Vital Signs

Colorectal Cancer Screening Test Use — United States, 2018

Djenaba A. Joseph, MD; Jessica B. King, MPH; Nicole F. Dowling, PhD; Cheryll C. Thomas, MSPH; Lisa C. Richardson, MD

Disclosures

Morbidity and Mortality Weekly Report. 2020;69(10):253-259. 

In This Article

Abstract and Introduction

Abstract

Background: Colorectal cancer (CRC) is the second leading cause of cancer death in the United States of cancers that affect both men and women. Despite strong evidence that screening for CRC reduces incidence and mortality, CRC screening prevalence is below the national target. This report describes current CRC screening prevalence by age, various demographic factors, and state.

Methods: Data from the 2018 Behavioral Risk Factor Surveillance System survey were analyzed to estimate the percentages of adults aged 50–75 years who reported CRC screening consistent with the United States Preventive Services Task Force recommendation.

Results: In 2018, 68.8% of adults were up to date with CRC screening. The percentage up to date was 79.2% among respondents aged 65–75 years and 63.3% among those aged 50–64 years. CRC screening prevalence was lowest among persons aged 50–54 years (50.0%) and increased with age. Among respondents aged 50–64 years, CRC screening prevalence was lowest among persons without health insurance (32.6%) and highest among those with reported annual household income of ≥$75,000 (70.8%). Among respondents aged 65–75 years, CRC screening prevalence was lowest among those without a regular health care provider (45.6%), and highest among those with reported annual household income ≥$75,000 (87.1%). Among states, CRC screening prevalence was highest in Massachusetts (76.5%) and lowest in Wyoming (57.8%).

Discussion: CRC screening prevalence is lower among adults aged 50–64 years, although most reported having a health care provider and health insurance. Concerted efforts are needed to inform persons aged <50 years about the benefit of screening so that screening can start at age 50 years.

Introduction

Of cancers that affect both men and women, colorectal cancer (CRC) is the second leading cause of cancer death in the United States. In 2016, 141,270 cases were diagnosed, and 52,286 persons died from the disease.[1] The U.S. Preventive Services Task Force recommends that adults at average risk (those who do not have a personal or family history of CRC or polyps, do not have inflammatory bowel disease, or a history of genetic syndromes associated with CRC) aged 50–75 years be screened for CRC by any of six available tests: 1) fecal occult blood test (FOBT), 2) fecal immunochemical test (FIT), 3) multitarget stool DNA (FIT-DNA), 4) computed tomographic colonography (CTC), 5) sigmoidoscopy, or 6) colonoscopy.[2] Strong evidence exists that screening for CRC reduces incidence and mortality.[2] Both CRC incidence and mortality have declined steadily over the past 30 years; the decline is attributable in part to the increasing percentage of adults aged 50–75 years who are up to date with CRC screening (i.e., have completed a CRC screening test within the recommended time interval).[3,4] Despite steady gains, the prevalence of CRC screening is lower than the stated national Healthy People 2020 target of 70.5%, and not all populations have achieved equivalent gains in CRC screening.[5] This report describes current CRC screening among U.S. adults aged 50–75 years, by demographic characteristics and state.

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