Colorectal cancer (CRC) is the second leading cause of cancer-related mortality in adults in the United States. Despite compelling evidence of improved outcomes in CRC, screening rates are not optimal. This study aimed to characterize CRC screening trends over the last two decades and assess the impact of various screening modalities on overall CRC screening rates. Using National Health Interview Survey data from 2005-2021, we examined CRC screening (colonoscopy, mt-sDNA, FOBT/FIT, sigmoidoscopy, CT Colonography) rates among adults aged 50-75 years (n = 85,571). A pseudo-time-series cross-sectional (pseudo-TSCS) analysis was conducted including a random effects GLS regression model to estimate the relative impact of each modality on changes in CRC screening rates. Among 50–75-year-olds, the estimated CRC screening rate increased from 47.7% in 2005 to 69.9% in 2021, with the largest increase between 2005 and 2010 (47.7% to 60.7%). Rates subsequently plateaued until 2015 but increased from 63.5% in 2015 to 69.9% in 2018. This was primarily driven by the increased use of mt-sDNA (2.5% in 2018 to 6.6% in 2021). Pseudo-TSCS analysis results showed that mt-sDNA contributed substantially to the increase in overall screening rates (77.3%; p < 0.0001) between 2018-2021. While CRC screening rates increased from 2005 to 2021, they remain below the 80% goal. The introduction of mt-sDNA, a non-invasive screening test may have improved overall rates. Sustained efforts are required to further increase screening rates to improve patient outcomes and offering a range of screening options is likely to contribute to achieving this goal.

中文翻译：

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国家健康访谈调查 (NHIS) 中结直肠癌筛查的趋势：分析不同方式对总体筛查率的影响

结直肠癌 (CRC) 是美国成人癌症相关死亡的第二大原因。尽管有令人信服的证据表明结直肠癌的结果有所改善，但筛查率并非最佳。本研究旨在描述过去二十年的结直肠癌筛查趋势，并评估各种筛查方式对结直肠癌总体筛查率的影响。使用 2005-2021 年全国健康访谈调查数据，我们检查了 50-75 岁成年人的 CRC 筛查（结肠镜检查、mt-sDNA、FOBT/FIT、乙状结肠镜检查、CT 结肠镜检查）率 (n = 85,571)。进行了伪时间序列横截面（伪 TSCS）分析，包括随机效应 GLS 回归模型，以估计每种方式对 CRC 筛查率变化的相对影响。在50-75岁人群中，估计CRC筛查率从2005年的47.7%上升到2021年的69.9%，其中2005年至2010年增幅最大（47.7%上升至60.7%）。随后该比率一直稳定到 2015 年，但从 2015 年的 63.5% 增加到 2018 年的 69.9%。这主要是由于 mt-sDNA 使用量的增加（2018 年的 2.5% 增加到 2021 年的 6.6%）。伪 TSCS 分析结果表明，mt-sDNA 对 2018 年至 2021 年间总体筛查率的增加做出了重大贡献（77.3%；p < 0.0001）。虽然 CRC 筛查率从 2005 年到 2021 年有所上升，但仍低于 80% 的目标。 mt-sDNA（一种非侵入性筛查测试）的引入可能提高了总体筛查率。需要持续努力进一步提高筛查率，以改善患者的治疗结果，而提供一系列筛查选项可能有助于实现这一目标。