US veteran preference for noninvasive CRC screening highest in West, rose by 19% per year
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Key takeaways:
- In a study of more than 50,000 U.S. veterans, 58.4% preferred a stool-based test vs. colonoscopy (40.6%) for colorectal cancer screening.
- This preference increased by 19% per recruitment year.
Veterans who declined participation in a colorectal cancer screening trial more often preferred noninvasive testing over colonoscopy, a preference that increased over time and was especially evident among those in the western United States.
“Given that there is currently a panel of options for CRC screening, there remains interest in determining which test is most effective in preventing CRC and death from CRC,” Douglas J. Robertson, MD, MPH, professor of medicine at Dartmouth Geisel School of Medicine and gastroenterologist at White River Junction VA Medical Center, and colleagues wrote in JAMA Network Open. “The Colonoscopy vs. Fecal Immunochemical Test in Reducing Mortality from Colorectal Cancer (CONFIRM) study is a randomized trial that directly compares colonoscopy with FIT for the prevention of CRC mortality.”
In a cross-sectional analysis of 50,126 veterans (mean age, 59.1 years; 93% men; mean BMI, 30.2) at average risk for CRC and due for screening, Robertson and colleagues aimed to describe characteristics of those who enrolled in the CONFIRM study and examine why others were ineligible or declined participation.
Veterans were recruited from 46 VA centers (median 1,027 per center) and most self-identified as white (69.1%), followed by Black (24%), Hispanic (11.4%), multiracial or other (3.7%), Asian (1.5%) and Native American or Alaska Native (0.8%). About 10% of fully screened individuals were ineligible for participation.
Among 11,109 veterans who declined enrollment, 45.3% did not provide a specific reason, while 43.4% declined because of a preference for a specific screening test. There was a higher preference for fecal occult blood test (FOBT) or FIT compared with colonoscopy (58.4% vs. 40.6%) or other screening tests (1%) among those who declined participation.
Further, preference for FOBT or FIT was strongest in the West (65.4%) compared with the Midwest (57.3%), South (55.6%) or Northeast (53.6%), which increased over recruitment years from 45% in 2012 to 65.5% in 2017.
After adjusting for region, researchers reported that the preference for stool-based testing with FOBT or FIT increased by 19% (OR = 1.19; 95% CI, 1.14-1.25) per year among those who declined participation.
“Our study suggests some increase in the preference for noninvasive FIT over time, especially in certain regions of the country,” Robertson and colleagues concluded. “Further work to better understand contemporary changes in preference for CRC screening in the U.S. is warranted.”
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