Introduction: Colorectal Cancer (CRC) is the 2nd leading cause of cancer-related mortality in the United States. Timely screening can improve survival rates. Despite the benefits, annual incident screening remains low, and only 69% of eligible members are adherent to CRC screening recommendations. The objectives of this study were to assess screening rates and adherence to screening recommendations among individuals at average risk for CRC.
Methods: This retrospective study used administrative claims data between 1/2006 and 12/2019 for commercially insured or Medicare Advantage enrollees from a large national insurer. The annual screening rate was calculated for 2009-2018 including members aged 50-75 at the beginning of each year. To estimate adherence rates, the primary analyses included members with 10 years of continuous enrollment (CE) without prior evidence of USPSTF recommended CRC screening, or diagnostic codes indicating high-risk for CRC in the year prior to start of the 10-year period. Adherence rates in years 2016-2018 were calculated as the sum of adherent members divided by total members in that year. We considered members to be adherent in a year if that year is covered by their last CRC screening per recommended frequency of USPSTF guidelines. In sensitivity analyses, adherence rates were calculated from 2009 to 2018 by taking the sum of the screening rates of the given modality over the last n-1 years, where n was the guideline screening frequency of that modality.
Results: Incident screening was ~15% across each of the study years, with cohort size ranging from 1,390,594 in 2009 to 1,654,544 in 2018. Among those with any CRC screening, colonoscopies accounted for ~50% of tests used. FIT rates increased from 17.2% in 2009 to 28.9% in 2018, while mt-sDNA had the largest increase in utilization from 0.4% in 2015 to 9.0% in 2018. The estimated adherence rate to all screening modalities was 52.3% in 2018 (n =754,867). Sensitivity analysis showed a much higher adherence rate (85.0%) vs. primary analysis, potentially due to the10-year CE requirement leading to selection bias which may underestimate overall adherence.
Discussion: Overall CRC screening and adherence rates remain relatively low in the average-risk population who are eligible for CRC screening, particularly among the younger population aged 50-54 years. Utilization of stool-based tests that can be performed at home increased in recent years, perhaps due to convenience and ease of use.
Disclosures: Henrik Kowalkowski: UnitedHealth Group – Employee. George Austin: UnitedHealth Group – Employee. Yinglong Guo: UnitedHealth Group – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds). Lesley-Ann Miller-Wilson: Exact Sciences – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds). Stacey Byfield: UnitedHealth Group – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds). Prat Verma: UnitedHealth Group – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds). Laura Housman: Exact Sciences – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds). Ethan Berke: UnitedHealth Group – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).
Henrik Kowalkowski, MS1, George Austin, MS1, Yinglong Guo, MS1, Lesley-Ann Miller-Wilson, PhD, MS, MBA2, Stacey Byfield, MPH, PhD1, Prat Verma, MS, MBA1, Laura Housman, MPH, MBA2, Ethan Berke, MD, MPH3. P2345 - Colorectal Cancer Screening and Adherence Rates Among Average Risk Population Enrolled in a National Health Insurance Provider During 2009-2018, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.