Public Health in Action: 80% by 2018

Few preventive interventions are as reliably effective in reducing avoidable death as screening for colorectal cancer. Because screening actually prevents many cases of colorectal cancer, this intervention is particularly cost effective and appealing to clinicians and patients alike. Avoiding a cancer completely is a health goal that many people readily embrace and seek. Largely as a result of the screening that has already occurred in the United States, mortality rates from colorectal cancer have been declining for nearly three decades. While gratifying, the 2013 National Health Interview Survey (NHIS) demonstrated that colorectal cancer screening rates had plateaued at 59%. More than one out of every three eligible adults — about 23 million men and women — were not being screened. Furthermore, data proved that individuals facing greater barriers to screening and with less interest in being screened were far less likely to be screened than individuals with higher income, more education, and health insurance.

In 2013, several events and actions converged to create a receptive environment for launching a major screening initiative focused on increasing colorectal cancer screening. These factors included expansion of insurance coverage, a request for dramatic action by Dr. Howard Koh, the assistant secretary for health for the U.S. Department of Health and Human Services, as well as sustained leadership and commitment by the Centers for Disease Control (CDC) and the American Cancer Society (ACS). The launch of the National Colorectal Cancer Roundtable’s 80% by 2018 effort in March 2014, constituted a public commitment on behalf of its member organizations to reach the 23 million unscreened individuals by developing and implementing a comprehensive plan to accelerate progress and to reach an 80% screening rate in less than five years. Our members knew this would demand urgent, informed action, but the time was right to do something bold and remarkable. Lives literally depend on our success.

We immediately embarked on constructing a strategic plan to achieve the goal. We reached out to and successfully engaged with nearly every professional and government organization involved in screening and follow-up care. We wrote an organizational pledge asking leaders to embrace and jointly pursue this goal. Leaders at the CDC provided expert guidance based on their experience with the national colorectal cancer screening program. Finally, the 600 nationally deployed American Cancer Society health systems staff embraced this goal as their own.

Today, I can state with gratitude and unbounded optimism that our efforts are working. Colorectal cancer screening rates in Federally Qualified Health Centers shot up by 4% from 2014 to 2015. Screening in commercial plans participating in the HEDIS program are up to 67.2% for plans serving the Medicare population. And now, we have the first national survey results captured since the launch of the 80% by 2018 effort. The 2015 NHIS results reveal a 4% increase in the screening rate from 2013 to 2015 — nearly 4 million additional adults over 50 have been screened for colorectal cancer. ACS researchers estimate that 37,200 deaths from colorectal cancer will be averted if our country can maintain this increase.

Even as we pursue our goal, we have an obligation to capture what is working. The 80% by 2018 effort represents one of the most complex and most successful public health efforts of its kind in history. Here is a quick summary of lessons learned so far.

1. Leadership and champions are obligatory. Show me an organization with rapidly increasing screening rates, and I assure you that you’ll find committed individuals leading the way.
2. Evidence-based interventions work. When organizations roll up their sleeves and implement what we know works, screening rates increase.
3. While a recommendation from a trusted source of primary care is the most powerful predictor of screening, every strategy must be pursued with equal vigor and enthusiasm. Promotion of screening directly to the public; partnerships with health systems, insurers, specialists, and large employers; policy solutions; population management; and patient navigation are all necessary to keep screening rates climbing as rapidly as possible.

I am being asked more and more often: Will we reach our 80% goal by the end of 2018? I don’t know if we’ll get there or not. But I know we can. If we act with informed urgency and if we believe we can, 80% is within reach. Even more importantly, the 80% by 2018 campaign has already been successful. We know 1,400 organizations have signed the 80% by 2018 pledge. We are seeing significant increases in screening rates across all sectors of our health care system. We already know of 65 organizations that have achieved 80%, many of which are reflected in our 80% by 2018 Hall of Fame. Lives are being saved. We will sustain this effort, working as fast as we can, as long as it takes, to reach 80% screening rates and beyond in every community throughout the nation.