USPSTF and CTC: Just Do It

The U.S. Preventive Services Task Force (USPSTF) released its final recommendations for colorectal cancer screening on June 15,(1) and there were two things about those recommendations that really grabbed my attention.

First, the obvious one: The task force reconsidered its previous decision to list CT colonography as an “alternative test” instead of granting it a full endorsement. This was a significant change, to be sure. In October 2015, when the USPSTF first published its draft recommendations, many in the imaging community were unhappy that CT colonography had not received an “A” grade. The Medical Imaging & Technology Alliance (MITA), for instance, released a statement(2) expressing its disappointment.

“We believe greater acceptance of CT colonography would likely increase access to early detection and life-saving treatment,” Patrick Hope, MITA executive director, said in the statement, “It is our hope that upon review of our comments, USPSTF will endorse CT colonography for colon cancer screening.”

As it turned out, that’s exactly what happened. CT colonography was no longer listed as an “alternative test”—in fact, all mentions of that phrase were completely removed to avoid any potential confusion—and the USPSTF officially endorsed the screening method. As one might expect, this led to a much more positive statement(3) from MITA.

“USPSTF’s final recommendation represents a major step forward in addressing the persistently high incidence of and deaths from colorectal cancer,” Hope said in that statement. “We hope this will encourage the Centers for Medicare & Medicaid Services to provide national coverage of CT colonography, granting more beneficiaries access to early detection and life-saving treatment and saving millions of lives.”

The Colon Cancer Alliance also praised the task force’s decision to update its recommendations, emphasizing the importance of taking advantage of newer screening methods. “By changing their recommendations to include these newer tests, the USPSTF has opened the door for countless more Americans to get screened,” Michael Sapienza, Colon Cancer Alliance CEO, said in a prepared statement.(4) “We thank the USPSTF for taking our input seriously and accepting our suggestions.”

There is something refreshing about an organization legitimately considering public opinion. It’s encouraging in a way. Sure, it’s easy to be cynical and think your input won’t matter, but wouldn’t you rather live in a world where your voice is heard and taken seriously?

Of course, public opinion wasn’t all that impacted the changed recommendation. (If discontent from the public was all it took for the task force to change course, the USPSTF breast cancer screening recommendations would have changed before being finalized earlier this year.)  

No, there was more behind this update than just satisfying the public, and that leads me to the second thing that grabbed my attention: the USPSTF has made it crystal clear that the most important thing about colorectal cancer screening is that it happens. Period.

“The best screening test is the one that gets done, and the USPSTF concludes that maximizing the total proportion of the eligible population that receives screening will result in the greatest reduction in colorectal cancer deaths,” the authors wrote. That was the final recommendation of the USPSTF on CT colonography.

It’s easy to understand, and appreciate, where the task force is coming from here. In the United States, colorectal cancer is the second most deadly cancer. Experts estimate that approximately 134,000 individuals will be diagnosed with the disease in 2016, and approximately 49,000 will die from it. What makes those numbers even more frightening is that the USPSTF said about one-third of eligible adults in the United States have never been screened for colorectal cancer.

No wonder the task force made this change related to CT colonography; colon cancer is a disease that impacts hundreds of thousands of patients throughout the United States. Instead of potentially limiting their screening options, give them a variety from which to choose.

Here it is in the task force’s own words. “Instead of emphasizing specific screening approaches, the USPSTF has instead chosen to highlight that there is convincing evidence that colorectal cancer screening substantially reduces deaths from the disease among adults aged 50 to 75 years and that not enough adults in the United States are using this effective preventive intervention.”

In the last few years, many radiologists, imaging societies and politicians have spoken out against decisions made by the USPSTF’s members. I’m not presenting either side as “right” or “wrong” in any of those debates, but I do applaud the task force for taking both public comments and the U.S. population’s need for more screening into account and producing these updated colorectal recommendations.

References:

1. US Preventive Services Task Force. Screening for colorectal cancer. JAMA. 2016;315(23):2564-75. Accessed June 22, 2016.
2. MITA disappointed in USPSTF draft recommendations for colorectal cancer screening. Published October 6, 2016. Accessed June 22, 2016.
3. MITA commends USPSTF endorsement of CT colonography as an effective colorectal cancer screening option for the Medicare population. Medical Imaging & Technology Alliance web site. Published June 16, 2016. Accessed June 22, 2016.
4. USPSTF responds to concerns, releases final screening report. Published June 16, 2016. Accessed June 22, 2016.