Bringing the Mission to Screen to Digestive Disease Week

As Digestive Disease Week (DDW) annual meeting kicks off in Chicago on May 6, it's encouraging to see the growing interest and substantial progress in colorectal cancer screening, the primary focus of my 25-year clinical career prior to joining Exact Sciences. Continued innovation is crucial to combat this still-too-common disease.  With more than 60 million unscreened individuals in this country alone¹, considerable work remains. Broad collaboration is required to evaluate screening ideas and help ensure that those with potential demonstrated effectiveness against defined performance thresholds are reviewed, endorsed, and positioned for appropriate use.

To address the screening gap collectively, three factors must be considered for a successful colorectal cancer screening program:

1. Accuracy: A colorectal cancer screening test needs to meet or exceed acceptable sensitivity (to detect both cancers and pre-cancers) and specificity (to minimize unnecessary evaluation resulting from false positives) performance thresholds to yield the most favorable clinical and economic outcomes.
2. Adoption: Patients and providers must be willing to complete both the initial test and any follow-up testing, when indicated (i.e. after a positive stool-based screening result), in order to realize the full benefits of early detection.
3. Access: System-level barriers to patients, providers, and to timely completion of initial and follow-up testing must be recognized and addressed to promote colorectal cancer screening particularly in vulnerable populations.  A recent example of notable progress in this space is the implementation of national policy changes eliminating the risk for patient cost-share with follow-up colonoscopy after a positive stool-based screening result.²

During DDW and beyond, we will thoughtfully discuss and actively debate novel approaches that could, with clear evidence of benefit, add to the screening paradigm. We know the pathway from laboratory discovery to clinical application remains both lengthy and challenging. However, there are no shortcuts around the well-established standards for study design, regulatory review, guideline inclusion, and other key milestones that must be achieved prior to widespread adoption. Nothing less is acceptable.

Exact Sciences will present nine abstracts during the upcoming DDW conference sessions and in doing so continue to lead and advance our field, stressing the importance of screening when it matters and detection of pre cancer, when screening is most impactful and important. We will continue to hold ourselves accountable to improving performance and adoption of screening modalities and clinical studies that represent the real world.

For more than 10 years Exact Sciences has led in helping more people get screened for colorectal cancer, always committed to conducting high-quality science with a patient-centered approach to support our current and future cancer early detection offerings.

Congratulations to all DDW presenters.  We look forward to engaging with you and other conference attendees to learn from each other and explore opportunities to accelerate successes in detecting colorectal cancers and precancers and ensuring the best for our patients.

1. Piscitello A, Edwards DK. Estimating the screening-eligible population size, aged 45 to 74, at average risk to develop colorectal cancer in the United States. Cancer Prev Res.2020;13(5):443-448. *Estimate based on the US population aged 45-74 as of 2018, adjusted for the reported rates of high-risk conditions and prior screening history for CRC
2. Fact sheet Calendar Year (CY) 2023 Medicare Physician Fee Schedule Final Rule. CMS. Updated November 1, 2022. Accessed April 24, 2023. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2023-medicare-physician-fee-schedule-final-rule