Changes in Colorectal Cancer Screening Modalities Among Insured Individuals

Importance Several colorectal cancer (CRC) screening modalities (eg, colonoscopy, stool-based tests) are currently available. Yet, recent national patterns in screening using these modalities and potential differences across sociodemographic groups remain unclear. Objective To evaluate possible changes in the use of different CRC screening modalities among average-risk individuals aged 50 to 75 years in the US. Design, Setting, and Participants This retrospective cohort study used deidentified claims data from 2017 to 2024. Participants included a dynamic cohort of commercially insured Blue Cross Blue Shield beneficiaries. Data were analyzed from May 1 to June 30, 2025. Exposures Invasive and noninvasive CRC screening modalities. Main Outcomes and Measures Changes in screening modality use were compared between the periods preceding the onset of the COVID-19 pandemic (ie, preonset: January 1, 2017, to February 28, 2020) and following the onset of the pandemic (ie, postonset: July 1, 2020, to December 31, 2024). Changes in screening by modality were also evaluated using autoregressive integrated moving average models, adjusting for temporal autocorrelation and seasonality. Results In this retrospective cohort study of 24 973 642 distinct beneficiaries (mean SD age, 57.36 4.27 years; 12 789 413 female 51.21%), the use of colonoscopy (mean SD, 1.29% 0.09% to 1.14% 0.07%; P lt; .001) and fecal immunochemical test (FIT) decreased between the 2 periods (mean SD, 0.54% 0.03% to 0.38% 0.07%; P lt; .001). However, stool DNA test use increased (mean SD, 0.19% 0.13% to 0.61% 0.16%; P lt; .001). Males had higher use of colonoscopy than females (mean SD, 1.21% 0.07% vs 1.07% 0.07%; P lt; .001), whereas females had higher use of stool DNA test than males (mean SD, 0.68% 0.16% vs 0.55% 0.15%; P lt; .001) and FIT (mean SD, 0.43% 0.08% vs 0.33% 0.05%; P lt; .001). Areas with socioeconomic status (SES) in the top 20% had higher use of colonoscopy compared with areas where a marker of SES was in the bottom 20% (mean SD, 1.37% 0.09% vs 0.91% 0.06%; P lt; .001) and stool DNA test (mean SD, 0.65% 0.17% vs 0.48% 0.13%; P lt; .001) and lower use of FIT (mean SD, 0.36% 0.09% vs 0.48% 0.06%; P lt; .001). Metropolitan area residents, compared with nonmetropolitan area residents, more frequently underwent colonoscopy (mean SD, 1.18% 0.08% vs 0.97% 0.06%; P lt; .001) and FIT (mean SD, 0.41% 0.08% vs 0.25% 0.04%; P lt; .001); however, their use of stool DNA test were similar (mean SD, 0.61% 0.16% vs 0.64% 0.16%; P = .51). Conclusions and Relevance Among privately insured individuals, the use of colonoscopy and FIT decreased after the COVID-19 pandemic while stool DNA test use increased, with differences by sex, area-level SES, and metropolitan area residence.