Colorectal cancer is the fourth most commonly diagnosed cancer in the U.S. and the second leading cause of cancer death. Recently, a growing number of young people have been diagnosed with colorectal cancer. According to the American College of Surgeons, the incidence rate of early onset colorectal cancer is expected to double by 2030. While these statistics are alarming, colon and rectal cancer are highly treatable forms of cancer if detected early.
The U.S. Preventive Services Task Force (USPSTF) currently recommends adults ages 45 to 75 be screened for colorectal cancer. An update in 2021 lowered the recommended screening age from 50 to 45 due to growing evidence that younger individuals were at increased risk for developing colorectal cancer.
There are many colorectal cancer screening options available, although colonoscopies are the most common screening service. In this analysis, all colorectal cancer screenings included colonoscopy, sigmoidoscopy, proctosigmoidoscopy, CT colonography, barium enema, Fecal Occult Blood Test (FOBT), Fecal Immunochemical Test (FIT), and Cologuard (a stool DNA test). These tests are important for prevention and also diagnosing colorectal cancer, but can be used to identify other conditions and disorders as well. While colonoscopies are considered the "gold standard" in terms of effectiveness, FOBT, FIT, and Cologuard are non-invasive, more affordable, and may be performed at home.
Using HCCI data on people with Employer-Sponsored Insurance (ESI), we examined the use of all colorectal cancer screenings from 2018 to 2022.
From 2018 to 2022, there was a 2% increase in the colorectal cancer screening rate across all ages. This was largely driven by a 30% increase in screenings among the 45-54 age group (Figure 1). This increase corresponds to the USPSTF age guideline change in 2021. Over the same period, colorectal cancer screenings decreased for all other age groups, with the largest decrease among the 35-44 age group (-16%).
As the incidence of colorectal cancer rises, life-saving screening procedures can help physicians diagnose patients early and provide more effective treatment. Tracking the use of these screening services remains critical to our country's public health response. Learn more about colonoscopy and other colorectal cancer screenings by visiting our Health Care Vitals dashboard.
Methods Notes
Diagnosis codes for all colorectal cancer screenings were collected from MD Clarity, Novitas Solutions, American Gastroenterological Association, Fisher DA et al. 2021, and JAMA Network Open. There may be additional preventive and diagnostic codes that indicate colorectal cancer screening that were not included in this analysis. This list also includes codes that may not apply to all payers, including Medicare.
The codes used in this analysis include:
- Colonoscopy (44388, 44389, 44390, 44391, 44392, 44393, 44394, 44397, 45355, 45378, 45379, 45380, 45381, 45382, 45382, 45383, 45384, 45385, 45388, 45390, 45391, 45392, 45393, G0105, G0121)
- Proctosigmoidoscopy (45300,45305,45308, 45309, 45315, 45320)
- Sigmoidoscopy (45331, 45333, 45335, 45338, 45339, 45346, 45349)
- Fecal Occult Blood Test (82270, 82271, 82272, 82273, G0107, G0327)
- Fecal Immunochemical Test (82274)
- CT colonography (74263)
- Double Contrast Barium Enema (74270, 74280, G0106, G0122)
- Stool DNA Test (Cologuard) (81528)
The annual rates displayed are the rates of encounters with the specified procedure code per 100,000 enrollees. The numerator was defined as number of unique patient encounter service dates with the procedure code present each year. The denominator was the count of all ESI enrollees ages 18-64 in the database each year.
