Screening Rates

The percentage of adults aged 50 to 75 years who were up-to-date with colorectal cancer (CRC) screening increased by 1.4% from 2016 to 2018; however, screening rates in the US  remain below the nationwide target of 80% regardless of state, age, or ethnicity.1,2a According to the National Health Interview Survey conducted in 2018, screening rates for CRC (67%) continued to lag those for cervical cancer (81.1%) and breast cancer (72.8%).1  Major organizations also support shared decision-making related to choice of screening modalities,4-6,b as evidence has shown that this strategy may improve screening rates.3,7

The overall CRC screening rate in the US is 67%,1 well short of the of the National Colorectal Cancer Roundtable national goal of 80%1,2,a

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

CRC screening rates are lower than for breast and cervical cancers1

ADULTS AGED 50–75 YEARS WHO REPORT BEING UP-TO-DATEc WITH CRC SCREENING, BY STATE (2018)1

Map of US with state screening rates
Source: Behavioral Risk Factor Surveillance System, 2018.

CRC SCREENING RATES COMPARED TO BREAST AND CERVICAL CANCERS1,2,8

Line graph of cancer screening rates

COLORECTAL CANCER SCREENING RATES BY AGE/GENDER1

Bar chart of CRC screening rates by age and sex

OFFERING PATIENTS A CHOICE OF SCREENING METHOD MAY IMPROVE SCREENING RATES7,d

Bar chart displaying patient compliance with CRC screening within 1 year
In a randomized clinical trial of racially/ethnically diverse adults aged 50–79 at average risk of CRC (n=997), health care 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 adherence7

ADHERENCE TO ASSIGNED CRC SCREENING STRATEGY OVER 3 YEARS3,e

Bar chart displaying colonoscopy and FOBT follow up over 3 years
  • In a 3-year follow-up (to the study in the preceding panel7) comparing completion of CRC screening strategies, participants offered a choice between FOBT and colonoscopy continued to have relatively high adherence, whereas adherence in the FOBT group fell significantly below that of the choice and colonoscopy groups3
  • 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)3

References

American Cancer Society. Colorectal Cancer Facts & Figures 2020-2022. Atlanta: American Cancer Society; 2020.

NCCRT. 80% in every community.. Accessed November 13, 2021. http://nccrt.org/

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

Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Colorectal Cancer Screening. V.2.2021. © National Comprehensive Cancer Network, Inc. 2021.  All rights reserved.  Accessed November 13, 2021.  To view the most recent and complete version of the guideline, go online to NCCN.org.

5 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.

Shaukat A, Kahi CJ, Burke CA, et al. ACG clinical guidelines: Colorectal cancer screening 2021. Am J Gastroenterol. 2021;116:458-479.

7 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.

8 American Cancer Society. Cancer prevention & early detection facts & figures tables and figures 2020. Atlanta: American Cancer Society; 2020.

Footnotes

The NCCRT has established the goal of 80% of adults ages ≥50 being regularly screened for CRC.

All recommendations are category 2A unless otherwise indicated. The National Comprehensive Cancer Network (NCCN®) makes no representations or warranties of any kind regarding their content, use or application and disclaims any responsibility for their application or use in any way

Up-to-date: fecal occult blood test within 1 year, or sigmoidoscopy within 5 years, or colonoscopy within 10 years.

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=50-75 with average risk for CRC.

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)

Last Updated: 3/1/2022