Screening Rates

The overall colorectal cancer (CRC) screening rate in the US is 59%,1 well short of the National Colorectal Cancer Roundtable national goal of 80%.2,a Screening rates are lowest for individuals aged 45-49 (20%), Asian Americans (50%), people with lower than high school education, and the uninsured (21%).1 Major organizations also support informed decision-making related to the choice of screening modalities3,4 as evidence has shown that this strategy may improve screening rates.5

The overall CRC screening rate in the US is 59%,1 well short of the of the National Colorectal Cancer Roundtable national goal of 80%1,2,a

~30% of patients who are diagnosed with CRC have a family history of the disease1

Offering patients a choice of screening method may improve screening rates5,b

>1 in 3 adults are not screened for CRC as recommended (ages 50-75)2

The percentage of adults aged 50-75 years who were up to date with CRC screening increased in the last decade but began to plateau in 2018; however, screening rates in the US remain below the nationwide target of 80% regardless of state, age, or ethnicity.1,2,a

59%

2020 Overall US CRC Screening Rate6

Colorectal Cancer Screeningc (%), Adults Aged ≥45 Years, by State (2020)6,d

Colorectal cancer screening percentage, adults aged ≥45 years, by state (2020)

Colorectal Cancer Screening Rates by Age/Gender1

%
Male 67
Female 66
50-64 63
65+ 75

Figure adapted from American Cancer Society, 20231

OFFERING PATIENTS A CHOICE OF SCREENING METHOD MAY IMPROVE SCREENING RATES5,b

Offering patients a choice of colorectal cancer screening method may improve screening rates. Figure shows screening rates of 67% in FOBT arm, 38% in colonoscopy arm, and 69% in patient choice arm. The patient choice arm resulted in a 31% absolute increase in patient adherence.

In a randomized clinical trial of racially/ethnically diverse adults aged 50-79 years at average risk of CRC (n=997), healthcare providers offered patients CRC screening with FOBT, colonoscopy, or patient choice for either and choice of screening modality resulted in a 31% absolute increase in patient adherence.5

ADHERENCE TO ASSIGNED CRC SCREENING STRATEGY OVER 3 YEARS7,e

In a 3-year follow-up study comparing completion of CRC screening strategies, participants offered a choice between fecal occult blood testing and colonoscopy continued to have relatively high adherence, whereas adherence in the fecal occult blood testing group fell significantly below that of the choice and colonoscopy groups.
  • In a 3 year follow up (to the study in the preceding panel6) comparing completion of CRC screening strategies, participants offered a choice between fecal occult blood testing (FOBT) and colonoscopy continued to have relatively high adherence, whereas adherence in the FOBT group fell significantly below that of the choice and colonoscopy groups.7
  • Participants assigned to annual FOBT completed screening at a significantly lower rate over 3 years (14%) than those assigned to colonoscopy (38%, P<0.001) or choice (42%, P<0.001)7

Related Topics

Footnotes

  1. The NCCRT has established the goal of 80% of adults ages ≥50 being regularly screened for CRC.
  2. This randomized clinical trial of competing CRC screening strategies in a racially/ethnically diverse population was conducted between April 2007 and March 2010 in the San Francisco Community Health Network. N=997, Age=50 79 years with average risk for CRC.
  3. Up to date: Home-based blood stool test within the past year, OR blood stool test within the past 3 years with sigmoidoscopy within the past 5 years OR colonoscopy within the past 10 years.
  4. Behavioral Risk Factor Surveillance System 2020.
  5. Cluster randomized trial conducted in San Francisco Health Network, a safety net public health system, that evaluated adherence to assigned strategy over 3 years in patients at average risk for CRC aged 50-79 (n=997): annual FOBT (n=344), colonoscopy (n=332), or choice between annual FOBT and colonoscopy (n=321).

List of definitions

CRC: colorectal cancer; FOBT: fecal occult blood testing; NCCRT: National Colorectal Cancer Roundtable; US: United States.


References

  1. American Cancer Society. Colorectal Cancer Facts & Figures 2023-2025. Accessed October 13, 2023. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2023.pdf
  2. National Colorectal Cancer Roundtable. 80% In Every Community. Accessed March 13, 2023. https://nccrt.org/80-in-every-community/
  3. Shaukat AK, Kahi CJ, Burke CA, et al. ACG clinical guidelines: colorectal cancer screening 2021. Am J Gastroenterol. 2021;116(3):458-479.
  4. Wolf AMD, Fontham ETH, Church TR, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018;68(4):250-281.
  5. Inadomi JM, Vijan S, Janz NK, et al. Adherence to colorectal cancer screening: a randomized clinical trial of competing strategies. Arch Intern Med. 2012;172(7):575-582.
  6. Siegel RL, Wagle NS, Cercek A, Smith RA, Jemal A. Colorectal cancer statistics, 2023. CA Cancer J Clin. 2023; 73(3):233-254. doi: 10.3322/caac.21772
  7. Liang PS, Wheat CL, Abhat A, et al. Adherence to competing strategies for colorectal cancer screening over 3 years. Am J Gastroenterol. 2016;111(1):105-114.