Utilization of colorectal cancer screening modalities in the United States (2017–2023): a national multi-payer claims database analysis

Colorectal cancer (CRC) is the second leading cause of cancer-related mortality in the U.S., with screening playing a critical role in early detection. This study aimed to estimate the proportion of CRC screening modalities used from 2017 to 2023 using a large, national multi-payer claims database. This retrospective, cross-sectional study analyzed data from 2017 to 2023 using a national multi-payer claims database, supplemented with laboratory data related to CRC screening. Patients aged 45-75 years, at average risk for CRC, with no prior CRC diagnosis, and who had continuous health insurance enrollment for 24 months (from January 1 of the baseline year to December 31 of the study year) were included. Annual proportions for colonoscopy, multi-target stool DNA (mt-sDNA) test, fecal immunochemical test/fecal occult blood test (FIT/FOBT), and other modalities were assessed, along with sociodemographic factors. Descriptive statistics and chi-square tests were used to assess utilization trends across the years. Colonoscopy remained the most commonly used screening modality, with its share increasing slightly from 53.0% in 2017 to 58.7% in 2023. The mt-sDNA test proportion increased significantly from 2.4% in 2017 to 20.4% in 2023, while the proportion of FIT/FOBT declined significantly, from 44% to 20.4%. Similarly, significant age-related shifts in screening utilization were observed, with colonoscopy proportion increasing from 48.1% to 61.6%, mt-sDNA rising from 0.0% to 24.0%, and FIT/FOBT declining from 50.8% to 14.1% in the 45-49 age group from 2017 to 2023. Significant shifts in CRC screening utilization were observed from 2017 to 2023, with a steady increase in colonoscopy use, notable rises in mt-sDNA testing, and a sharp decline in FIT/FOBT usage. Continued monitoring of these trends is essential to understanding the evolving landscape of CRC screening and ensuring access to the most effective modalities for all populations.