Screening for colorectal cancer in the United States: correlates and time trends by type of test.

Shapiro, Jean A; Soman, Ashwini V; Berkowitz, Zahava; Fedewa, Stacey A; Sabatino, Susan A; de Moor, Janet S; Clarke, Tainya C; Doria-Rose, V Paul; Breslau, Erica S; Jamal, Ahmedin; Nadel, Marion R

BACKGROUND It is strongly recommended that adults aged 50-75 years be screened for colorectal cancer (CRC). Recommended screening options include colonoscopy, sigmoidoscopy, computed tomography colonography, guaiac fecal occult blood testing (FOBT), fecal immunochemical testing (FIT), or the more recently introduced FIT-DNA (FIT in combination with a stool DNA test). CRC screening programs can benefit from knowledge of patterns of use by test type and within population subgroups. METHODS Using 2018 National Health Interview Survey data, we examined CRC screening test use for adults aged 50-75 years (N=10,595). We also examined time trends in CRC screening test use from 2010-2018. RESULTS In 2018, an estimated 66.9% of U.S. adults aged 50-75 years had a CRC screening test within recommended time intervals. However, the prevalence was less than 50% among those aged 50-54 years, those without a usual source of health care, those with no doctor visits in the past year, and those who were uninsured. The test types most commonly used within recommended time intervals were colonoscopy within 10 years (61.1%), FOBT or FIT in the past year (8.8%), and FIT-DNA within 3 years (2.7%). After age-standardization to the 2010 census population, the percentage up-to-date with CRC screening increased from 61.2% in 2015 to 65.3% in 2018, driven by increased use of stool testing, including FIT-DNA. CONCLUSIONS These results show some progress, driven by a modest increase in stool testing. However, CRC testing remains low in many population subgroups. IMPACT These results can inform efforts to achieve population CRC screening goals.