CRC Screening Rates Increase During Past Decade While Remaining Suboptimal

The USPSTF recommends screening adults aged 50 to 75 for colorectal cancer.
The USPSTF recommends screening adults aged 50 to 75 for colorectal cancer.
Investigators assessed rates of colorectal cancer screening participation in the time periods before and after introduction of multi-target stool DNA tests.

The proportion of individuals with an average risk for colorectal cancer (CRC) who were up to date on CRC screening increased from 41% in 2011 to 69% in 2019; while this represents an improvement, it is still less than the 80% goal set by the National Colorectal Cancer Roundtable, researchers reported in JAMA Network Open.

This longitudinal cohort study used the MarketScan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits administrative claims databases to assess CRC screening test use from August 1, 2011, to August 31, 2019.

This period was divided into a screening measurement period (August 1, 2011, to July 31, 2019) and a 10-year prescreening period (August 1, 2001, to July 31, 2011). The screening measurement period was further divided into the pre-multi-target stool DNA (mt-sDNA) period (August 1, 2011, to July 31, 2014) and the post-mt-sDNA period (August 1, 2016, through July 31, 2019). The time from August 1, 2014, to July 31, 2016, was defined as a washout period.

Eligible participants were aged 45 to 67 years on August 1, 2011, which ensured that they were aged 75 years or younger by the end of the screening measurement period on July 31, 2019.

A total of 97,776 individuals were included (mean age, 50.8 years; SD, 3.5 years; 55.5% women), of whom 62.2% were aged 50 years or older and 37.8% were aged 45 to 49 years on August 1, 2011. Among those aged 50 years and older, the percentage who were up to date on screening increased each year, from 50.4% in 2011 to 2012 to 69.7% in 2018 to 2019. In those aged 45 to 49 years, the proportion of individuals up to date with screening in the first year was 25.8%, but the difference between age groups was nearly eliminated by the last year of measurement (67.7%).

After the Current Procedural Terminology code for mt-sDNA was available beginning in 2016, the use of this modality increased from 1.9% in 2016 to 2017 to 14.2% in 2018 to 2019.

No consistent trends were observed for fecal immunochemical tests or screening colonoscopy. Less than 1% of the screened population underwent computed tomography colonography, double-contrast barium enema, and flexible sigmoidoscopy in any given measurement year.

The main study limitation is that all up-to-date screening periods were assigned based on the assumption that individuals are not in a high-risk category for CRC; thus, the percentage of individuals with up-to-date screening may be overestimated. Additionally, the study was limited to individuals with commercial health coverage or private Medicare supplemental coverage, and the data are subject to coding limitations and entry errors.

“Although there remains progress to be made before reaching the 80% screening rate goal set by the National Colorectal Cancer Roundtable, the results of this analysis and other studies highlight the effectiveness these population-level interventions have had on increasing CRC screening uptake in the United States,” the investigators commented.

Disclosure: This study was funded by Exact Sciences Corporation. Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Fisher DA, Princic N, Miller-Wilson L-A, et al. Utilization of a colorectal cancer screening test among individuals with average risk. JAMA Netw Open. 2021;4(9):e2122269. doi: 10.1001/jamanetworkopen.2021.22269