Screening for Colorectal Cancer in the United States: Correlates and Time Trends by Type of Test

Cancer Epidemiol Biomarkers Prev. 2021 Aug;30(8):1554-1565. doi: 10.1158/1055-9965.EPI-20-1809. Epub 2021 Jun 4.


Background: It is strongly recommended that adults aged 50-75 years be screened for colorectal cancer. Recommended screening options include colonoscopy, sigmoidoscopy, CT 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). Colorectal cancer screening programs can benefit from knowledge of patterns of use by test type and within population subgroups.

Methods: Using 2018 National Health Interview Survey (NHIS) data, we examined colorectal cancer screening test use for adults aged 50-75 years (N = 10,595). We also examined time trends in colorectal cancer screening test use from 2010-2018.

Results: In 2018, an estimated 66.9% of U.S. adults aged 50-75 years had a colorectal cancer 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, colorectal cancer testing remains low in many population subgroups.

Impact: These results can inform efforts to achieve population colorectal cancer screening goals.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / epidemiology
  • Early Detection of Cancer*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Surveys and Questionnaires
  • United States / epidemiology