title: Clinical outcomes from the CDC's Colorectal Cancer Screening Demonstration Program.
abstract: BACKGROUND
  Colorectal cancer remains the second leading cause of cancer-related deaths among US men and women. Screening rates have been slow to increase, and disparities in screening remain.
  
  
  METHODS
  To address the disparity in screening for this high burden but largely preventable disease, the Centers for Disease Control and Prevention (CDC) designed and established a 4-year Colorectal Cancer Screening Demonstration Program (CRCSDP) in 2005 for low-income, under-insured or uninsured men and women aged 50 to 64 years in 5 participating US program sites. In this report, the authors describe the design of the CRCSDP and the overall clinical findings and screening test performance characteristics, including the positive fecal occult blood testing (FOBT) rate; the rates of polyp, adenoma, and cancer detection with FOBTs and colonoscopies; and the positive predicative value for polyps, adenomas, and cancers.
  
  
  RESULTS
  In total, 5233 individuals at average risk and increased risk were screened for colorectal cancer across all 5 sites, including 44% who underwent screening FOBT and 56% who underwent screening colonoscopy. Overall, 77% of all individuals screened were women. The FOBT positivity rate was 10%. Results from all screening or diagnostic colonoscopies indicated that 75% had negative results and required a repeat screening colonoscopy in 10 years, 16% had low-risk adenomas and required surveillance colonoscopy in 5 to 10 years, 8% had high-risk adenomas and required surveillance colonoscopy in 3 years, and 0.6% had invasive cancers.
  
  
  CONCLUSIONS
  This report documents the successes and challenges in implementing the CDC's CRCSDP and describes the clinical outcomes of this 4-year initiative, the patterns in program uptake and test choice, and the comparative test performance characteristics of FOBT versus colonoscopy. Patterns in final outcomes from the follow-up of positive screening tests were consistent with national registry data.
authors.affiliation: Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3717, USA. lseeff@cdc.gov
authors.forename: Laura C
authors.initials: LC
authors.lastname: Seeff
authors.forename: Janet
authors.initials: J
authors.lastname: Royalty
authors.forename: William E
authors.initials: WE
authors.lastname: Helsel
authors.forename: William G
authors.initials: WG
authors.lastname: Kammerer
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Boehm
authors.forename: Diane M
authors.initials: DM
authors.lastname: Dwyer
authors.forename: William R
authors.initials: WR
authors.lastname: Howe
authors.forename: Djenaba
authors.initials: D
authors.lastname: Joseph
authors.forename: Dorothy S
authors.initials: DS
authors.lastname: Lane
authors.forename: Melinda
authors.initials: M
authors.lastname: Laughlin
authors.forename: Melissa
authors.initials: M
authors.lastname: Leypoldt
authors.forename: Steven C
authors.initials: SC
authors.lastname: Marroulis
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Mattingly
authors.forename: Marion R
authors.initials: MR
authors.lastname: Nadel
authors.forename: Ellen
authors.initials: E
authors.lastname: Phillips-Angeles
authors.forename: Tanner J
authors.initials: TJ
authors.lastname: Rockwell
authors.forename: A Blythe
authors.initials: AB
authors.lastname: Ryerson
authors.forename: Florence K L
authors.initials: FK
authors.lastname: Tangka
mesh_terms: D002487:Centers for Disease Control and Prevention, U.S.; D003113:Colonoscopy / Q000379:methods; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty; D014481:United States / Q000453:epidemiology
keywords: cancer screening programs; colonoscopy; colorectal cancer prevention; colorectal cancer screening; fecal occult blood testing