Colorectal Cancer Screening in United States

United States

There is strong evidence that screening for colorectal cancer reduces mortality by removing precancerous growths and increasing early detection, which is optimal for effective treatment. Since peaking in 1985, colorectal cancer incidence rates have decreased 46% as of 2019.

Colorectal cancer was the third-leading cause of cancer deaths according to 2023 estimates and the third-leading cause of new cancer cases for both men and women in the United States. The American Cancer Society’s Cancer Facts & Figures report projects 153,020 new cases of colorectal cancer and over 52,550 colorectal cancer deaths in 2023.

According to the U.S. Preventive Services Task Force, screening for colorectal cancer, which may include fecal sample testing, colonoscopy and/or sigmoidoscopy, is recommended for adults ages 45-75. Screening at earlier ages is recommended for those with particular risk factors or a family history of colorectal cancer. 

Multiple studies have shown that screening for colorectal cancer is cost-effective compared with not screening. Furthermore, if routine screenings started at age 45, an estimated 24-28 colorectal cancer deaths could be averted for every 1,000 adults screened.

According to America’s Health Rankings data, populations of adults ages 45-75 with a higher percentage of colorectal cancer screening include:

• Women compared with men. 
• White adults compared with Hispanic and Asian adults.
• College graduates compared with those with lower levels of educational attainment. 
• Adults with annual household incomes of $50,000 or more compared with those with an income of less than $25,000.
• Straight adults compared with LGBQ+ adults.
• Adults who have served in the U.S. armed forces compared with those who have not served.

There are many strategies to increase colorectal cancer screening. The Community Guide — a collection of evidence-based findings of the Community Preventive Services Task Force — recommends a multicomponent approach. The guide lists several strategies that work best when used in combination. These strategies include: 

• Media campaigns to increase awareness.
• Client reminders.
• Cost reduction.
• Addressing language and transportation barriers.

The Centers for Disease Control and Prevention (CDC) has implemented a Colorectal Cancer Control Program that focuses on increasing screening for targeted groups. The National Colorectal Cancer Roundtable has resources for increasing colorectal cancer screening rates in primary care. 

Additionally, County Health Rankings & Roadmaps recommends using patient navigators, also called system navigators, to help guide patients through medical, insurance and social support systems.

Healthy People 2030 has an objective of increasing the proportion of adults who receive the recommended colorectal cancer screening.

American Cancer Society. “Cancer Facts & Figures 2023.” Atlanta, GA: American Cancer Society, 2023. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2023/2023-cancer-facts-and-figures.pdf.

———. “Colorectal Cancer Facts & Figures 2020-2022.” Atlanta, GA: American Cancer Society, 2020. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2020-2022.pdf.

DeGroff, Amy, Krishna Sharma, Anamika Satsangi, Kristy Kenney, Djenaba Joseph, Katherine Ross, Steven Leadbetter, et al. “Increasing Colorectal Cancer Screening in Health Care Systems Using Evidence-Based Interventions.” Preventing Chronic Disease 15 (August 9, 2018): 180029. https://doi.org/10.5888/pcd15.180029.

Patel, Shaan S., and Meredith L. Kilgore. “Cost Effectiveness of Colorectal Cancer Screening Strategies.” Cancer Control: Journal of the Moffitt Cancer Center 22, no. 2 (April 2015): 248–58. https://doi.org/10.1177/107327481502200219.

Siegel, Rebecca L., Nikita Sandeep Wagle, Andrea Cercek, Robert A. Smith, and Ahmedin Jemal. “Colorectal Cancer Statistics, 2023.” CA: A Cancer Journal for Clinicians 73, no. 3 (May 2023): 233–54. https://doi.org/10.3322/caac.21772.