A national survey conducted by Zhu et al to identify patient preferences among colorectal cancer screening modalities to improve population adherence to colorectal cancer screening has found, when presented with a choice, most individuals with an average risk of colorectal cancer prefer stool-based tests over colonoscopy. The findings, published in Cancer Prevention Research, showcase the heavy reliance on colonoscopy for colorectal cancer screening in clinical practice, as well as highlight the importance of considering patient preference in colorectal cancer screening recommendations.

Excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in men and women in the United States, and the second most common cause of cancer-related deaths when men and women are combined. According to the American Cancer Society, this year, nearly 53,000 Americans will die from colorectal cancer. Despite these statistics, about one in three adults aged 50 to have not been tested for colorectal cancer as recommended by the United States Preventive Services Task Force.

Study Methodology

The researchers collected data from a survey they developed and implemented by the National Opinion Research Center at the University of Chicago. The survey focused on three commonly utilized colorectal cancer screening options, including fecal immunochemical test or guaiac-based fecal occult blood test (FIT/gFOBT), multitarget stool DNA (mt-sDNA) test, and colonoscopy. A general population sample of 1,595 adults aged 40 to 75 at average risk of colorectal cancer completed the survey. The researchers used a sampling strata based on age, sex, race/ethnicity, and education.

Study Results

The researchers found that when presented a choice between two colorectal cancer screening modalities, more respondents (65.4%) preferred mt-sDNA over colonoscopy; FIT/gFOBT (61%) over colonoscopy; and mt-sDNA (66.9%) over FIT/gFOBT. Certain demographic characteristics and awareness of and/or experience with various screening modalities influenced preferences. For example, uninsured people were 2.5 times more likely to prefer less expensive stool-based tests over colonoscopy (odds ratio [OR] = 2.53, 95% confidence interval [CI] = 1.22–5.65 and OR = 2.73, 95% CI = 1.13–7.47).

People who had heard of stool-based screening were more likely to prefer mt-sDNA over FIT/gFOBT (OR = 2.07, 95% CI = 1.26–3.40). People who previously had a stool-based test were more likely to prefer FIT/gFOBT over colonoscopy (OR = 2.75, 95% CI = 1.74–4.41), while people who previously had a colonoscopy were less likely to prefer mt-sDNA or FIT/gFOBT over colonoscopy (OR = 0.39, 95% CI = 0.24–0.63 and OR = 0.40,  95% CI = 0.26–0.62).

In addition, preference for mt-sDNA over colonoscopy was higher among non-Hispanic White individuals compared with non-Hispanic Black and Hispanic individuals. The overall awareness of stool-based tests was about 60% compared to 90% for colonoscopy—suggesting that there is an opportunity to improve patient education about stool-based options.

Clinical Relevance

“These findings underscore the importance of continuing to offer colorectal cancer screening options to patients and encourage health-care providers to engage patients in shared decision-making to discuss these various options in alignment with patient needs, resources, and preferences,” concluded the study authors.

“The best colorectal cancer screening test is the one that patients are most likely to complete,” said Xuan Zhu, PhD, Senior Health Analyst at the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery and lead author of this study, in a statement. “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.”

Disclosure: Funding for this study was provided by Exact Sciences Corporation and the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. For full disclosures of the study authors, visit cancerpreventionresearch.aacrjournals.org.