When people have no choice, life is almost unbearable. . . . But as the number of choices keeps growing . . . choice no longer liberates, but debilitates.—Barry Schwartz1(p2)
Colorectal cancer (CRC) incidence and mortality is decreasing in the United States, owing in large part to increased uptake of CRC screening.2 The incidence of CRC has decreased from 59.5 per 100 000 population in 1975 to 44.7 per 100 000 in 2007, and the CRC death rate has decreased from 28.6 per 100 000 population in 1976 to 16.7 per 100 000 in 2007.3 Not everyone is benefiting equally from this decline, however. In a recent American Cancer Society analysis, the decrease in CRC-related death rates between 1990 and 1994 and between 2003 and 2007 ranged from 9% in Alabama to greater than 33% in Massachusetts, Rhode Island, New York, and Alaska, but Mississippi and Wyoming showed no significant decrease. There is clearly a strong imperative to continue all efforts to increase screening rates. If screening uptake can be increased, we can expect substantial continued declines in CRC incidence and mortality.2