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In 2019, 67.1% of adults aged 50-75 had received colorectal cancer screening based on the most recent guidelines.
Background
In 2016, the U.S. Preventive Services Task Force (USPSTF) recommended screening for colorectal cancer for adults aged 50 to 75 years, and that adults aged 76 to 85 years should make an individual decision about screening. In May 2021, the USPSTF updated their guidance to lower the recommended screening start age to 45 years. This was based on evidence indicating a trend for increasing risk of colorectal cancer in adult birth cohorts younger than 50 years and statistical modeling suggesting that starting at age 45 years may increase life years gained compared to 50 years.
Regular colorectal cancer screening is important for preventing new colorectal cancers from developing as well as for identifying existing colorectal cancers early - which can reduce the risk of death. A variety of screening tests can be used to detect colorectal cancer and/or precancerous polyps.
Measure
Colonoscopy - A procedure where a doctor looks into the rectum and the entire colon using a flexible narrow tube to identify colorectal cancer or precancerous polyps. Used not only as a screening test, colonoscopies are also used as a diagnostic procedure to follow up after positive results from a fecal occult blood test (FOBT) or fecal immunochemical test (FIT), fecal DNA test, sigmoidoscopy, or CT colonography. The USPSTF suggests a screening colonoscopy once every 10 years.
Computed tomography (CT) colonography (otherwise known as a virtual colonoscopy) - Produces a three-dimensional image of the colon which your doctor examines for colorectal cancer and precancerous polyps. The USPSTF suggests CT colonography once every 5 years.
Fecal occult blood test (FOBT) and fecal immunochemical test (FIT) - These tests identify hidden blood in the stool, which can be a sign of cancer. The USPSTF suggests FOBT or FIT annually, using a home-based kit.
Fecal DNA test – In addition to checking for hidden blood in the stool like a FIT, this test also looks for abnormal genetic material that may be a sign of colorectal cancer. The USPSTF suggests fecal DNA testing at least every 3 years.
Sigmoidoscopy - A procedure where a doctor looks into the rectum and part of the colon using a flexible narrow tube to identify colorectal cancer or precancerous polyps. The USPSTF suggests sigmoidoscopy once every 5 years, or once every 10 years when conducted along with FIT every year.
Healthy People 2030 Target
- Increase to 74.4 percent the proportion of adults aged 50 to 75 years who have received a colorectal screening test based on the most recent guidelines.
Healthy People 2030 is a set of goals set forth by the Department of Health and Human Services.
Note: Goals are indicated as blue line on Detailed Trend Graphs.
Data Source
Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey, 1987–2019.
Please note that these data were collected while the 2016 USPSTF recommendations were in place. Therefore, the estimates include adults aged 50 to 75 years.
In 2019 the NHIS questionnaire was redesigned to increase relevance, enhance data quality, and minimize respondent burden. In addition, the COVID-19 pandemic created challenges conducting in-person interviews for the 2020 NHIS, requiring changes to field procedures to conduct most surveys by telephone, which impacted survey response rates. For details related to the potential impacts of these issues, please refer to Potential Impact of NHIS Redesign and COVID-19 on the Cancer Trends Progress Report.
Trends and Most Recent Estimates
Guideline Screening
By Sex
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2019) | |
|---|---|---|---|
| Percent of adults | 95% Confidence Interval | ||
|
Both Sexes
|
67.1 | 66.1 - 68.1 |
Male
|
65.7 | 64.3 - 67.2 | |
Female
|
68.4 | 67.1 - 69.7 | |
By Race/Ethnicity
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2019) | |
|---|---|---|---|
| Percent of adults | 95% Confidence Interval | ||
|
All Races
|
67.1 | 66.1 - 68.1 |
Non-Hispanic White
|
70.1 | 69.0 - 71.2 | |
Non-Hispanic Black
|
68.5 | 65.8 - 71.1 | |
Hispanic
|
54.7 | 51.3 - 58.0 | |
By Poverty Income Level
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2019) | |
|---|---|---|---|
| Percent of adults | 95% Confidence Interval | ||
|
<200% of federal poverty level
|
55.4 | 53.3 - 57.5 |
>=200% of federal poverty level
|
71.3 | 70.2 - 72.3 | |
By Education Level
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2019) | |
|---|---|---|---|
| Percent of adults | 95% Confidence Interval | ||
|
Less than High School
|
50.7 | 47.2 - 54.3 |
High School
|
63.7 | 61.9 - 65.4 | |
Greater than High School
|
72.3 | 71.1 - 73.4 | |
By Contributing Test Type
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2019) | |
|---|---|---|---|
| Percent of adults | 95% Confidence Interval | ||
|
Home FOBT
|
3.3 | 3.0 - 3.7 |
Sigmoidoscopy or Colonoscopy
|
63.1 | 62.1 - 64.2 | |
CT Colonography
|
1.2 | 1.0 - 1.5 | |
Cologuard
|
2.4 | 2.1 - 2.8 | |
Home FOBT or FIT
By Sex
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2019) | |
|---|---|---|---|
| Percent of adults | 95% Confidence Interval | ||
|
Both Sexes
|
3.3 | 3.0 - 3.7 |
Male
|
2.9 | 2.4 - 3.4 | |
Female
|
3.8 | 3.2 - 4.4 | |
By Race/Ethnicity
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2019) | |
|---|---|---|---|
| Percent of adults | 95% Confidence Interval | ||
|
All Races
|
3.3 | 3.0 - 3.7 |
Non-Hispanic White
|
3.1 | 2.7 - 3.5 | |
Non-Hispanic Black
|
2.5 | 1.7 - 3.7 | |
Hispanic
|
5.1 | 3.9 - 6.6 | |
Sigmoidoscopy or Colonoscopy
By Sex
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2019) | |
|---|---|---|---|
| Percent of adults | 95% Confidence Interval | ||
|
Both Sexes
|
63.1 | 62.1 - 64.2 |
Male
|
62.1 | 60.6 - 63.6 | |
Female
|
64.1 | 62.7 - 65.5 | |
By Race/Ethnicity
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2019) | |
|---|---|---|---|
| Percent of adults | 95% Confidence Interval | ||
|
All Races
|
63.1 | 62.1 - 64.2 |
Non-Hispanic White
|
66.4 | 65.2 - 67.6 | |
Non-Hispanic Black
|
65.3 | 62.5 - 68.0 | |
Hispanic
|
48.8 | 45.6 - 52.0 | |
CT Colonography
By Sex
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2019) | |
|---|---|---|---|
| Percent of adults | 95% Confidence Interval | ||
|
Both Sexes
|
1.2 | 1.0 - 1.5 |
Male
|
1.3 | 1.0 - 1.7 | |
Female
|
1.1 | 0.8 - 1.5 | |
By Race/Ethnicity
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2019) | |
|---|---|---|---|
| Percent of adults | 95% Confidence Interval | ||
|
All Races
|
1.2 | 1.0 - 1.5 |
Non-Hispanic White
|
0.9 | 0.8 - 1.2 | |
Non-Hispanic Black
|
2.5 | 1.7 - 3.6 | |
Hispanic
|
2.4 | 1.5 - 3.9 | |
Fecal DNA Test
By Sex
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2019) | |
|---|---|---|---|
| Percent of adults | 95% Confidence Interval | ||
|
Both Sexes
|
2.4 | 2.1 - 2.8 |
Male
|
2.3 | 1.9 - 2.8 | |
Female
|
2.5 | 2.1 - 3.0 | |
By Race/Ethnicity
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2019) | |
|---|---|---|---|
| Percent of adults | 95% Confidence Interval | ||
|
All Races
|
2.4 | 2.1 - 2.8 |
Non-Hispanic White
|
2.6 | 2.2 - 3.1 | |
Non-Hispanic Black
|
2.8 | 1.8 - 4.3 | |
Hispanic
|
1.6 | 0.9 - 2.6 | |
Additional Information on Colorectal Cancer Screening
- Colorectal Cancer Screening (PDQ®)-Patient Version. National Cancer Institute.
- Tests to Detect Colorectal Cancer and Polyps. National Cancer Institute.
- Medicare Coverage for Cancer Prevention and Early Detection. American Cancer Society.
- Colorectal (Colon) Cancer. Centers for Disease Control and Prevention.
- Colorectal Cancer Screening Evidence-Based Programs Listing. National Cancer Institute.
- Colorectal Cancer Screening (PDQ®)-Health Professional Version. National Cancer Institute.
- The Community Guide: Cancer. Centers for Disease Control and Prevention, Community Preventive Services Task Force.
- Colorectal Cancer: Screening (May 2021). U.S. Preventive Services Task Force.
- Evaluating screening participation, follow-up, and outcomes for breast, cervical, and colorectal cancer in the PROSPR consortium. Barlow WE, Beaber EF, Geller BM, et al. J Natl Cancer Inst 2020;112(3):238-246.
- Performance Characteristics of Fecal Immunochemical Tests for Colorectal Cancer and Advanced Adenomatous Polyps: A Systematic Review and Meta-analysis. Imperiale TF, Gruber RN, Stump TE, et al. Ann Intern Med 2019;170(5):319-329.
- Screening for Colorectal Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. Lin JS, Perdue LA, Henrikson, et al. JAMA. 2021; 325(19):1978-98.
- Effect of digital health intervention on receipt of colorectal cancer screening in vulnerable patients: a randomized controlled trial. Miller DP Jr, Denizard-Thompson N, Weaver KE et al. Ann Intern Med 2018;168(8):550-557.
- Screening for colorectal cancer: the role of the primary care physician. Triantafillidis JK, Vagianos C, Gikas A, et al. Eur J Gastroenterol Hepatol. 2017;29(1);e1-e7.
- Interventions to increase uptake of faecal tests for colorectal cancer screening: a systematic review. Rat C, Latour C, Rousseau R et al. Eur J Cancer Prev 2018;27(3):227-236.
- SEER Cancer Stat Facts: Colorectal Cancer. National Cancer Institute.
- Behavioral Risk Factor Surveillance System: Prevalence Data & Data Analysis Tools. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion.