Regional and Racial Trends in US Colorectal Cancer Screening

Objective: Colorectal cancer screening is proven to reduce cancer burden and mortality. Despite several well-established screening methods, colorectal cancer still has the third-highest cancer mortality rate in the United States. Methods: We examine the self-reports of individuals ever having a colonoscopy or fecal occult blood test (FOBT) from the Behavioral Risk Factor Surveillance System questionnaire to determine if screening rates differed by race and year while controlling for state and other variables. Results: Colonoscopy rates increased between years while FOBT rates decreased. Blacks had higher colonoscopy rates than Whites and other racial minorities had lower rates. Blacks also had higher FOBT rates, as did American Indians/Alaska Natives (AI/ ANs), Native Hawaiian/Pacific Islanders (NH/PIs), and the multiracial category (MR). Whites and Asians saw a rise in colonoscopy rates between 2014 and 2018, whereas AI/ANs, NH/PIs, MR, and the other category (Other) saw a rise in FOBT rates. State-level screening rates were not associated with state-level incidence or mortality rates. Conclusions: Racial disparities still exist in self-reported colorectal screening patterns, though some are trending in the right direction, and there is a gap between screening rates and incidence rates by state that depend on further factors.