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Health Policy: Colorectal Cancer - Landmark Studies

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The contents of this section were published in 2003 as part of SEER's 30th Anniversary celebration.

Several studies using SEER data have shed light on the use and usefulness of colorectal cancer screening. In 1990, scientists examined the public health impact of mass media coverage of President Reagan’s colon cancer episode of 1985. They found a sharp but somewhat transitory increase in public interest following the diagnosis of the President’s colon cancer, with a corresponding increase in early detection tests. An analysis of the incidence data showed an increase in early stage colorectal cancers in the months following the President’s diagnosis and a decrease in advanced disease in 1986- 1987, suggestive of a screening effect.

In 1994, NCI scientists again turned to SEER data as well as national mortality data to examine the abrupt downturn in colorectal mortality rates that began in 1985. SEER data from 1974-1990 revealed for both men and women declining incidence and mortality rates since the mid-1980s, steady declines in distant disease, and increases in local and regional disease until the mid-1980s, followed by declines in the late 1980s. An analysis of mortality rates showed improvements in risk with advancing birth cohorts and more recent time period. This study confirmed the important role of screening to detect early stage cancers for reducing mortality. It also suggested that lifestyle changes observed in younger cohorts have contributed to the lowering of risk.

A study of racial and ethnic patterns in colorectal cancer screening used 1988-1995 data from the California Cancer Registry to compare the cost-effectiveness of two screening interventions. The results showed that average annual age-specific colorectal cancer incidence rates were highest in blacks and lowest in Latinos. Indeed, a 35-year screening program that screened blacks at age 42, whites at 44, or Asians at age 46 would be more cost-effective than screening Latinos at age 50. This study attempted to define more useful cancer screening guidelines and suggested that unique racial/ethnic disease patterns for other cancers also may have implications for screening.

Selected References

Brown ML, Potosky AL. The presidential effect: the public health response to media coverage about Ronald Reagan’s colon cancer episode. Public Opin Q 1990;54:317-329.

Chu KC, Tarone RE, Chow WH, Hankey BF, Ries LAG. Temporal patterns in colorectal cancer incidence, survival and mortality from 1950 through 1990. J Natl Cancer Inst 1994;86:997-1006.

Theuer CP, Wagner JL, Taylor TH, Brewster WR, Tran D, McLaren CE, Anton-Culver H. Racial and ethnic colorectal cancer patterns affect the cost-effectiveness of colorectal cancer screening in the United States. Gastroenterology 2001;120:848-856.

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