One in Three American Adults Do Not Comply With Screening Guidelines for Colorectal Cancer 


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The percentage of American adults aged 50 to 75 who are up-to-date with recommended screening for colorectal cancer “increased from 54% in 2002 to 65% in 2010, primarily driven by increased use of colonoscopy,” according to data from the 2012 Behavioral Risk Factor Surveillance System survey. However, 1 in 3 adults aged 50 to 75 have not complied with national screening guidelines. Developed by the U.S. Preventive Services Task Force, the guidelines recommend either a high-sensitivity fecal occult blood test annually, colonoscopy every 10 years, or sigmoidoscopy every 5 years with fecal occult blood test every 3 years. 

As reported in Morbidity and Mortality Weekly Report, published by the Centers for Disease Control and Prevention (CDC), “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%).” Men and those who do not live in metropolitan areas were also more likely to never have been screened. “As education level and annual household income increased, the proportion of respondents who had never been screened decreased,” according to the report.

Types of Tests Used

Among survey respondents who were up-to-date with colorectal cancer screening, “colonoscopy was the most commonly used test (61.7%), followed by [fecal occult blood test] (10.4%), and sigmoidoscopy in combination with [fecal occult blood test] (0.7%).” While fecal occult blood test was infrequently used, the authors noted, “Newer tests, such as the high-sensitivity guaiac [fecal occult blood test] and high-sensitivity fecal immunochemical test are recommended for colorectal cancer screening in current guidelines.” Variations in the use of tests might be attributed to patient and provider preferences or reimbursement policies and availability.

“The potential to increase screening rates exists if health-care providers identify the test that their patient is most likely to complete and consistently offer all recommended screening tests,” the authors noted. Achieving the CDC’s Colorectal Cancer Control Program goal of increasing colorectal cancer screening to 80% by 2014 will also require “development of organized, population-based strategies that extend colorectal cancer screening efforts to settings beyond the medical provider’s office.” ■

Klabunde CN, et al: MMWR 62:881-888, 2013.



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