Shapiro et al. 2021 analyzed CRC screening test utilization rates using self-reported data from participants in the 2018 National Health Interview Survey (NHIS).1 Specifically, the use of CRC screening tests overall and the use of specific tests (colonoscopy, stool-based tests, sigmoidoscopy, and CT colonography) were examined.1 Time trends in use for the specific tests were also examined to understand how the use of different tests contributed to overall changes in CRC screening prevalence between 2010-2018. The sample included 10,595 adults in 2018 aged 50-75 years without a personal history of CRC and with complete information for at least one CRC screening test. Overall, 66.9% were up to date with CRC screening in 2018.1
The most commonly used tests were colonoscopy (61.1% within the past 10 years), FOBT/FIT (8.8% within the past year), mt-sDNA or FIT-DNA (2.7% within the past 3 years), sigmoidoscopy (2.4% within the past 5 years), and CT colonography (1.0% within the past 5 years).1
After the CRC screening rates were age-standardized to the 2010 census population, the percentage of participants up to date with screening increased between 2015 (61.2%) and 2018 (65.3%). This increase was primarily due to the increased use of stool-based tests, including mt-sDNA (or FIT-DNA).1
Use of any CRC screening test was lower for adults who were younger, had less education or lower family income, were born outside of the US, without a usual source of healthcare, and/or had fewer doctor visits. Use was also lower for non-Hispanic Black, non-Hispanic Asian, and Hispanic adults, for those who were never married, and for those who lived in the South and West. Specifically for stool-based tests, the use of any stool-based test was higher for adults who were Hispanic and non-Hispanic Asian, not born in the US, having fair/poor health status, living in the West, aged 50-64 years with Medicaid or other (not private) insurance, and aged 65-74 with dual-eligible health coverage or Medicare Advantage.1
Possible study limitations include the use of self-reported NHIS survey data in which respondents may have incorrectly reported use and/or timing of CRC tests. Also, the 2018 NHIS adult response rate was relatively low (53%) as compared to data from earlier years. While survey results were weighted to account for non-response bias, some bias may still exist.1
In Limburg, et al. 2021, trends in utilization of CRC screening tests were examined using Medicare claims data from 2014-2018.2 As shown in the figure below, the use of colonoscopy and FIT remained relatively constant over time. There was a significant increase in the use of mt-sDNA (P<0.001) and a significant decrease in the use of FOBT (P<0.001).2
Fisher, et al. 2021 queried administrative claims databases to examine CRC screening and test use between 8/1/2011 and 7/31/2019.3 Participants included individuals aged 45-75 years at average risk of CRC. The primary outcome was the proportion of patients who were up to date or not due for CRC screening during each measurement year and the type of screening test used. The sample included 97,776 individuals and data were determined for 2 age groups – 45 to 49 years (n=37,006) and ≥50 years (n=60,770).
Trends showed an increase in participants up to date with CRC screening from 50.4% in 2011 to 69.7% in 2019. The use of FOBT decreased between 2011 (17.4%) and 2019 (6.6%), mt-sDNA increased between 2016 (1.9%) and 2019 (14.2%), and there was no change for FIT or screening colonoscopy. The increase in mt-sDNA use occurred after the CPT code became available in 2016.
Barthold, et al. 2022 conduced a cohort study to examine CRC screening rates in 2 states (Oregon and Kentucky) that have implemented policies to eliminate consumer cost-sharing of CRC screening compared to neighboring states that did not using data from administrative claims databases from January 1, 2012, to December 31, 2019.4 Oregon was compared to Idaho and Washington and Kentucky was compared to Indiana, Tennessee, and West Virginia. Participants included individuals aged 45-64 years with 12 months of continuous enrollment in self-funded plans. Oregon was further restricted to ages 50-64 years and excluded enrollees with high-deductible plans. The sample included 2,327,935 person-years among 1,215,580 individuals.
After policy implementation in 2017 in Oregon, individuals had 6% higher odds of receiving any CRC screening and 35% higher odds of undergoing an initial noninvasive test after policy implementation. There was no statistically significant difference for the odds of receiving a colonoscopy conditional on undergoing noninvasive CRC screening in Oregon. For Kentucky, there was no significant difference for any outcome. The authors concluded that access to full coverage resulted in significant increases in overall CRC screening and the use of noninvasive testing in Oregon but not Kentucky. Learn more at Modalities.
References
1. Shapiro JA, Soman AV, Berkowitz Z, et al. Screening for colorectal cancer in the United States: correlates and time trends by type of test. Cancer Epidemiol Biomarkers Prev. 2021; doi:10.1158/1055-9965.EPI-20-1809
2. Limburg PJ, Finney Rutten JL, Ozbay AB, et al. Recent trends in colorectal cancer screening methods based on Medicare claims data. Curr Med Res Opin. 2021;37(4):605-607.
3. Fisher DA, Princic N, Miller-Wilson LA, et al. Utilization of a colorectal cancer screening test amount individuals with average risk. JAMA Netw Open. 2021;4(9):e2122269.
4. Barthold D, Yeung K, Lieberman D, et al. Comparison of screening colonoscopy rates after positive noninvasive testing for colorectal cancer in states with and without cost-sharing. JAMA Netw Open. 2022;5(6):e2216910.