Research Spotlight: New Insights on US Colorectal Cancer Screening Trends Post-Pandemic

Saeed Soleymanjahi, MD, MPH, of the Gastroenterology Division within the Department of Medicine at Mass General Brigham, is the lead author of a new study published in the Journal of the National Comprehensive Cancer Network, “Nationwide trends in colorectal cancer screening by the end of the COVID-19 pandemic: racial/ethnic differences and opportunities.” Sapna Syngal, MD, MPH, also of the Gastroenterology Division, is one of the senior authors. This study represents a collaborative effort between researchers at Mass General Brigham and Yale School of Medicine.

Q: What challenges or unmet needs make this study important?

Colorectal cancer is not only one of the most frequently diagnosed cancers in the United States, but it also remains among the leading causes of cancer-related death. In addition, recent data shows a notable increase in the incidence of colorectal cancer among younger Americans that further underscores why screening is critical.

However, research shows that colorectal cancer screening across the country was disrupted during the early phases of the COVID-19 pandemic, leading to a sharp decline in overall screening rates and shifts in the types of screening tests patients received. Now, it is critical to understand whether these changes have persisted, worsened or rebounded to pre-pandemic levels. It’s equally important to learn how these trends differ across racial, ethnic and insurance groups, and whether existing disparities in cancer prevention have narrowed or deepened in the wake of the pandemic.

Q: What central question(s) were you investigating?

Our study centered on this key question: has colorectal cancer screening in the United States truly recovered since the pandemic? Specifically, we wondered whether screening rates have rebounded among socioeconomic groups that were disproportionately affected early on in the global crisis.

We also asked whether Americans are returning to colonoscopy, the gold standard for screening, or if these disruptions led to lasting changes in the types of screening tests being used.

Q: What methods or approach did you use?

To study these national trends, we analyzed data from the National Health Interview Survey, a large survey conducted by the Centers for Disease Control and Prevention (CDC). We focused on data collected in 2019 (pre-pandemic), 2021 (early pandemic) and 2023 (later pandemic recovery phase). The survey is based on in-person interviews and is designed to reflect the entire noninstitutionalized U.S. population.

Q: What did you find?

We found that colonoscopy use has largely rebounded to pre-pandemic levels. However, this recovery has not been equal: Asian Americans continue to have lower colonoscopy use than before the pandemic, highlighting a persistent gap in care. At the same time, stool-based screening tests have continued to rise in popularity through 2023. This shift helped offset the drop in screening seen early in the pandemic, particularly in resource-limited communities, and played an important role in restoring overall screening rates.

But this trend comes with an important caveat. Unlike colonoscopy, which can both detect and remove pre-cancerous polyps in a single procedure, stool-based tests are only the first step. Patients with positive results must undergo a timely follow-up colonoscopy to complete the screening process. As more Americans rely on stool-based testing, especially in certain subgroups (e.g., Asian Americans), the healthcare system must ensure that appropriate follow-up care is not delayed, or the benefits of increased screening through stool-based testing could be undermined.

Q: What are the real-world implications, particularly for patients?

For patients, our findings offer both reassurance and a note of caution. On the positive side, colorectal cancer screening in the United States has largely rebounded after the disruptions of COVID-19, meaning more people are again seeking prevention efforts. The growing use of stool-based tests has also made screening more accessible, especially for individuals who may face barriers to colonoscopy, such as cost, time or limited access to care.

However, screening is no longer a one-step process for all patients. Stool-based tests are only effective if a positive result is followed by a timely colonoscopy. Without that crucial next step, early cancers and pre-cancerous polyps may go untreated. This concern is very alarming since prior data has shown that almost one in two patients with a positive stool test don’t get follow-up colonoscopy to complete their screening process. This becomes even more important to address in the light of recent data that shows increasing colorectal cancer incidence in the younger U.S. population with lower overall screening uptake.

Overall, we’d like to highlight two actionable steps for patients: first, get screened by any approved method; and second, if a stool-based test is positive, complete follow-up colonoscopy promptly.

Q: What part of this work feels most meaningful to you personally?

While it was important to our team to find out whether colorectal cancer screening recovered after the pandemic, we found it most meaningful to uncover who may have been left behind.

As clinicians, this work goes beyond data. It directly reflects the patients we see every day in clinic and the communities we interact with on regular basis. Those who face barriers to care, delays in follow-up or limited access to procedures like colonoscopy. Being able to identify these gaps is important because it creates an opportunity to address them.

If our findings can help guide more equitable screening strategies and ensure that patients not only get screened but also complete the full process of care, that is what makes this work truly worthwhile.

Authorship: In addition to Soleymanjahi, Mass General Brigham authors include Nicolette Juliana Rodriguez and Sapna Syngal. Other authors include Young-Rock Hong, Sneha Saha, Juhan Lee, Michelle L. Hughes and Xavier Llor.

Paper cited: Soleymanjahi, Saeed., et al. “Nationwide trends in colorectal cancer screening by the end of the COVID-19 pandemic: racial/ethnic differences and opportunities.” Journal of the National Comprehensive Cancer Network (JNCCN). DOI: 10.6004/jnccn.2026.7023

Funding: This work was supported by a (K12TR004381) award through Harvard Catalyst (Rodriguez); The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health) (Rodriguez); and internal funds (Llor).

Disclosures: None