2025-10-28 イェール大学
<関連情報>
- https://news.yale.edu/2025/10/28/study-reveals-demographic-disparities-uptake-colorectal-cancer-screenings
- https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2840376
保険加入者における大腸がん検診方法の変化 Changes in Colorectal Cancer Screening Modalities Among Insured Individuals
Sunny Siddique, MPH, PhD; Rong Wang, PhD; Folasade P. May, MD, PhD, MPhil;et al
JAMA Network Open Published:October 21, 2025
DOI:10.1001/jamanetworkopen.2025.38578
Key Points
Question Did use of colorectal cancer (CRC) screening modalities change in the US between 2017 and 2024?
Findings In this cohort study of 24 973 642 privately insured individuals aged 50 to 75 years, the use of colonoscopy and fecal immunochemical test decreased, and stool DNA test use increased. Males had higher use of colonoscopy while females had higher use of stool DNA test; areas with high socioeconomic status (SES) and metropolitan areas had more frequent use of both modalities.
Meaning These findings suggest that use of different CRC screening modalities changed, varying by sex, area-level SES, and urban or rural residence.
Abstract
Importance Several colorectal cancer (CRC) screening modalities (eg, colonoscopy, stool-based tests) are currently available. Yet, recent national patterns in screening using these modalities and potential differences across sociodemographic groups remain unclear.
Objective To evaluate possible changes in the use of different CRC screening modalities among average-risk individuals aged 50 to 75 years in the US.
Design, Setting, and Participants This retrospective cohort study used deidentified claims data from 2017 to 2024. Participants included a dynamic cohort of commercially insured Blue Cross Blue Shield beneficiaries. Data were analyzed from May 1 to June 30, 2025.
Exposures Invasive and noninvasive CRC screening modalities.
Main Outcomes and Measures Changes in screening modality use were compared between the periods preceding the onset of the COVID-19 pandemic (ie, preonset: January 1, 2017, to February 28, 2020) and following the onset of the pandemic (ie, postonset: July 1, 2020, to December 31, 2024). Changes in screening by modality were also evaluated using autoregressive integrated moving average models, adjusting for temporal autocorrelation and seasonality.
Results In this retrospective cohort study of 24 973 642 distinct beneficiaries (mean [SD] age, 57.36 [4.27] years; 12 789 413 female [51.21%]), the use of colonoscopy (mean [SD], 1.29% [0.09%] to 1.14% [0.07%]; P < .001) and fecal immunochemical test (FIT) decreased between the 2 periods (mean [SD], 0.54% [0.03%] to 0.38% [0.07%]; P < .001). However, stool DNA test use increased (mean [SD], 0.19% [0.13%] to 0.61% [0.16%]; P < .001). Males had higher use of colonoscopy than females (mean [SD], 1.21% [0.07%] vs 1.07% [0.07%]; P < .001), whereas females had higher use of stool DNA test than males (mean [SD], 0.68% [0.16%] vs 0.55% [0.15%]; P < .001) and FIT (mean [SD], 0.43% [0.08%] vs 0.33% [0.05%]; P < .001). Areas with socioeconomic status (SES) in the top 20% had higher use of colonoscopy compared with areas where a marker of SES was in the bottom 20% (mean [SD], 1.37% [0.09%] vs 0.91% [0.06%]; P < .001) and stool DNA test (mean [SD], 0.65% [0.17%] vs 0.48% [0.13%]; P < .001) and lower use of FIT (mean [SD], 0.36% [0.09%] vs 0.48% [0.06%]; P < .001). Metropolitan area residents, compared with nonmetropolitan area residents, more frequently underwent colonoscopy (mean [SD], 1.18% [0.08%] vs 0.97% [0.06%]; P < .001) and FIT (mean [SD], 0.41% [0.08%] vs 0.25% [0.04%]; P < .001); however, their use of stool DNA test were similar (mean [SD], 0.61% [0.16%] vs 0.64% [0.16%]; P = .51).
Conclusions and Relevance Among privately insured individuals, the use of colonoscopy and FIT decreased after the COVID-19 pandemic while stool DNA test use increased, with differences by sex, area-level SES, and metropolitan area residence.
