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. 2021 Sep 1;4(9):e2122269.
doi: 10.1001/jamanetworkopen.2021.22269.

Utilization of a Colorectal Cancer Screening Test Among Individuals With Average Risk

Deborah A Fisher  1 , Nicole Princic  2 , Lesley-Ann Miller-Wilson  3 , Kathleen Wilson  2 , A Mark Fendrick  4 , Paul Limburg  5
Affiliations

Utilization of a Colorectal Cancer Screening Test Among Individuals With Average Risk

Deborah A Fisher et al. JAMA Netw Open. .

Abstract

Importance: Colorectal cancer (CRC) screening reduces CRC incidence and mortality. It is important to examine screening patterns over time, including after the introduction of new screening modalities.

Objective: To compare use of CRC screening tests before and after the availability of the multitarget stool DNA (mt-sDNA) test, given that endorsed options have changed.

Design, setting, and participants: This longitudinal cohort study used administrative claims data to examine CRC screening use in 2 discrete periods: before (August 1, 2011, to July 31, 2014) and after (August 1, 2016, to July 31, 2019) the mt-sDNA test became available. The MarketScan Commercial and Medicare Supplemental databases were queried for individuals aged 45 to 75 years between August 1, 2011, and July 31, 2019, with average risk of CRC and with continuous enrollment in the databases from August 1, 2001, to July 31, 2019.

Main outcomes and measures: The proportion of individuals up to date or not due for CRC screening during each measurement year and the type of screening test used among individuals due for screening. Data were reported overall and among individuals aged 45 to 49 or 50 years and older on August 1, 2011.

Results: A total of 97 776 individuals with average risk were identified. Individuals had a mean (SD) age of 50.8 (3.5) years, and 54 227 (55.5%) were women. The proportion of individuals with average risk aged 50 to 75 years with commercial or Medicare supplemental insurance who were up to date with CRC screening increased from 50.4% in 2011 (30 605 of 60 770) to 69.7% in 2019 (42 367 of 60 770). Among individuals due for screening and screened, the use of high-sensitivity fecal occult blood test (FOBT) decreased between 2011 (1088 of 6241 eligible individuals [17.7%]) and 2019 (195 of 2943 eligible individuals [6.6%]), and the use of mt-sDNA increased between 2016 (58 of 3014 eligible individuals [1.9%]) and 2019 (418 of 2943 eligible individuals [14.2%]). No consistent trends were observed with fecal immunochemical test (FIT) or screening colonoscopy. Computed tomography colonography, double-contrast barium enema, and flexible sigmoidoscopy were rarely performed.

Conclusions and relevance: In this cohort study, the proportion of individuals with average risk who were up to date with CRC screening increased between 2011 and 2019 but remained suboptimal. There were no substantial changes in the use of the colonoscopy or FIT; however, there was an increase in the adoption of mt-sDNA and a decrease in the use of FOBT during the study period.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Fisher reported receiving personal fees from Exact Sciences during the conduct of the study; receiving grants from Exact Sciences; and serving on the advisory board of Guardant Health outside the submitted work. Ms Princic reported being employed by IBM Watson Health, which was paid by Exact Sciences to conduct this research. Dr Miller-Wilson reported being an employee of Exact Sciences during the conduct of the study. Ms Wilson reported being employed by IBM Watson Health, which received funding from Exact Sciences Corporation to conduct this analysis. Dr Fendrick reported serving as a consultant for AbbVie, Amgen, Bayer, Centivo, the Community Oncology Association, Covered California, EmblemHealth, Exact Sciences, Freedman Health, GRAIL, Harvard University, Health and Wellness Innovations, Health at Scale Technologies, HealthCorum, Hygieia, MedZed, Merck, Mercer, Montana Health Cooperative, Pair Team, Penguin Pay, Phathom Pharmaceuticals, Risalto, Risk International, Sempre Health, the State of Minnesota, the US Department of Defense, Virginia Center for Health Innovation, Wellth, Wildflower Health, YaleNew Haven Health System, and Zansors; holding equity interest in Health and Wellness Innovations, Health at Scale Technologies, Pair Team, Sempre Health, Wellth, and Zansors; receiving research funding from the Agency for Healthcare Research and Quality, Boehringer-Ingelheim, the Gary and Mary West Health Policy Center, Arnold Ventures, National Pharmaceutical Council, the Patient-Centered Outcomes Research Institute, PhRMA, Robert Wood Johnson Foundation, and the State of Michigan/Centers of Medicare & Medicaid Services; serving as coeditor for The American Journal of Managed Care; being a member of the Medicare Evidence Development & Coverage Advisory Committee; and being a partner in V-BID Health outside the submitted work. Dr Limburg reported receiving royalties from Exact Sciences to their institution during the conduct of the study and outside the submitted work and serving as chief medical officer for screening at Exact Sciences through a contracted services agreement with Mayo Clinic; Dr. Limburg and Mayo Clinic have contractual rights to receive royalties through this agreement.

Figures

Figure 1.
Figure 1.. Study Flowchart
CRC indicates colorectal cancer.
Figure 2.
Figure 2.. Individuals Aged 50 to 75 Years Who Were Up to Date With Colorectal Cancer (CRC) Screening
mt-sDNA indicates multitarget stool DNA.
Figure 3.
Figure 3.. Screening Patterns Among All Individuals Aged 50 to 75 Years Who Were Due for Screening and Newly Screened
FIT indicates fecal immunochemical test; FOBT, fecal occult blood test; and mt-sDNA, multitarget stool DNA.
See this image and copyright information in PMC

Comment in

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