Presentation (CTI)

OBJECTIVES: Direct to consumer health tests are becoming more common and provide patients with increased preventative healthcare choices. At home colorectal cancer (CRC) screening (e.g., stool test) is a well-established platform currently available in the US; this study investigated patient response to at home testing options by evaluating CRC screening methods from 2018-2024.
METHODS: The rate of colorectal cancer screening, overall and by type (colonoscopy, computed tomography [CT], or stool ), was evaluated annually among patients in the MarketScan® Commercial and Medicare Databases who were 45-75 in the screening year, had ≥1 healthcare encounter, and no evidence of CRC, hospice, or advanced illnesses. Demographics and baseline characteristics were also evaluated in test-based subgroups.
RESULTS: Annual cohorts included between 4.7 and 6.5 million adults. Overall annual screening rates increased from 14.7% to 18.2% over the study period; there was a drop in screening rates to 12.8% in 2020, coincident with the height of the COVID-19 pandemic. In 2018 colonoscopy accounted for 72.3% of all CRC screening; stool tests (23.1%), CT (0.1%), and unspecified testing (4.6%) accounted for the remainder. By 2024 colonoscopies only accounted for 68.0% of screenings, while stool tests accounted for 28.1%. The 2020 calendar year (height of COVID-19) had the lowest rate of colonoscopy screening (67.2%) and the second highest rate of stool testing (27.1%). Among the approximate 90% of patients who had a single screening type in the year, CT patients were the oldest and colonoscopy patients were most likely to be male; comorbidity burdens were highest for CT patients and lowest for stool testing patients.
CONCLUSIONS: At least in the CRC screening space, at home testing is gaining ground. Results suggest that increased availability of other at home preventative tests, like those recently approved for cervical cancer, may help to increase accessibility to and completion of preventative care screenings.