Too Many Cancers Diagnosed at Late-Stages Despite Available Screening Tests

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Yesterday the Centers for Disease Control and Prevention (CDC) released a report which notes 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.

The report was published as a surveillance summary in the Nov. 26 Morbidity and Mortality Weekly Report. It highlights 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 from 2004 to 2006.

Marcus Plescia, MD, MPH, Director, Division of Cancer Prevention and Control stated in the press release, "This report causes concern because so many preventable cancers are not being diagnosed when treatment is most effective. 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."

Using data on new cancer cases from cancer registries affiliated with the CDC National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results Program, the researchers examined stage-specific cancer incidence rates and screening prevalence for breast, cervical and colorectal cancer by demographic characteristics in states.

Researchers found incidence rates of late-stage colorectal cancer were highest among black men (114.0 compared to 92.6 in white men) and women (85.6 compared to 68.6 in white women). 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.

Pap smears are widely available yet 47% of all cases are diagnosed in the late-stages. The incidence rates for late-stage cervical cancer were highest among women aged 50-79 years and in Hispanic women (8.4). 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.

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Researchers found the incidence rates of late-stage breast cancer were highest among women aged 70-79 years (123.9) and black women (124.3). 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

Colorectal cancer
is the third most commonly diagnosed cancer in both men and women in the United States. Incidence increases with age and is higher among men than among women and among blacks than among whites. Colorectal cancer incidence rates have been decreasing since 1985, most markedly during 1998--2005, partially as a result of increases in screening.

Breast cancer is the most commonly diagnosed cancer in women. The 5-year survival rate for women who receive a diagnosis of localized breast cancer is 98%, compared with 84% for regional stage and 23% for distant stage. Since 1999, breast cancer incidence has decreased, partially because the use of mammography has stabilized and screening in the 1980s and 1990s had detected many undiagnosed prevalent cases, and because after 2002 many women stopped using hormone replacement therapy.

The dramatic decrease in cervical cancer incidence and mortality since the mid-20th century has been termed one of the nation's foremost health success stories. Much of this success is due to the Pap test. Survival after cervical cancer diagnosis depends on stage at diagnosis; the 5-year survival rate for women who have localized disease is 92%, compared with 58% for regional disease and 17% for distant disease.

The U.S. Preventive Services Task Force recommends these cancer screenings:

  1. All men and women ages 50 to 75 should be screened with a fecal blood test each year, with flexible sigmoidoscopy every five years, or colonoscopy every 10 years.
  2. Women ages 50 to 74 should have mammograms every two years.
  3. Cervical cancer screening with Pap tests should begin within three years of initiation of sexual activity or at age 21

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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.

Source
Centers for Disease Control and Prevention "Surveillance of screening-detected cancers (colon and rectum, breast, and cervix) -- United States, 2004-2006" MMWR 2010; 59: 1-25.

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