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Research supports the use of several screening tests for colorectal cancer. Usage is monitored by total test use and the following two specific tests:
FOBT: Percentage of adults aged 50 and older who reported that they had a fecal occult blood test (FOBT) within the past 2 years, by racial/ethnic group. In the 2000 National Health Interview Survey (NHIS), questions were asked on both home and office FOBT and in 2003 questions were asked only on home FOBT. Responses from the 2000–2005 NHIS for home FOBT are directly calculated.
Colorectal endoscopy: Percentage of adults aged 50 and older who reported that they ever had an endoscopy (proctoscopy, sigmoidoscopy or colonoscopy).
Colorectal cancer test use: Percentage of adults aged 50 and older who had a colorectal cancer test (home-based FOBT in the last 2 years and/or ever had a colorectal endoscopy).
Home FOBT: Decline. Home FOBT had been rising until 2000, then began falling slightly in Whites, rose in Blacks and Hispanics until 2003, then fell in Blacks in 2005 and stabilized in Hispanics.
Colorectal endoscopy: Rising overall. Colorectal endoscopy had been rising from 1987–1998, stabilized until 2000, then began to rise again after 2000 and rose especially rapidly (Annual Percent Change=7%) between 2003–2005. These same trends characterize both Whites and Blacks. Among Hispanics, there has been no significant change in rates since 1992.
Colorectal cancer test use: Rising slightly. Rising, especially between 1987–1992, 1998–2000, and 2003–2005. Since 1987, colorectal cancer test use has been rising in Whites. Overall rise in Blacks was attributable to large significant increases between 1987–1992 and between 1998–2000. After a large rise among Hispanics between 1987–1992, the trend has been stable. Among Asians interviewed in California only, rates were stable between 2001–2003 (not graphed).
In 2005, 25 percent of people aged 50 and older had a home FOBT within the past 2 years. This includes 18 percent of Hispanics, 24 percent of Blacks, and 26 percent of Whites. Among Asian women interviewed in California, 22 percent had a home FOBT within the past 2 years. In 2005, 50 percent of people 50 and older had ever had a colorectal endoscopy . This includes 32 percent of Hispanics, 43 percent of Blacks, and 53 percent of Whites. Among Asian women interviewed in California, 53 percent had ever had a colorectal endoscopy. In 2005, 59 percent of people 50 and older had used a colorectal cancer test . This includes 40 percent of Hispanics, 52 percent of Blacks, and 61 percent of Whites. Among Asian women interviewed in California, 60 percent had used a colorectal cancer test.
Increase to 50 percent the proportion of adults aged 50 and older who have had an FOBT within the past 2 years.
Increase to 50 percent the proportion of adults aged 50 and older who have ever had a sigmoidoscopy. This target was met (for endoscopy including colonoscopy and sigmoidoscopy) in 2005.
No Healthy People 2010 target has been set for the proportion of adults who should receive colonoscopy screenings.
Immigrants and those with lower incomes, with less education, without insurance, and lacking a usual health care provider are less likely to be screened for colorectal cancer.
Despite some improvements over time, colorectal cancer screening rates remain low. Understanding and overcoming doctor and patient barriers to these life-saving tests is critical.
Newer screening methods, such as virtual colonoscopy and fecal DNA testing, are promising and need further evaluation.
A substantial proportion of reported FOBT and colorectal endoscopy procedures may be used for diagnostic rather than screening purposes.