Patterns of colorectal cancer screening and adherence rates among an average-risk population enrolled in a national health insurance provider during 2009–2018 in the United States

While colorectal cancer (CRC) is the second leading cause of cancer-related mortality in the United States (US), outcomes can be improved through timely screening. Despite the benefits and widespread availability of screening tests, adherence to recommended screening strategies is low. The study aimed to provide recent evidence regarding screening rates and adherence to screening recommendations among adults at average risk for CRC in a commercially insured and Medicare Advantage population. De-identified administrative data from a large US research database were examined to determine screening rates for the years 2009 through 2018. The study population included adults aged 50–75 years and annual study population counts ranged from 1,390,594 in 2009 to 1,654,544 in 2018. Incident screening rates were found to be relatively stable across the study years (approximately 15%) with adherence lowest in the youngest age group (ages 50–54 years). Colonoscopies accounted for approximately 50% of all screening tests performed, while there was a substantial increase in the use of home-based screening tests over the study timeframe. The use of the fecal immunochemical test increased from 17.2% in 2009 to 28.9% in 2018 and the multi-target stool DNA test increased from 0.4% in 2015 to 9.0% in 2018. Overall, CRC screening and adherence rates remain relatively low among adults at average risk for CRC in the US. However, the use of non-invasive stool-based tests increased from 2009 to 2018. Improving adherence rates with CRC screening recommendations among individuals at average risk for CRC is required to improve health outcomes.