Mark Fendrick, MD: Addressing the Colonoscopy Backlog with New Screening Modalities

In 2021, the US Preventive Services Task Force updated its colorectal cancer screening guidelines to recommend that patients begin screening at 45 years of age. This age eligibility expansion, paired with screening disruptions from the COVID-19 pandemic, has rendered the current colonoscopy capacity insufficient for the screening-eligible population.

Findings from a recent analysis are calling attention to the value of stool-based screening tests with high colorectal cancer sensitivity for eliminating the current colonoscopy backlog. The study was presented at Digestive Disease Week (DDW) 2024 in Washington, DC, this weekend and suggests expanded use of noninvasive colorectal cancer screening tests along with follow-up colonoscopy for patients with a positive stool test may help address this public health challenge.

“The fact that lowering the colorectal cancer screening age from 50 to 45 identified 20 million more Americans who now will benefit from colorectal cancer screening, and it should be available to them at no cost is very, very important,” Mark Fendrick, MD, professor and director of the Center for Value-Based Insurance Design at the University of Michigan, explained in an interview with HCPLive. “The availability of additional modalities for colorectal cancer screening has really helped these patients who need to be screened, let alone the millions of other people who are above 50 or at average risk who need to be screened.”

Indeed, results showed with an estimated 59.2 million adults eligible for colorectal cancer screening and 6.3 million annual colonoscopy capacity that can be used for screening, the required number of screening colonoscopy exams would exceed current capacity for 8 years, causing 90% of colorectal cancer cases to remain undiagnosed within the first year. If it progresses to late-stage, colorectal cancer could result in reduced survival rates and greater treatment costs, totaling an estimated $87.5 billion. However, the cost of undiagnosed colorectal cancer cases can be reduced by $31.3 billion and $3.6 billion when multitarget stool DNA and fecal immunochemical test are used in the first year.

“When I started in colorectal cancer screening, it was clearly colonoscopy as the first and only choice,” Fendrick said. “Very fortunate for me, and even more so for my patients, the number of modalities that are not only available, but the number of modalities that are recommended by guidelines as first-line colorectal screening tests have expanded.”

However, Fendrick was careful to note that patients who test positive on a non-colonoscopic first-line screening test will eventually need to undergo a colonoscopy to confirm the presence of polyps or cancer, something he pointed out should be fully covered under almost all circumstances in Medicare and commercial insurance.

Reference:

^{Fendrick M, Ebner D, Kisiel JB, et al. ELIMINATING THE COLONOSCOPY BACKLOG WITH STOOL-BASED COLORECTAL CANCER SCREENING OPTIONS. Abstract presented at Digestive Disease Week (DDW) 2024 Annual Meeting. Washington, DC. May 17-21, 2024.}