The triple effect of colorectal cancer screening: reducing deaths, government spending, and mortality disparities

Colorectal cancer (CRC) screening accounts for over 60% of cancer screening costs in the United States, prompting recurrent debates about its value. Yet CRC screening remains the main tool to curb overall CRC incidence, mortality, and disparities that affect Black Americans. Using the race-specific CRC-SPIN microsimulation model, we show that CRC screening in the United States simultaneously achieves three goals: it saves lives by preventing 24 deaths per 1000 Black Americans screened with the fecal immunochemical test (FIT) and 26 screened with colonoscopy; saves tax dollars by shifting costs from Medicare to private payers; and reduces racial incidence and mortality disparities, helping offset disparities in CRC survival. Both FIT and colonoscopy screening are cost-effective relative to no screening, with annual FIT remaining the most cost-effective option. Changes to policy requiring coverage of preventive care services must avoid compromising the effectiveness of CRC screening-arguably the greatest equalizer of cancer disparities.