31% of colorectal cancer screenings are DNA stool tests

Based on data from an Epic Research study, DNA stool testing in the first quarter of 2018 comprised 3% of all colorectal cancer screenings; however, by the fourth quarter of 2023, they accounted for 31% of screenings. With the rising rates of colorectal cancer, particularly in the Western world, understanding screening patterns and frequencies can guide public health and widespread screening efforts.

Multiple types of colorectal cancer screening tools exist, including stool-based screenings, liquid biopsies, radiology screenings, and endoscopies; however, the accuracy and recommended use of these screening tools vary.

This study by Epic Research analyzed 1,422,099 first-time colorectal cancer screenings conducted via colonoscopy and stool-based tests.

According to the data gathered by the researchers, 96% of colorectal cancer screenings in early 2018 were colonoscopies; however, the proportion of colonoscopies declined over time, dropping below 70%.

On the other hand, the use of DNA stool tests has risen significantly, with one of the most prominent increases occurring in 2020. This is potentially because the onset of the pandemic paused preventative care procedures in healthcare facilities, including colonoscopies. However, even after the modest drop in stool testing as preventative care procedures resumed, DNA stool tests increased in popularity.

FIT-DNA tests, sometimes called MT-sDNA tests (multitargeted stool DNA tests), have a 92–95% sensitivity and an 84–95% specificity.  

In May 2021, the United States Preventative Services Task Force (USPSTF) updated its colorectal cancer screening recommendations to include adults 45 and older, expanding the previous recommendation, which suggested that those 50 and older get screened.

These updates followed research from multiple studies that pointed out rising rates of colorectal cancer among younger individuals. For example, a 2023 report in CA: A Cancer Journal for Clinicians reported increasing rates of early-onset colorectal cancer, defined as a colorectal cancer diagnosis before the age of 50. The study also noted that colorectal cancer rates in those under 55 have increased by 1–2% annually since the mid-1990s.  

Epic Research wanted to assess how other demographics, including age, impacted the type of screening patients opted for. According to the research, DNA stool screening was used by 32% of patients 45–49 by the final quarter of 2023. Comparatively, those 50–55 only used DNA stool screenings 29% of the time.

In addition to age, the study also looked at how social vulnerability indexes impacted the use of DNA stool screenings. The researchers found that those in the highest social vulnerability quartile had the lowest DNA stool test use percentage at 28%, followed by the third quartile at 31%, the lowest at 31%, and the second at 32%.

“We did not observe meaningful differences in the proportion of colorectal cancer screenings performed using a DNA stool test over time when stratified by patient sex or rural and urban classification,” the researchers added in the study.

As new screening tools emerge, including blood tests and liquid biopsies, the colorectal cancer screening landscape will continue to evolve. Future research may evaluate how new tools could be utilized among patients who have not been screened.