Trends in utilization of colorectal cancer screening modalities among patients with average risk in the United States from 2017 to 2023.

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98 Background: Colorectal cancer (CRC) is the second leading cause of cancer mortality in the US. The national CRC screening rate (58%) is still below 80%, which is the goal set by the National Colorectal Cancer Roundtable. National guidelines recommend multiple strategies for CRC screening including colonoscopy, sigmoidoscopy, CT colonography, fecal occult blood test (FOBT), fecal immunochemical tests (FIT), or multi-target stool DNA (mt-sDNA) test. To provide updated insights regarding proportional utilization of different CRC screening strategies, we analyzed modality-specific CRC screening rates across demographic subgroups between 2017 and 2023. Methods: A retrospective review was conducted using a large national claims database that covers over 165 million lives and is representative of the US population for the study period from 2017 to 2023. Individuals were included if they were aged 45-75 years, at average CRC risk in the baseline period of 1 year before the index date and continuously enrolled in a health plan for at least 1 year after the index date. The index date was defined as date of the first claim for a CRC screening test. CRC screening uptake by modality and newly screened individuals each calendar year were examined among the entire eligible population and across demographic subgroups. Results: Overall rates of CRC screening were relatively stable across the study years (approximately 20%) with the lowest annual proportion of screen eligible patients in 2020 (16.6%) and highest in 2023 (24.4%). For CRC-screened individuals, colonoscopy was the most commonly used screening modality, increasing from 1,943,733 (53%) in 2017 to 2,319,695 (58.7%) in 2023. The mt-sDNA test use increased significantly from 87,769 (2.4%) in 2017 to 807,227 (20.4%) in 2023; while FIT/FOBT use declined from 1,611,730 (44%) in 2017 to 805,150 (20.4%) in 2023. Utilization of colonoscopy and mt-sDNA tests increased notably among the 45–49 age group starting in 2021, while FIT/FOBT use simultaneously declined in this age group. Observed trends were similar to the above findings across additional subgroups defined by gender, race/ethnicity, payer type, and geographic region. Conclusions: Data from this large study of national claims data provides updated results for overall and proportional utilization of guideline-endorsed CRC screening strategies. While colonoscopy usage remained stable , the use of the non-invasive mt-sDNA test has increased significantly as FIT/FOBT usage declined over time, reflecting growing interest in this noninvasive, home-based option.