This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.
Please go to www.ahrq.gov for current information.
Press Release Date: January 23, 1997
The Agency for Health Care Policy and Research (AHCPR) today released the
first evidence report under its new Evidence-based Practice Initiative. The
report indicates that screening has been shown to be effective in
early-stage colorectal cancers and their precursors. Early
treatment are the primary means of preventing deaths from
Colorectal cancer is the third most commonly diagnosed cancer
and the second
leading cause of cancer death in the United States. It is
estimated that in
1996, 133,500 new cases of colorectal cancer were diagnosed, and
cancer accounted for 54,900 deaths.
"This evidence report will improve the early detection
and treatment of
colorectal cancer by giving clinicians and others
on screening and diagnostic tests to help them reduce the
mortality from this
deadly disease," said AHCPR Administrator Clifton R. Gaus.
is to make this information, and all the evidence reports
released in the
future, available in the public domain to the widest audience
AHCPR's Evidence-based Practice Initiative, established in
will provide medical societies, health care systems, purchasers,
and others with a scientific foundation for developing and
own clinical practice guidelines, performance measures, and other
improvement tools. In December 1996, AHCPR issued a
Request for Proposals to fund
Practice Centers to produce future evidence reports and also
published a notice
in the Federal Register inviting nominations for report topics.
The Colorectal Cancer Screening Evidence Report is based on a
review of 3,500 citations from the scientific literature
published between 1966
and 1994. The review found evidence that a reduction in deaths
cancer can be achieved through detection and treatment of
cancers and the identification and removal of adenomatous
precursors of colorectal cancers. Other findings include:
- Colorectal cancer incidence rises with age, beginning
around age 40,
and is higher in men than in women (60.4 versus 40.9 per 100,000
- Survival from colorectal cancer is closely related to the
pathological stage of the disease at diagnosis. Up to 90 percent
with cancer limited to the bowel wall will be alive five years
as compared with 35-60 percent of those with involvement of
nodes, and less than 10 percent of patients with metastatic
- Racial differences in colorectal cancer survival have been
1983-1989 five-year relative survival for colon cancer was
61 percent among
white men, 50 percent among white women, 48 percent among
men, and 49 percent among African-American women.
African-American men and
women with colorectal cancer have a 50 percent greater
probability of dying
of colon cancer than do white men and women.
- Well-established risk factors for colorectal cancer include
older age, male
sex, history of inflammatory bowel disease, certain
and a family history of colorectal cancer. However, about
75 percent of
all colorectal cancer occurs in people with no known risk
- Most Americans are not screened for colorectal cancer. More
two-thirds of patients present with advanced disease.
Information from the
National Health Interview Survey (NHIS) indicates that in
1992, only 17.3
percent of people aged 50 and older had undergone fecal
testing the previous year, and 9.4 percent had undergone
sigmoidoscopy in the
previous three years.
- Screening with fecal occult blood testing has been shown to
colorectal cancer mortality. Screening with flexible
sigmoidoscopy can reduce
colorectal cancer mortality risk but clinical trials have not
that directly assess mortality reduction. Double contrast barium
colonoscopy are proven methods of identifying polyps and
but have not been studied as screening tests. Further
research is needed
to demonstrate the effectiveness of colorectal cancer screening
determine proper intervals for such testing.
The information contained in AHCPR's evidence report is the
basis for a
clinical practice guideline by the American Gastroenterology
on colorectal cancer screening that will be published in the
February issue of
Gastroenterology. The AGA led a consortium that
AHCPR-sponsored clinical practice guideline panel on colorectal
screening. Work on the AHCPR-sponsored guideline was
discontinued when the
agency ended its clinical practice guideline program and began
evidence reports. The AGA then decided to sponsor its own
guideline on colorectal cancer screening.
"AGA's use of this information on colorectal cancer
develop its guideline on colorectal cancer screening demonstrates
and potential impact of AHCPR's Evidence-based Practice
Dr. Gaus. "AHCPR is filling a need for comprehensively
analyzed science sought by public- and private-sector
organizations to use in
improving the quality of health care services they provide."
An executive summary of the Evidence Report on Colorectal
is available from AHCPR's Publications Clearinghouse at 800-358-9295. Select for Colorectal Cancer Screening: Summary. The complete evidence report will be available in the near future.
For additional information, contact AHCPR Public Affairs: Karen Carp, (301) 427-1858, or Salina Prasad, (301) 427-1864.