention & Control Research, Jonnson Comprehensive Cancer Center
ROBERT R. GERMAN, Dr.P.H., M.P.H., Associate Director for Science (Acting),
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention
ROY S. HERBST, M.D., Ph.D., Chief,
Thoracic/Head and Neck, Medical Oncology, M.D. Anderson Cancer Center
THOMAS J. KEAN, M.P.H., Executive Director,
C-Change
WILLIAM LAWRENCE, M.D., M.S., Senior Service Fellow in Outcomes Research,
Agency for Healthcare Research and Quality
LYNN M. MATRISIAN, Ph.D., Chair,
Department of Cancer Biology, Vanderbilt University Medical Center
JOHN E. NIEDERHUBER, M.D., Director,
National Cancer Institute
DAVID R. PARKINSON, M.D., President and CEO,
Nodality, Inc.
EDITH A. PEREZ, M.D., Director,
Clinical Investigation and Breast Cancer Program, Mayo Clinic
SCOTT RAMSEY, M.D., Ph.D., Full Member,
Cancer Prevention Program, Fred Hutchinson Cancer Research Center
MARGARET R. SPITZ, M.D., Chair,
Epidemiology, M.D. Anderson Cancer Center
1
Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.
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Implementing Colorectal Cancer Screening: Workshop Summary
ELLEN STOVALL, President and CEO,
National Coalition for Cancer Survivorship
JANET WOODCOCK, M.D., Deputy Commissioner and Chief Medical Officer,
Food and Drug Administration
Staff
ROGER HERDMAN, M.D., Director,
National Cancer Policy Forum and Board on Health Care Services
SHARYL NASS, Ph.D., Senior Program Officer
CHRISTINE MICHEEL, Ph.D., Program Officer
LAURA LEVIT, J.D., Senior Program Associate
ERIN BALOGH, M.P.H., Research Associate
MICHAEL PARK, Senior Program Assistant
ASHLEY MCWILLIAMS, Senior Program Assistant
ADAM SCHICKEDANZ, Intern
SHARON MURPHY, M.D., Scholar in Residence
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Implementing Colorectal Cancer Screening: Workshop Summary
Reviewers
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:
George Isham, HealthPartners, Inc.
Thomas J. Kean, C-Change
Laura Seeff, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention
Robert A. Smith, American Cancer Society
Judith L. Wagner, Independent Consultant, Bethesda, Maryland
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was overseen by Dr. Melvin Worth. Appointed by the Institute of Medicine, they
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Implementing Colorectal Cancer Screening: Workshop Summary
were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authors and the institution.
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Implementing Colorectal Cancer Screening: Workshop Summary
Contents
Introduction
1
Moving Evidence-Based Recommendations into Practice
2
Natural History and Epidemiology
5
Effectiveness of Colorectal Cancer Screening
10
Screening Strategies
15
Effectiveness of Community- and Office-Based Interventions
19
Overcoming Barriers to Screening
26
Public and Patient Interventions to Implement Screening
31
Primary Care Practice Interventions to Implement Screening
36
Gastrointestinal Specialty Practice Concerns
40
State and Federal Initiatives to Boost Colorectal Cancer Screening
44
Colorado Screening Initiatives
44
Nebraska Screening Initiatives
47
Population-Based Federal Screening Initiatives
50
Employer-Based Initiatives to Increase Screening
53
Strategies to Monitor Performance
56
Interventions to Address Costs of Developing and Maintaining Screening Programs
59
Colorectal Cancer Screening in Primary Care
59
Cost Considerations in Medical Practice
62
Costs of Developing and Maintaining Public Health Colorectal Cancer Screening Programs
66
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Implementing Colorectal Cancer Screening: Workshop Summary
General Discussion and Wrap-up
69
Screening Implementation
71
Communications
73
Costs and Coverage
75
Primary Care System
76
Final Words
78
Acronyms
79
Glossary
81
References
86
Appendix A
Workshop Agenda
97
Appendix B
Workshop Speakers
100
Appendix C
Epidemiology of Colorectal Cancer and Colorectal Cancer Screening: A Background Paper
101
Appendix D
The Medical Home
111
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