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Vital Signs: Colorectal Cancer Screening Test Use — United States, 2012

	MMWR Weekly Volume 62, No. 44 November 8, 2013 PDF of this issue

Vital Signs: Colorectal Cancer Screening Test Use — United States, 2012

Weekly

November 8, 2013 / 62(44);881-888

On November 5, 2013, this report was posted as an MMWR Early Release on the MMWR website (http://www.cdc.gov/mmwr).

Abstract

Background: Strong evidence exists that screening with fecal occult blood testing (FOBT), sigmoidoscopy, or colonoscopy reduces the number of deaths from colorectal cancer (CRC). The percentage of the population up-to-date with recommended CRC screening increased from 54% in 2002 to 65% in 2010, primarily through increased use of colonoscopy.
Methods: Data from the 2012 Behavioral Risk Factor Surveillance System survey were analyzed to estimate percentages of adults aged 50–75 years who reported CRC screening participation consistent with United States Preventive Services Task Force recommendations.
Results: In 2012, 65.1% of U.S. adults were up-to-date with CRC screening, and 27.7% had never been screened. The proportion of respondents who had never been screened was greater among those without insurance (55.0%) and without a regular care provider (61.0%) than among those with health insurance (24.0%) and a regular care provider (23.5%). Colonoscopy was the most commonly used screening test (61.7%), followed by FOBT (10.4%). Colonoscopy was used by more than 53% of the population in every state. The percentages of blacks and whites up-to-date with CRC screening were equivalent. Compared with whites, a higher percentage of blacks across all income and education levels used FOBT.
Conclusions: Many age-eligible adults did not use any type of CRC screening test as recommended. Organized, population-based approaches might increase CRC screening among those who have never been screened. Promoting both FOBT and colonoscopy as viable screening test options might increase CRC screening rates and reduce health disparities.
Introduction
Colorectal cancer (CRC) is the second most common cause of cancer death among cancers that affect both men and women (1). Strong evidence exists that screening for CRC reduces the incidence and mortality of the disease (2). Approximately 90% of those diagnosed with early stage cancer live 5 or more years (3). Screening with either a fecal occult blood test (FOBT) or sigmoidoscopy has been shown in randomized controlled trials to decrease CRC mortality (2). Currently, no randomized controlled trials demonstrate the efficacy of colonoscopy; however, observational studies have reported a reduction in CRC incidence (2). The United States Preventive Services Task Force (USPSTF) recommends several tests for the prevention or early detection of CRC among adults ages 50–75 years: 1) high-sensitivity FOBT annually, 2) colonoscopy every 10 years, or 3) sigmoidoscopy every 5 years with FOBT every 3 years (4).
The percentage of the U.S. adult population that is up-to-date with recommended CRC screening increased from 54% in 2002 to 65% in 2010, primarily driven by increased use of colonoscopy (5). Use of FOBT and sigmoidoscopy declined steadily over the same period (5). This report describes current CRC screening test use by state and type of test, using data from the 2012 Behavioral Risk Factor Surveillance System (BRFSS) survey.