Colorectal Cancer Screening Modalities in the US: Regional and Rural Variance, the Resilience of Colonoscopy, and the Rise of mt-sDNA Testing.

Abstract

This study examined trends in colorectal cancer (CRC) 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 CRC screenings analyzed, overall utilization rose 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 under 1% to 17% of all screenings, while fecal occult blood testing and fecal immunochemical testing (FOBFIT) 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 to other groups, while the West maintained the highest reliance on FOBFIT. 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 CRC screening uptake and adherence.