David Greenwald, MD: An Update on the 80% by 2018 Colon Cancer Initiative

The Emily Couric Memorial Lecture at this year’s American College of Gastroenterology (ACG) 2018 Annual Scientific Meeting was given by David A Greenwald, MD, director of clinical gastroenterology and endoscopy at Mount Sinai Hospital in New York City.

After being introduced by ACG President Irving Pike, MD, Dr Greenwald spoke in-depth about the 80% by 2018 colorectal cancer (CRC) screening initiative, which was set forth by the National Colorectal Cancer Roundtable in March 2014.

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The 80% by 2018 campaign—also dubbed a “Big Hairy Audacious Goal”—had overall very positive and significant effects on CRC screening rates nationally, considering that the screening rate for CRC was once 47% in 2005.

In fact, going forward, the 80% by 2018 campaign is estimated to help prevent 277,000 cases of CRC and 203,000 CRC deaths that would have otherwise occurred by 2030. According to Dr Greenwald, achieving these estimates “[w]ould essentially allow everybody at the Indianapolis 500 to not get colorectal cancer.”

Much of the campaign’s success came from “micro-campaigns,” Dr Greenwald explained, which targeted specific messages about CRC screening to various audiences in smaller populations, especially in underserved, low-income, and underinsured communities.

“[A]lthough we continue to see significant disparities here, screening rates across the board here have gone up,” said Dr Greenwald. In fact, although disparities still exist among these communities, they have nonetheless seen increases in screening rates.

Now that the end of 2018 is near, creating a new name for the campaign is still a work-in-progress, However, the message will remain the same, said Dr Greenwald.

The same campaign metric will remain in place for patients aged 50 to 75 years, whereas new methods will be formed for audiences aged 50 to 64 years in particular, which have the lowest rates of CRC screening compared with ages 65 to 75 years (61.8% vs 78.4%). Future messages will also be tailored to meet the needs of specific races/ethnicities.

Navigating barriers—including fear, financial and logistical barriers, and conflicting guidelines—will remain a key component of the campaign.

Moreover, the 80% by 2018 initiative will continue aiming to reach the 85% of the population that is insured, as well as the 32% who have either never been screened or who are not up-to-date in their screening.

“[T]he unscreened population is either a challenge or an opportunity,” Dr Greenwald reminded the audience at ACG 2018 several times.

Additional campaigns for unscreened populations will continue to be developed, said Dr Greenwald, with priority audiences including the “rationalizer” or “procrastinator”, the newly insured, and the economically disadvantaged.

Ultimately, the larger goals outlined in the 80% by 2018 campaign will continue to be achieved in smaller steps, beginning with one group at a time and one hospital at a time, said Dr Greenwald,

“But really, it comes down to one person at a time,” he added.

—Christina Vogt

Reference:

Greenwald DA. 80% colorectal cancer screening by 2018: how did we do and where do we go from here? Presented at: American College of Gastroenterology 2018 Annual Scientific Meeting; October 9, 2018; Philadelphia, PA.