2021 BQ Journal Vol 42 - 13

PREVENTING CHRONIC DISEASE
PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY

VOLUME 17, E123
OCTOBER 2020

Acknowledgments

However, those analyses did not factor in competing risks or future medical costs, although taking those into account may still
render CRC screening to be considered cost-effective even if not
cost-saving (26).

The authors thank Martin Meltzer and Phoebe Thorpe for their
contributions. No financial disclosures were reported by the authors of this article, and no external financial support was received for this work. No copyrighted instruments or tools were
used for this study. The findings and conclusions in this report are
those of the authors and do not necessarily represent the official
position of CDC.

Our estimates of the relative contributions of recommended
screenings align with previous estimates, although methods differ
(27). In particular, the results of Farley et al reflect annual impact
in a US cross-section, while our estimates reflect the lifetimes of a
US birth cohort. These different methods could produce the same
number of life-years at risk of cancer and the same results if,
among other things, the successive birth cohorts represented in the
cross-section were all the same size. However, because the older
cohorts in a cross-section came from smaller, pre-1946 birth cohorts, annual estimates tend to be smaller than lifetime estimates
from a birth cohort. Our estimate of 68% (35,530) CRC deaths
prevented, associated with increasing screening from 68% to
100%, is higher than the Meester et al estimate (28) of 58% CRC
deaths prevented in 2020, even with an increase in screening rate
from 60% to 100%.

Author Information
Corresponding Author: Krishna P. Sharma, PhD, Division of
Cancer Prevention and Control, National Center for Chronic
Disease Prevention and Health Promotion, Centers for Disease
Control and Prevention, 4770 Buford Highway, MS-MF76,
Atlanta, GA 30341. Telephone: 404-498-1530. Email:
ksharma@cdc.gov.
Author Affiliations: 1Division of Cancer Prevention and Control,
National Center for Chronic Disease Prevention and Health
Promotion, Centers for Disease Control and Prevention, Atlanta,
Georgia. 2National Center on Birth Defects and Developmental
Disabilities, Centers for Disease Control and Prevention, Atlanta,
Georgia. 3 HealthPartners Institute, Minneapolis, Minnesota.
4
National Center for Chronic Disease Prevention and Health
Promotion, Centers for Disease Control and Prevention, Atlanta,
Georgia. 5Office of the Associate Director for Science, Centers for
Disease Control and Prevention, Atlanta, Georgia.

Limitations
The current rates of screening used in this study were based on
self-reported BRFSS survey data, but actual rates could be substantially less. Past studies have suggested that self-reports of
screening overestimated screening rates by as much as 15 to 25
percentage points (29,30). We did not account for the potential
contribution from the use of human papillomavirus (HPV) vaccination to reduce incidence of cervical cancer; neither did we include HPV testing for cervical cancer screening in women aged 30
or older. The estimates for CRC deaths prevented were based on 3
screening strategies: FOBT alone, flexible sigmoidoscopy combined with FOBT, and colonoscopy alone; other currently available or recommended strategies or test methods (eg, fecal immunochemical test, fecal DNA, Cologuard) were not included. Furthermore, our approach assumes proportional effects of screening
and does not account for population heterogeneity in screening
frequencies and risk of death. Also, the validity of our approach to
extrapolate outside the observed range of data is not known, although this is often the only approach available.

References
1. US Preventive Services Task Force. The guide to clinical
preventive services 2014: recommendations of the US
Preventive Services Task Force. Agency for Healthcare
Research and Quality; 2014.
2. Han X, Robin Yabroff K, Guy GP Jr, Zheng Z, Jemal A. Has
recommended preventive service use increased after
elimination of cost-sharing as part of the Affordable Care Act
in the United States? Prev Med 2015;78:85-91.
3. US Department of Health and Human Services. Prevention and
Public Health Fund; 2016. https://www.hhs.gov/open/
prevention/index.html. Accessed July 7, 2020.
4. Miller JW, Plescia M, Ekwueme DU. Public health national
approach to reducing breast and cervical cancer disparities.
Cancer 2014;120(Suppl 16):2537-9.

Conclusions
Increasing screening for CRC and breast and cervical cancers
could prevent a substantial number of deaths attributed to these
cancers. Organized screening approaches that leverage partnerships between public health and primary health care to implement
evidence-based strategies could be used to reduce the prevalence
of these cancers.

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.

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

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2021 BQ Journal Vol 42

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