Nationwide Trends in Colorectal Cancer Screening by the End of the COVID-19 Pandemic: Racial/Ethnic Differences and...

Although studies have reported on the impact of the COVID-19 pandemic on colorectal cancer (CRC) screening, data on long-term changes remain limited, particularly during the later phases of the pandemic (post 2021) and among racial and ethnic subgroups.

We analyzed data from the 2019, 2021, and 2023 National Health Interview Survey to assess clinician recommendations for CRC screening, past 2-year screening rates, and screening modalities used. Trends were compared across racial/ethnic groups and social determinants of health, including insurance status and income.

Our sample represented 95 million individuals in 2019, 97 million in 2021, and 98 million in 2023. Compared with 2019, CRC screening recommendations dropped by 20% in 2021 (P<.0001), with larger decreases among Hispanics (28%) and uninsured individuals (41%). Recommendations remained 11% lower in 2023 (P=.03). In 2021, past 2-year colonoscopy use declined by 8% (P=.001), whereas multitarget stool DNA testing (mt-sDNA) increased by 18% (P=.03) and fecal immunochemical test/fecal occult blood test (FIT/FOBT) use increased by 55% (P<.001). Colonoscopy declines were greatest among Asian individuals (32%), whereas increases in FIT/FOBT use were highest among Hispanic (78%) and Black (92%) individuals. By 2023, colonoscopy use had returned to prepandemic levels (28%), and mt-sDNA use increased by an additional 40%, resulting in an overall 8% increase in past 2-year screening compared with 2019 (P<.001).

Early in the pandemic, increased stool-based testing offset reduced colonoscopy uptake. Colonoscopy rates have since recovered, whereas stool-based testing continues to increase, with notable differences across ethnic groups. This sustained shift toward stool-based testing offers an opportunity to improve screening, especially where colonoscopy access is limited.