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

Abstract

Background: 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.

Patients and methods: 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.

Results: 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).

Conclusions: 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.