Mark Fendrick, MD: The “Perfect Storm” of Colorectal Cancer Screening Demand

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.

Study results were presented at Digestive Disease Week (DDW) 2024 in Washington, DC, this weekend and highlight the promise of noninvasive colorectal cancer screening tests, paired with follow-up colonoscopy for patients with a positive test, for addressing the public health challenge posed by the surplus of screening-eligible patients.

In an interview with HCPLive, Mark Fendrick, MD, professor and director of the Center for Value-Based Insurance Design at the University of Michigan, described the current colorectal cancer screening demand as “the perfect storm,” pointing to the number of average risk screening colonoscopy patients that need to be attended to, patients with other conditions that require a colonoscopic exam, and the added 20 million US adults who are eligible for no-cost screening because of the updated United States Preventive Services Task Force recommendations.

Additionally, Fendrick noted the health care system simply was not prepared to take on the significant increase in new needs for colonoscopies. Here, he described the value that stool-based tests offer for helping alleviate the current colonoscopy backlog by allowing colonoscopy to be used as a follow-up rather than a first-line option, emphasizing the importance of “completing the screening process” by ensuring that follow-up occurs.

Results of the analysis presented at DDW showed 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. However, with multitarget stool DNA and fecal immunochemical tests in the first year, the cost of undiagnosed colorectal cancer cases can be reduced by $31.3 billion and $3.6 billion, respectively.

“We just don't have the capacity to do what many people believe is the ‘preferred’ screening test,” Fendrick said. “If we moved our initial screening tests around to make sure we got more people screened total, and that those people who went from average risk to higher than average risk after a positive stool-based test all got their follow-up colonoscopies, we would do much better off on every metric.”

Reference:

^{Brooks, A. Mark Fendrick, MD: Addressing the Colonoscopy Backlog with New Screening Modalities. HCPLive. May 18, 2024. Accessed May 18, 2024. https://www.hcplive.com/view/mark-fendrick-md-addressing-the-colonoscopy-backlog-with-new-screening-modalities}