Colorectal Cancer Screening

Colorectal Cancer Screening in United States

United States

There is strong evidence that screening for colorectal cancer reduces mortality by removing precancerous growths and increasing early detection, which is optimal for effective treatment. Colorectal cancer was the second-leading cause of cancer deaths in 2020 and the fourth-leading cause of new cancer cases for both men and women in the United States. The American Cancer Society’s Cancer Facts & Figures report projects 151,030 new cases of colorectal cancer and over 52,580 colorectal cancer deaths in 2022.

According to the U.S. Preventive Services Task Force, screening for colorectal cancer, which may include fecal sample testing, colonoscopy and/or sigmoidoscopy, is recommended for all adults ages 50-75. Screening at earlier ages is recommended for those with particular risk factors or a family history of colorectal cancer. 

Multiple studies have shown that screening for colorectal cancer is cost-effective compared with not screening. Furthermore, if routine screenings started at age 45, an estimated 24-28 colorectal cancer deaths could be averted for every 1,000 adults screened.

Populations of adults ages 50-75 with a higher percentage of colorectal cancer screening include:

• Women compared with men. 
• Non-Hispanic Black adults compared with Asian adults.
• College graduates compared with those with lower levels of educational attainment. 
• Adults with an annual household income of $75,000 or more compared with those with an income of less than $25,000.
• Adults with health insurance compared with those who are uninsured. 
• Adults with a regular health care provider compared with those without a regular provider. 

There are numerous strategies for increasing colorectal cancer screening. County Health Rankings & Roadmaps’ recommendations include:

• Using patient navigators, also called system navigators, to help guide patients through medical, insurance and social support systems.
• Providing financial incentives, such as payments or vouchers, for preventive care.

The Community Guide — a collection of evidence-based findings of the Community Preventive Services Task Force — recommends a multicomponent approach. The guide lists several strategies that work best when more than one are used together. These strategies include: 

• Media campaigns to increase awareness.
• Client reminders.
• Cost reduction.
• Addressing language and transportation barriers.

The Centers for Disease Control and Prevention (CDC) has implemented a Colorectal Cancer Control Program that focuses on increasing screening for targeted groups. The National Colorectal Cancer Roundtable has resources for increasing colorectal cancer screening rates in clinical practice and in community health centers.

Increasing the proportion of adults ages 50-75 who receive a colorectal cancer screening is a Healthy People 2030 leading health indicator.

“Cancer Facts & Figures 2022.” 2022. Atlanta, GA: American Cancer Society. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2022/2022-cancer-facts-and-figures.pdf.

“Colorectal Cancer Facts & Figures 2020-2022.” 2020. Atlanta, GA: American Cancer Society. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2020-2022.pdf.

de la Cruz, Maria Syl D., and Mona Sarfaty. 2014. “Steps for Increasing Colorectal Cancer Screening Rates: A Manual for Community Health Centers.” National Colorectal Cancer Roundtable, American Cancer Society. http://nccrt.org/wp-content/uploads/0305.60-Colorectal-Cancer-Manual_FULFILL.pdf.

DeGroff, Amy, Krishna Sharma, Anamika Satsangi, Kristy Kenney, Djenaba Joseph, Katherine Ross, Steven Leadbetter, et al. 2018. “Increasing Colorectal Cancer Screening in Health Care Systems Using Evidence-Based Interventions.” Preventing Chronic Disease 15 (August): 180029. https://doi.org/10.5888/pcd15.180029.

Joseph, Djenaba A., Jessica B. King, Nicole F. Dowling, Cheryll C. Thomas, and Lisa C. Richardson. 2020. “Vital Signs: Colorectal Cancer Screening Test Use — United States, 2018.” MMWR. Morbidity and Mortality Weekly Report 69 (10): 253–59. https://doi.org/10.15585/mmwr.mm6910a1.

Patel, Shaan S., and Meredith L. Kilgore. 2015. “Cost Effectiveness of Colorectal Cancer Screening Strategies.” Cancer Control: Journal of the Moffitt Cancer Center 22 (2): 248–58. https://doi.org/10.1177/107327481502200219.