2021 BQ Journal Vol 42 - 11

PREVENTING CHRONIC DISEASE
PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY
vice; grade " B " reflects high certainty of moderate benefit or moderate certainty of substantial benefit. USPSTF recommendations
include routine screening for female breast cancer in women aged
50 to 74 years, cervical cancer in women aged 21 to 65 years, and
colorectal cancer (CRC) in men and women aged 50 to 75 years
(1). Most private health plans cover these services without copays
or deductibles. However, insurance coverage does not ensure uptake of recommended services, and many preventive services remain underutilized (2).

VOLUME 17, E123
OCTOBER 2020

ing, 21-year-old women for cervical cancer screening, and 50year-old men and women for CRC screening. The simulations followed each cohort through their lifetimes. Screening modalities included mammography for breast cancer and cytology or Pap test
for cervical cancer. For CRC, the model assumed a mix of annual
fecal occult blood test (FOBT), flexible sigmoidoscopy every 5
years plus FOBT every 3 years, or colonoscopy every 10 years
(Table 1).
The estimates of avoidable burden were prepared in 2018 by
Health Partners Institute researchers using models that were previously used in peer-reviewed studies to inform the National Commission on Prevention Priorities (NCPP) ranking of clinical preventive services (8). Specifically, the estimates for avoidable
deaths from breast cancer screening (9) were based on results of 5
Cancer Information Surveillance Modeling Network screening
models (10) plus an estimate from a sixth model (11). Estimates
for cervical cancer screening and CRC screening were based on
results from models to inform the same NCPP ranking (12,13).
These reports provide estimates of cancer deaths that would be
prevented either by screening 100% of the target population compared with no screening (8,9) or by screening a portion of the target population who would accept and follow up with screening if
recommended by a physician (10,11,14). Each model estimated
cancer deaths prevented by first constructing a natural history of
cancer based on progression of lesions through cancer stages and
then simulating the potential for screening to interrupt cancer progression and prevent death. Using the estimates from models, we
calculated the deaths prevented from each 1% increase in screening uptake in the US eligible population and linearly scaled that
estimate from current screening rates up to the screening rates in
the scenarios just described. Linear extrapolation should provide a
reasonable estimate of the impact of increasing screening rates
when capacity exists or is developed to provide additional screening and follow-up of quality equal to existing screening and
follow-up, and when the currently screened and unscreened populations have similar risks of lesion development and cancer progression.

To increase the use of these services, the US Department of Health
and Human Services supports various programs and initiatives (3).
For example, 2 cancer control programs at the Centers for Disease
Control and Prevention (CDC), the National Breast and Cervical
Cancer Early Detection Program (NBCCEDP) and the Colorectal
Cancer Control Program (CRCCP), seek to increase screening use
among low-income, medically underserved populations (4,5). Despite the availability of screening services and better treatment outcomes, a large number of patients still die of these cancers. In
2016, the number of deaths from female breast cancer was 41,487;
from cervical cancer, 4,188; and from CRC, 52,286 (6). In 2016,
the self-reported screening rates for female breast and cervical
cancers were 78.3% and 79.9%, respectively, and the self-reported
screening rate for CRC was 67.7% (7).
In this article, we assess the number of potential deaths that could
be prevented by increasing screening for female breast and cervical cancers and for CRC according to USPSTF recommendations. The report is motivated by the need to increase the use of
evidence-based interventions that reduce the rates of illness and
death from cancer.

Methods
We simulated and compared the number of deaths that could be
prevented by increasing screening from current rates to defined
targets by using previously reported model-based estimates. We
compared the cumulative numbers of cancer deaths for a singleyear age cohort under different scenarios: current level of screening (2016), current level plus 10 percentage points, and increasing
screening to 90% and 100% of the eligible population. We also
calculated the numbers of adults currently screened and expected
to be screened under different scenarios of increased screening.
Table 1 provides a summary of key analysis assumptions and
model inputs. Current screening estimates are based on 2016 survey data from the Behavioral Risk Factor Surveillance System
(BRFSS) (7).

Results
If the current level of screening use were maintained, 10,179
deaths from breast cancer would be prevented among the cohort of
50-year-old women over their lifetime; 27,166 deaths from cervical cancer would be prevented among the cohort of 21-year-old
women; and 74,470 deaths from CRC would be prevented among
the cohort of 50-year-old men and women (Table 2).

Each of the simulation models on which our calculations are based
followed a synthetic cohort from the USPSTF-recommended starting age of screening: 50-year-old women for breast cancer screen-

Using a linear relation between screening use and avoided deaths
indicated a similar pattern of relative incremental deaths preven-

The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions.

2

Centers for Disease Control and Prevention * www.cdc.gov/pcd/issues/2020/20_0039.htm

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A Henry Schein Publication
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2021 BQ Journal Vol 42

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