Colorectal cancer screening uptake and adherence by modality at a large tertiary care center in the United States: a retrospective analysis

Abstract

Objective Real-world data regarding colorectal cancer (CRC) screening adherence and use of various screening modalities is critical to improving efficacy of CRC prevention programs. We assessed overall CRC screening adherence rates and utilization by modality over a three-year period (2017-2019) within a large Primary Care network. Methods A retrospective review of individuals aged 50-75 years at average risk for CRC with at least one clinic visit in the previous 24 months. The primary outcome was CRC screening adherence each calendar year, overall and by modality, among the entire eligible population and among individuals newly completing screening (i.e., newly adherent). The final sample included 107,366 patients and 218,878 records. Results Overall CRC screening adherence increased from 2017 to 2019 (71% to 78%). Colonoscopy was the most utilized modality (up to approximately 74% were “up-to-date” with colonoscopy versus 4% for non-invasive options). However, utilization of various modalities accounting for individuals being “up-to-date” with screening changed over time, with the highest increase for mt-sDNA (10.2-fold increase), followed by FIT (1.6-fold increase) and colonoscopy (1.1-fold increase). Among newly adherent individuals, the proportion screened by colonoscopy and FOBT decreased (89% to 80% and 2.4% to 1.2%, respectively), while uptake of FIT and mt-sDNA increased (7.7% to 11.5% and 0.9% to 6.8%, respectively). Notably, FIT and mt-sDNA increased disproportionately among the age and race-ethnicity groups with the lowest overall screening rates. Conclusions In an opportunistic CRC screening program, adherence increased over time but remained below the national goal of 80%. Although colonoscopy remained the most utilized screening modality, colonoscopy uptake rates decreased, while utilization rates of mt-sDNA and FIT increased. Among minority populations, new uptake increased most with mt-sDNA and FIT. Multiple CRC screening options should be leveraged by patients and Providers to potentially improve the effectiveness and help address disparities in CRC prevention programs.