Colorectal cancer screenings are essential for early disease detection, prevention, and treatment. Since 2014, Cologuard, a DNA-based screening test that can detect colorectal cancer and precancerous cells, has been available to individuals 45 and older at average risk for colorectal cancer. In contrast to colonoscopies, which must be done at a health care facility, Cologuard is non-invasive and can be done in the privacy of one's home without sedation. A positive Cologuard result would lead to a follow-up colonoscopy. Colonoscopy screenings are also generally recommended every 5 to 10 years for adults aged 45 and older in addition to people at high or increased risk of colorectal cancer.

Given the non-invasive nature of Cologuard, the importance of colorectal cancer screening, and the increased reluctance of many people to go to health care facilities during the COVID-19 pandemic, we were interested in seeing whether Cologuard use increased over the last several years. Using HCCI's data on people with employer-sponsored insurance (ESI) as well as those with traditional Medicare, we examined Cologuard use patterns from 2018 through 2020. Detailed data on Cologuard and colonoscopy use by age, sex, and state can be found on HCCI's Health Care Vitals Dashboard.

Three charts highlight the key findings:

• Prior to the pandemic, the use of Cologuard grew 126% from 2018 to 2020.
• Cologuard rates for the rest of 2020 were affected by the onset of the pandemic.
• From 2018 to 2020, women had a higher rate of colorectal cancer screening compared to men.

The rate of Cologuard use among ESI enrollees rose more than 350% over this period, from 22 per 100,000 enrollees in January 2018 to 102 per 100,000 enrollees in January 2020, while the Medicare rate rose 82%, from 111 per 100,000 to 202 per 100,000 enrollees.  

Among ESI enrollees, the January and February rates of Cologuard use in 2020 were 55% and 49% higher, respectively, than rates in the same months in 2019. With the onset of the pandemic, however, use in April and May fell and was much lower compared to the same months in the previous year (43% lower in April 2020 compared to April 2019).

In later months of 2020, Cologuard use not only rebounded to its pre-pandemic levels, but rose above the comparable months in 2019. For example, in November 2020, Cologuard use was 27% higher than use in November 2019. In comparison, Cologuard rates among Medicare enrollees also fell during the early months of the pandemic but then remained slightly below 2019 rates throughout most of the rest of 2020.

Despite the drop early in the pandemic, by the end of 2020, Cologuard use among ESI and Medicare enrollees combined was close to double the rate at the start of 2018 (137 per 100,000 in December 2020 compared to 69 per 100,000 in January 2018). 

Across ESI and Medicare, colorectal cancer screening rates were higher among women than men. For example, average monthly Cologuard use among ESI enrollees in 2020 was 105 screenings per 100,000 people among women compared to 80 screenings per 100,000 people among men. The difference in rates between women and men in Medicare was similar, though use was higher among both sexes in Medicare than in ESI (179 screenings per 100,000 women compared to 132 per 100,000 men). 

This pattern is consistent with colonoscopy screening rates, although the differences between rates of use for Cologuard were greater than differences in use of colonoscopies. Average monthly colonoscopy use among ESI enrollees in 2020 was 531 screenings per 100,000 people among women compared to 517 screenings per 100,000 people among men. The difference in rates between women and men in Medicare was similar, though use was higher among both sexes in Medicare than in ESI (692 screenings per 100,000 women compared to 673 per 100,000 men). Please see HCCI's Health Care Vitals Dashboard.