OBJECTIVES: We examined patterns of the colorectal cancer (CRC) screening utilization in US childhood cancer survivors at a national level. Our findings would add to the literature information on the association of the CRC screening utilization and predisposing, enabling and need factors following the Andersen’s Behavioral Model of Health Services Use.

METHODS: Using 2020 Behavioral Risk Factor Surveillance System data, we identified cancer survivors (cancer diagnosis at birth–20y; current age ≥45y,) and healthy matched controls (1:5). Our CRC screening methods included sigmoidoscopy, colonoscopy, blood stool test using home kit, stool DNA test and virtual colonoscopy. Logistic regression models were used to assess the likelihood of CRC screening and colonoscopy among childhood cancer survivors and conditional logistic models were used in all sample accounting for the matching.

RESULTS: We included 222 childhood cancer survivors and 1110 controls. Compared to controls, childhood cancer survivors had a higher proportion of current smokers (19.4% vs. 12.4%; p=0.006), and >1 chronic health conditions (80.6% vs. 69.1%; p<0.001). Childhood cancer survivors and controls had similar health insurance rates (94.6% vs. 96.1%). Childhood cancer survivors had a CRC screening rate of 80.6% overall and 72.1% for colonoscopy – not statistically different from the controls’ rates. Among childhood cancer survivors, older age and having >1 chronic health conditions increased CRC screening likelihood (adjusted odds ratio [aOR]=3.47, 95% confidence interval [CI]=1.27-9.46). Childhood cancer survivors with higher education (aOR=4.11, 95%CI=1.69-9.96) and >1 chronic health conditions (aOR=2.25, 95%CI=1.02-4.95) were more likely to report experiencing colonoscopy. Childhood cancer survivors in the West were less likely to have colonoscopy than those in the Northeast (aOR=0.32, 95%CI=0.13-0.84).

CONCLUSIONS: Eighty-one percent of childhood cancer survivors have undergone CRC screening in their lifetime. Among CCS, the odds of having undergone CRC screening and colonoscopy increased with age, with having chronic health conditions, and in those with higher education.