While screening rates for colorectal cancer (CRC) have increased substantially since 2008, disparities in screening between racial and ethnic groups continue to pose a challenge to equitable clinical care, a study in Clinical Gastroenterology and Hepatology suggests.

Researchers performed a cross-sectional analysis of individuals between the ages of 50 and 75 years who responded to a random-digit-dialed health survey, the Behavioral Risk Factors Surveillance Survey (BRFSS). A total of 1,089,433 respondents who answered questions regarding CRC screening from years 2008, 2010, 2012, 2014, and 2016 were included in the final analysis.

The self-reported CRC screening status of respondents was the primary outcome of the study. The investigators also examined overall screening rates for CRC as well as screening rates by ethnicity and race for each survey. The researchers examined screening modalities used overall and also those by ethnicity and race.

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From 2008 to 2016, CRC screening uptake increased from 61.1% to 67.6% (P <.001). Screening for CRC was highest for white patients and lowest for Hispanic patients (2016: 70.4% vs 53.4%, respectively; P <.001). The CRC screening rate in 2008 among Hispanic patients was 19.2% lower than the screening rate reported in white patients. By the end of the study period, this difference was only reduced to 17%. In 2016, the screening rate for black patients was 4.3% lower than for white patients.

Colonoscopy represented the most common screening modality for CRC each year (range, 74.9%-84.2%). There was a decline in the use of flexible sigmoidoscopy with fecal occult blood test from 2008 to 2016 (2.9% to 0.7%, respectively; P <.001).

Limitations of the study include that respondents to the survey might have been subject to recall bias as well as that the survey sampled only a small subset of the US population.

“In order to achieve national screening goals,” the researchers wrote, “we must further diversify screening modalities, particularly in populations and settings where access to colonoscopy is limited.”


May FP, Yang L, Corona E, Glenn BA, Bastani R. Disparities in colorectal cancer screening in the United States before and after implementation of the affordable care act [published online September 13, 2019]. Clin Gastroenterol Hepatol. doi:10.1016/j.cgh.2019.09.008.