Examining Colorectal Cancer Screening Preferences

Stool-based tests were favored over colonoscopy for colorectal cancer screening, according to research published in the AACR journal Cancer Prevention Research.

When given a choice, most people at average risk of colorectal cancer said they would prefer a stool-based screening test for colorectal cancer over colonoscopy, the method most often recommended by health care providers, according to results of a study published in the AACR journal Cancer Prevention Research. 

“The best colorectal cancer screening test is the one that patients are most likely to complete,” said study author Xuan Zhu, PhD, senior health services analyst at the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. “Previous research has shown that fewer patients complete colorectal cancer screening when only colonoscopy is recommended compared to when stool-based options are also recommended.” 

The three most common tests are an annual fecal immunochemical test or fecal occult blood test (FIT/FOBT) that detects blood in the stool; the multitarget stool DNA (mt-sDNA) test (Cologuard), completed every three years, which detects altered DNA from cancer cells, precancerous polyps, or blood in the stool; and a colonoscopy every ten years, which involves a gastroenterologist examining the colon with a camera and removing any precancerous polyps while a patient is under sedation.  

The U.S. Preventive Services Task Force (USPSTF) recommends colorectal cancer screening for adults ages 50 to 75 at average risk, and the USPSTF is considering a proposal to lower the starting age to 45. 

Although colorectal cancer is the second most frequent cause of cancer-related death in the United States, about one-third of eligible American adults have never completed a colorectal cancer screening test, Zhu said. Colorectal cancer screening is particularly underutilized by individuals experiencing socioeconomic disadvantages, racial and ethnic minorities, and certain age groups, he said.

In this study, Zhu and colleagues evaluated patient preferences for colorectal cancer screening through a survey conducted in collaboration with the National Opinion Research Center at the University of Chicago. The survey included short descriptions of FIT/FOBT, mt-sDNA, and colonoscopy, and asked a nationally representative sample of adults ages 40 to 75 to choose between two options presented at a time. A total of 1,595 respondents completed the survey. The researchers focused their analysis on a subgroup of 1,062 respondents aged 45 to 75 with an average risk of colorectal cancer. 

When presented with a choice, 66 percent of respondents said they preferred mt-sDNA over colonoscopy, and 61 percent said they preferred FIT/FOBT over colonoscopy. When asked to choose between the two stool-based options, 67 percent indicated a preference for mt-sDNA over FIT/FOBT. 

The findings highlight the importance of patient education about available screening options and taking patients’ needs, preferences, and values into account in shared decision-making discussions to increase colorectal cancer screening rates, Zhu added.  

“Providing patients with as-needed navigation support, from initiation of screening to completion of a colonoscopy after stool-based tests show abnormal results may increase screening completion and adherence,” he said.