Colorectal Cancer Screening Modalities in the United States: Regional and Rural Variance, the Resilience of...

This study examined trends in colorectal cancer screening modality utilization across the United States from 2016 to 2022, leveraging a large national claims database. The purpose was to identify national, regional, and demographic patterns in screening behavior during a period that encompassed the introduction of multitarget stool DNA testing (mt-sDNA) and the COVID-19 pandemic. Among 6.9 million colorectal cancer screenings analyzed, overall utilization increased through 2019, dipped in 2020 due to pandemic disruptions, and rebounded by 2022. Colonoscopy remained the dominant modality, with its utilization increasing in both relative and absolute terms. mt-sDNA testing experienced rapid adoption, increasing from less than 1% to 17% of all screenings, whereas fecal occult blood testing and fecal immunochemical testing declined. Multinomial logistic regression revealed that utilization patterns varied significantly by region, rurality, sex, age, and year. The Midwest and rural patients exhibited higher uptake of both colonoscopy and mt-sDNA compared with other groups, whereas the West maintained the highest reliance on fecal occult blood testing and fecal immunochemical testing. Findings highlight the nonuniform adoption of screening modalities across regions, urban and rural patients, categories of sex, and age cohorts. Understanding these patterns can inform and improve future resource allocation with the goal of increasing colorectal cancer screening uptake and adherence.

This study informs cancer prevention by revealing regional and demographic variation in colorectal cancer screening modality use. Understanding these evolving patterns can inform and improve targeted strategies and allocation of resources to improve screening uptake and adherence.