The fecal immunochemical test (FIT)-fecal DNA test every 3 years is the most preferred colorectal cancer (CRC) screening option among individuals aged 40 to 49 years and those aged 50 years and older, according to a study in Clinical Gastroenterology and Hepatology.
The findings are based on an online survey of US adults aged 40 years and older with an average risk for CRC and who had not been previously screened.
Survey invitations were emailed to 7130 individuals from April 29, 2021, to June 2, 2021, which was close in time to the US Preventive Services Task Force’s 2021 recommendation to lower the CRC screening age to 45 years.
The final analysis included 1000 respondents. The mean age for those aged 40 to 49 years was 44.2±2.6 years and 60.7±8.1 years for those aged 50 years and older. Of the cohort, 59.0% and 46.0% of those aged 40 to 49 years and 50 years older, respectively, stated that they planned to be tested.
When the 5 US Multi-Society Task Force (MSTF)-recommended tests were considered, a FIT-fecal DNA test every 3 years was the most preferred option (34.6%) among respondents aged 40 to 49 years (n=456; 61.2% men). Colon video capsule every 5 years was the next most preferred test (28.2%), followed by colonoscopy every 10 years (13.7%), FIT every year (12.2%), and CT colonography every 5 years (11.3%).
Among individuals aged 50 years and older (n=544; 61.6% women), most preferred a FIT-fecal DNA every 3 years (37.3%), followed by colon video capsule every 5 years (22.9%), FIT every year (18.7%), colonoscopy every 10 years (13.6%), and CT colonography every 5 years (7.6%). The proportion of preferred tests was significantly different in those aged 40 to 49 years vs those aged 50 years and older (adjusted P =.019).
When only the US MSTF tier 1 CRC screening tests were considered, 68.9% and 77.4% of individuals aged 40 to 49 years and those aged 50 years and older, respectively, preferred an annual FIT vs a colonoscopy every 10 years (adjusted P =.004 when comparing preferences between the 2 age groups).
For individuals aged 40 to 49 years, those with 2 or more medical comorbidities were less likely to prefer an FIT compared with individuals without comorbidities. In the 50-year-old and older group, individuals who planned to be screened for CRC were less likely to prefer an FIT.
The most common factor cited by responders for choosing a CRC screening test was convenience and ease of use (travel time, disruption of daily activities, preparation time; 42.1%). Other considerations included potential complications (23.8%), invasiveness/level of embarrassment (16.7%), and financial considerations (out-of-pocket costs, insurance; 15.4%).
Among several limitations, the study was conducted only in the United States, and results from the online survey may not be generalizable to older adults or those who lack basic computing skills. In addition, only 19.4% of respondents identified as racial and ethnic minorities, and all respondents were members of paid survey panels, which may have introduced selection bias. Furthermore, the survey was conducted during the COVID-19 pandemic, when more people may have preferred at-home stool tests compared with more invasive options that require visiting health care facilities.
“In light of the recently lowered screening age to 45 years, further research examining screening test preferences among broader populations is warranted to inform and enhance the effectiveness of CRC screening programs,” the study authors wrote.
Disclosure: One of the study authors declared an affiliation with a diagnostics company. Please see the original reference for a full list of the author’s disclosures.
Makaroff KE, Shergill J, Lauzon M, et al. Patient preferences for colorectal cancer screening tests in light of lowering the screening age to 45 years. Clin Gastroenterol Hepatol. Published online July 20, 2022. doi:10.1016/j.cgh.2022.07.012