Complementary Studies Point to How to Boost CRC Screening Rates

Two new studies published in Current Medical Research and Opinion offer important insights for clinicians seeking to improve colorectal cancer (CRC) screening rates among their patients. The research examines both patient and physician preferences for different screening modalities1 and demonstrates the significant impact of eliminating cost-sharing requirements on follow-up colonoscopy completion.2

“Given that one-third of insured adults in this country who qualify for no-cost colorectal cancer screening under the Affordable Care Act are not getting screened, we need to better understand the reasons why eligible individuals are not receiving this potentially life-saving preventive service,” A Mark Fendrick, MD, said in a statement.3 Fendrick, lead author of one paper and senior author of the other, is a professor of internal medicine in the University of Michigan (U-M) School of Medicine and a professor of health mangement and policy in the U-M School of Public Health.

Patient-Physician Preference Mismatch1

A discrete choice experiment involving 1,249 adults aged 45-75 and 400 physicians revealed a striking disconnect: 75% of eligible adults preferred non-invasive screening options using stool or blood samples, while 95% of physicians recommended colonoscopy as their first choice for patients.

Patient perspectives. Among the noninvasive options, multitarget stool DNA (mt-sDNA) testing emerged as the clear patient favorite, with 39% choosing this modality. This compared to 25% preferring colonoscopy, 21% selecting cell-free DNA blood tests (cf-DNA-BT), and 15% opting for fecal immunochemical tests (FIT).

The preference for mt-sDNA testing was consistent across nearly all demographic subgroups analyzed, including age groups, racial backgrounds, and screening history. Notably, patients who had never undergone any CRC screening showed an even stronger preference for mt-sDNA (42.1%), as did those with only noninvasive screening experience (53.5%).

Among populations historically less likely to complete CRC screening, including adults aged 45-49 years and non-White individuals—colonoscopy preferences were notably lower, while mt-sDNA remained the preferred option. For the 45-49 age group, colonoscopy preference was just 21.1%, while non-White respondents showed 23.1% preference for colonoscopy compared to 25.1% among White respondents.

Physician perspectives. Among the 400 physician participants, equally divided between primary care physicians and gastroenterologists, colonoscopy was overwhelmingly preferred at 95%, with no significant difference between specialties. However, when physicians did consider noninvasive options, mt-sDNA was preferred over other alternatives by a factor of 10, likely due to its superior sensitivity for both cancer and adenoma detection.

The research suggests physicians may value the procedural accuracy and immediate polyp removal capability of colonoscopy, while patients place greater emphasis on convenience factors such as avoiding bowel preparation, sedation, and time away from work.

Impact of Eliminating Cost-Sharing2

The second study examined the impact of federal policies implemented in January 2023 that eliminated patient cost-sharing for follow-up colonoscopies after positive stool-based tests. Analysis of 10.8 million colonoscopies performed in 2022 and 2023 revealed a 41% relative increase in follow-up colonoscopy completion after the policy took effect.

Before implementation, follow-up colonoscopies comprised 3.59% of all procedures. Following the policy change, this increased to just over 5%, an absolute increase of 1.48 percentage points that was both immediate and sustained through November 2023, according to the study results.

Critically, this increase occurred without expanding total colonoscopy volume, suggesting a beneficial shift in procedure utilization rather than system strain. This finding is particularly important given existing colonoscopy scheduling delays following the 2021 guideline change that extended screening eligibility to adults aged 45-49, adding 20 million Americans to the screening-eligible population.

Clinical Implications

Their findings have several important implications for practicing clinicians, the authors emphasized, which can be summarized as follows:

Shared decision making: The preference gap between patients and physicians underscores the importance of discussing multiple screening options rather than defaulting to colonoscopy recommendations. Research shows that discussing CRC screening options with providers is associated with higher screening adherence rates.

Removing barriers: Financial barriers significantly impact screening completion. The studies demonstrate that policy interventions eliminating cost-sharing can produce immediate, sustained improvements in follow-up colonoscopy rates.

Capacity management: Increased use of non-invasive screening followed by appropriate follow-up colonoscopies may help optimize the use of limited colonoscopy capacity while preserving availability for diagnostic procedures in symptomatic patients.

Addressing disparities: Given the strong preference for mt-sDNA testing among younger adults and non-White populations—groups with historically lower screening rates—offering this option may help reduce screening disparities.

Patient commitment: Fendrick emphasizes the importance of clearly communicating to patients choosing non-invasive tests that follow-up colonoscopy is required after abnormal results, which up to 10% will receive depending on the test chosen. Strategies such as having patients formally commit to follow-up at the time of initial screening may improve completion rates.

The Future

With an estimated 60 million Americans currently not up to date with CRC screening recommendations,4 and total annual colonoscopy capacity estimated at 15-20 million procedures for all clinical indications,5 efficient use of available screening modalities becomes essential. The research suggests that programs prioritizing patient-preferred options, particularly non-invasive tests like mt-sDNA, combined with elimination of financial barriers for necessary follow-up, may achieve greater population-level screening effectiveness.

Editors' note: Both studies were funded by Exact Sciences, manufacturer of the Cologuard mt-sDNA test, though the research included multiple screening modalities in the analysis. Fendrick, who is also directs the U-M Center for Value-Based Insurance Design, is a paid advisor to Exact Sciences, according to the statement.3

References

1. Fendrick AM Greene M, Ozbay AB, et al. Patient and physician preferences among colorectal cancer screening tests: updated predictions from a discrete choice experiment. Curr Med Res Opin. Published online November 1, 2025. doi:10.1080/03007995.2025.2576596
2. Greene M, Le QA, Oxbay AB, Karlitz JJ, Fendrick AM. Completing the colorectal cancer screening process: impact of eliminating cost-sharing for follow-up colonoscopy. Curr Med Res Opin. Published online October 29, 2025. doi:10.1080/03007995.2025.2577763
3. As millions lag in colon cancer screening, new studies point to strategies to boost uptake and follow-up. News release. University of Michigan Institute for Healthcare Policy & Innovation. November 4, 2025. Accessed November 5, 2025. https://ihpi.umich.edu/news-events/news/millions-lag-colon-cancer-screening-new-studies-point-strategies-boost-uptake-and
4. Increase the proportion of adults who get screened for colorectal cancer. Office of Disease Prevention and Health Promotion. Updated 2023. Accessed November 5, 2025. https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/cancer/increase-proportion-adults-who-get-screened-colorectal-cancer-c-07
5. Gangwani MK, Aziz A, Dahiya DS, et al. History of colonoscopy and technological advances: a narrative review. Transl Gastroenterol Hepatol. 2023;8:18. doi:10.21037/tgh-23-4