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Research supports the use of several screening tests for colorectal cancer. Usage is monitored by total test use and the following two specific tests:
FOBT: Percentage of adults aged 50 and older who reported that they had a fecal occult blood test (FOBT) within the past two years, by racial/ethnic group. In the 2000 National Health Interview Survey (NHIS), questions were asked on both home and office FOBT, and in 2003, questions were asked only on home FOBT. Responses from the 2000–2010 NHIS for home FOBT are directly calculated.
Note: Responses from the 1987–1998 NHIS may underrepresent use of home FOBT because, prior to 2000, respondents were asked when—but not where—they had their most recent blood stool test. From 2000 on, respondents were asked when their most recent blood stool test was and whether it was a home or office test. If a home and office test were both received within the past two years and the office test was the more recent, the response would be counted in the 2000 and later surveys and not in the pre-2000 surveys.
Colorectal endoscopy: Percentage of adults aged 50 and older who reported that they ever had an endoscopy (proctoscopy, sigmoidoscopy, or colonoscopy).
Colorectal cancer test use: Percentage of adults aged 50 and older who had a colorectal cancer test (home-based FOBT in the past two years or ever had a colorectal endoscopy).
Home FOBT: Declining. Home FOBT had been rising until 2000 and then began falling in whites and non-Hispanic blacks, continued to rise in Hispanics until 2003 and then fell in these groups through 2010.
Colorectal endoscopy: Rising overall. Colorectal endoscopy had been rising from 1987 to 1998, stabilized until 2000, and then began to rise again after 2000 and rose especially rapidly (Annual Percent Change = 7 percent) from 2003 to 2010. These same trends characterize both whites and blacks. Among Hispanics, rates began to rise rapidly after 2003.
Colorectal cancer test use: Rising overall among each racial/ethnic group (non-Hispanic white, non-Hispanic black, and Hispanic) and all education and income groups.
In 2010, 13 percent of people aged 50 and older had a home FOBT within the past two years. This includes 9 percent of Hispanics, 13 percent of blacks, and 14 percent of whites. Among Asians interviewed in California, 22 percent had a home FOBT within the past two years. In 2010, 62 percent of people 50 and older had ever had a colorectal endoscopy. This includes 49 percent of Hispanics, 58 percent of blacks, and 65 percent of whites. Among Asians interviewed in California, 53 percent had ever had a colorectal endoscopy. In 2010, 65 percent of people 50 and older had used a colorectal cancer test. This includes 52 percent of Hispanics, 61 percent of blacks, and 69 percent of whites. Among Asians interviewed in California, 60 percent had used a colorectal cancer test.
The new Healthy People 2020 target calls for 70.5 percent of adults ages 50 to 75 to be up to date with recommended colorectal cancer screening, defined according to U.S. Preventive Services Task Force Guidelines as high-sensitivity FOBT done at home every year; sigmoidoscopy every five years, with high-sensitivity FOBT every three years or colonoscopy every 10 years.
Individuals with household income < 200 percent of the federal poverty level and those with less than a high school education are less likely to be screened for colorectal cancer.
Colorectal cancer screening rates are increasing, but are still considerably lower than rates of mammography and Pap testing in the United States.
Newer screening methods, such as virtual colonoscopy and fecal DNA testing, are promising and need further evaluation.
A substantial proportion of reported FOBT and colorectal endoscopy procedures may be used for diagnostic rather than screening purposes.
Different organizations have generated different guidelines. To see guidelines issued by the U.S. Preventive Services Task Force and others, go to http://www.ahrq.gov/clinic/USpstfix.htm. The Guide to Community Preventive Services, http://www.thecommunityguide.org/index.html , is a source of information about evidence-based approaches for enhancing cancer screening.