Shifts in Colorectal Cancer Screening Trends After COVID-19

Among nearly 25 million privately insured adults, significant shifts in colorectal cancer (CRC) screening practices were identified after the onset of COVID-19.¹ Between 2017 and 2024, colonoscopy and fecal immunochemical test (FIT) use declined, while stool DNA testing rose sharply. The findings also highlight notable disparities in screening preferences by sex, socioeconomic status (SES), and whether individuals lived in metropolitan or nonmetropolitan areas.

This retrospective cohort study is published in JAMA Network Open.

“This study assessed recent patterns and potential shifts in the use of various CRC screening modalities among a large cohort of commercially insured individuals aged 50 to 75 years with average risk of CRC,” wrote the researchers of the study. “Differences in the type of screening modality used were evaluated across groups with differing demographic and area-level socioeconomic characteristics while accounting for previously established disruptions to screening due to the COVID-19 pandemic.”

CRC screening trends in the US continue to reveal stark inequities, particularly between rural and urban populations.² A recent analysis of more than 535,000 adults found that over 70% of the rural–urban screening gap could not be explained by measurable factors, suggesting the influence of deeper systemic and cultural barriers. These findings underscore the need for equity-focused strategies that address not only access and affordability but also trust, awareness, and local health infrastructure to improve screening uptake and reduce CRC mortality across all communities.

For the current study, the prepandemic period was defined as January 1, 2017, to February 28, 2020, and the postpandemic period as July 1, 2020, to December 31, 2024.¹ Changes in screening use were assessed using autoregressive integrated moving average models to account for temporal trends, autocorrelation, and seasonal variation. Analyses were conducted between May and June 2025 to evaluate shifts in screening patterns and differences across sociodemographic groups, including sex, SES, and metropolitan vs nonmetropolitan residence.

Of the included 24,973,642 beneficiaries (mean [SD] age, 57.36 [4.27] years; 51.21% female), the study found notable shifts in CRC screening trends after the onset of the COVID-19 pandemic. Colonoscopy use declined from a mean of 1.29% (0.09%) to 1.14% (0.07%) (P < .001), and fecal immunochemical test (FIT) use dropped from 0.54% (0.03%) to 0.38% (0.07%) (P < .001).

In contrast, stool DNA test use increased significantly from 0.19% (0.13%) to 0.61% (0.16%) (P < .001). Screening patterns varied by demographic and socioeconomic factors: males more frequently underwent colonoscopy (1.21% vs 1.07%; P < .001), while females were more likely to use stool DNA tests (0.68% vs 0.55%; P < .001) and FIT (0.43% vs 0.33%; P < .001).

Individuals in the highest socioeconomic areas showed higher colonoscopy (1.37% vs 0.91%; P < .001) and stool DNA test use (0.65% vs 0.48%; P < .001) but lower FIT use (0.36% vs 0.48%; P < .001) compared with those in the lowest SES areas. Metropolitan residents were more likely to undergo colonoscopy (1.18% vs 0.97%; P < .001) and FIT (0.41% vs 0.25%; P < .001) than those in nonmetropolitan regions, although stool DNA test use was similar between groups (0.61% vs 0.64%; P = .51).

However, the researchers noted some limitations on their findings. First, the findings may not be generalizable to the broader US population, as Blue Cross Blue Shield (BCBS) beneficiaries tend to be younger and primarily covered through employer-based insurance, with varying representation across states. Differences in coverage, co-pays, and network status may also have influenced screening uptake. Because test results were unavailable, the analysis could not determine whether beneficiaries were current with recommended screening. In addition, the study did not require continuous enrollment, so screenings conducted outside BCBS coverage were not captured. Furthermore, geographic variation in screening practices and state-level restrictions during the COVID-19 pandemic may have contributed to unmeasured differences in screening access and utilization.

Despite these limitations, the researchers believe the study captured significantly lower CRC screening trends among privately insured individuals after COVID-19.

“Among privately insured individuals, the use of colonoscopy and FIT decreased after the COVID-19 pandemic while stool DNA test use increased, with differences by sex, area-level SES, and metropolitan area residence," they concluded.

References

1. Siddique S, Wang R, May FP, et al. Changes in colorectal cancer screening modalities among insured individuals. JAMA Netw Open. 2025;8(10):e2538578. doi:10.1001/jamanetworkopen.2025.38578

2. Steinzor P. Rural-urban disparities in colorectal cancer screening persist. AJMC^®. September 21, 2025. Accessed October 20, 2025. https://www.ajmc.com/view/rural-urban-disparities-in-colorectal-cancer-screening-persist