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Big Drop In Colon Cancer Fuels Push To Get More People Screened

The number of people getting colon cancer has fallen by 30 percent over the past decade in people over 50, and much of that progress is due to screening, a study finds.

But a substantial number of people in that target age group still haven't been screened, and a consortium of organizations say they're pushing to get 80 percent of those people screened at least once by 2018.

The decline in new cases of colorectal cancer is accelerating, with declines of 3 percent a year in the past decade, according to data published Monday in the journal CA. That progress is a result of people having gotten screened years before — and having precancerous polyps removed before they become cancer.

The biggest improvements were in people ages 65 and over, who are also the ones most at risk of dying from colon cancer.

Given the good news, public health officials are zeroing in on the 30 percent or so of people ages 50 to 75 who haven't been screened. That's about 23 million people.

But many of those millions have good reasons why they haven't participated, so getting them in the door is going to be a big challenge, according to Dr. Richard Wender, chief cancer control officer for the American Cancer Society.

"We know it can be done if we eliminate the barriers," Wender said Monday at a meeting launching the initiative in Washington, D.C. The consortium includes the Centers for Disease Control and Prevention, the American Cancer Society and numerous other heavy hitters in public health.

College graduates have already hit that magic 80 percent. Massachusetts, Vermont and some other states that have made a concerted effort to remove economic barriers for screening have rates above 70 percent.

But among people without health insurance or primary care providers, fewer than half have ever been screened. Money is a big issue.

Insurers are required to cover colon cancer screening under the Affordable Care Act, but they don't always cover the facility and anesthesiologist for a colonoscopy, one of three forms of cancer screening recommended by the U.S. Preventive Services Task Force. Those costs can easily run more than $1,000.

"Patients come in and the first thing they want to know is, how much is it going to cost?" Dr. Gary Wiltz, clinical director of the Teche Action Clinic in Franklin, La., said at the news conference. "Well, the screening is free, but the surprise is if a polyp is discovered, it's an $800 cost. These are real issues with real people."

Surprisingly, the "ick" factor isn't at the top of the list of reasons why people aren't getting screened, Wender told Shots. "We've mainstreamed it," he says. "We've mainstreamed having a colonoscopy. Most people know it's the prep that's annoying, but at the end of the day it's not that terrible an experience."

Still, he acknowledges that worries about colonoscopy can still be an issue for some people. If the two other recommended forms of screening — fecal occult blood tests and sigmoidoscopy — find a problem, colonoscopy is the only way to remove a precancerous polyp. "It's the idea that 'nobody's putting anything up there,' " Wender says.

Given all that, hitting that 80 percent target is going to be tough, Wender admits, especially since it means also making sure that people who have been screened in the past are up to date. "But if we work in a determined, organized, relentless way I believe it can be achieved."

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