2021 BQ Journal Vol 42 - 12

PREVENTING CHRONIC DISEASE
PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY
ted through increased screening. Increases of 10 percentage points
would prevent an additional 1,300 deaths from breast cancer;
3,400 deaths from cervical cancer; and 11,000 deaths from CRC
over the lifetime of each cohort. In terms of the 2016 general population, those reductions would require additional screenings of
4.9 million women for breast cancer, 9.7 million women for cervical cancer, and 9.6 million men and women for CRC (Table 1).

VOLUME 17, E123
OCTOBER 2020

Our estimates suggest that large numbers of deaths from cancer
could be prevented through increased use of evidence-based
screenings. The greatest impact could be realized for increased
CRC screening. The magnitude of potential impact of universal
CRC screening is attributed to the fact that CRC screening has a
current rate that is lower than breast and cervical cancer screening,
includes both men and women, and has a larger proportionate decrease in mortality associated with it. Although we recognize that
100% screening is not an achievable goal, we included it as a target to illustrate the maximum benefit that could be achieved by increased screening.

The impact of increasing the screening rate to 100% sets the upper limit on the number of potentially avoidable deaths (Figure).
Screening of 100% age-appropriate adults could prevent 2,821 additional deaths from breast cancer over the lifetime of a cohort of
50-year-old women; 6,834 additional deaths from cervical cancer
over the lifetime of 21-year-old women; and 35,530 additional
deaths from CRC over the lifetime of 50-year-old men and women. Increasing use of CRC screening would prevent approximately 8.5 times as many deaths as the equivalent increase in use of
breast cancer screening (women only), although twice as many
people (men and women) would have to be screened for CRC (Table 1).

The Community Preventive Services Task Force (CPSTF) recommends evidence-based strategies, such as patient and provider reminders, to increase screening rates for all 3 cancers (16-18).
CDC's CRCCP aims to increase screening rates among priority
populations through implementation of these strategies in health
system clinic settings. The NBCCEDP is a long-standing CDC initiative that screened over 1.4 million low-income, uninsured and
underinsured women over the 5 years ending in 2017 alone (19).
These public health programs, along with other state and local efforts, are critical to increasing cancer screening. For example,
early results of CRCCP suggested a 4.4 percentage-point annual
increase in screening rates among the participating clinics (5). By
the second and third year of the CRCCP, the rate increased by 8.3
and 10.1 percentage points, respectively. An increase of 10.1 percentage points implied more than 82,000 additional CRC screenings under CRCCP (20).
Increasing cancer screening rates would require additional resources for the delivery of clinical services, as well as strategies to
promote uptake of screening in population groups with lower use
of screening. Previous studies that examined the cost of public
provision of programs to increase screening found that such programs include not only cost of screening services but also substantial cost of administering and promoting the programs (21,22). The
incremental costs associated with additional screenings may be
offset by early detection of cancer or precancerous abnormalities
through routine screening. In particular, use of colonoscopy for
CRC screening or as follow-up to abnormal fecal screening can
significantly reduce the onset of CRC through removal of precancerous polyps in addition to allowing early detection of tumors.
Consequently, economic analyses have concluded that screening
for CRC might be cost-saving to health care systems, with the
magnitude of cost savings greater for colonoscopy-based screening (23,24). A CPSTF systematic review found that multicomponent interventions to promote CRC might also be cost-saving, a
finding that was based on a small study in a disadvantaged population in south Texas and a modeling study from South Korea (25).

Figure. Estimates of maximum number of preventable deaths in a single-year
cohort with increased use of screening under US Preventive Services Task
Force guidelines (study year 2018). Preventable deaths over a lifetime for
breast cancer are among women aged 50, for cervical cancer among women
aged 21, and for colorectal cancer among men and women aged 50.

Discussion
The estimated deaths from breast cancer, cervical cancer, and
CRC prevented under different scenarios, comparing the impact of
incremental screening rates, may be useful for setting goals and
making resource allocation decisions on prevention. For example,
one of the goals of Healthy People 2020, the US government's 10year national health objectives, is to reduce female breast and cervical cancer mortality by 10% and CRC mortality by 15% (15).

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.

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

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2021 BQ Journal Vol 42

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