Millions of middle-aged and older Americans remain undiagnosed for colorectal cancer due to suboptimal adherence to recommended screening guidelines. Despite established protocols endorsing colonoscopy as the gold standard, many individuals have not undergone initial or follow-up tests to detect early precancerous lesions or malignancies. This gap in screening adherence raises significant public health concerns, given that early detection dramatically improves survival rates and reduces treatment complexity for colorectal cancer.
Recent investigations illuminate two critical dimensions of the colorectal cancer screening paradigm: the contrasting preferences of patients and physicians toward available screening modalities and the real-world impact of a pivotal 2023 federal policy reform aimed at eliminating financial barriers for follow-up colonoscopies necessitated by abnormal home-based stool test results. Together, these studies provide nuanced insights into behavioral factors influencing screening uptake and reveal how policy interventions can modulate clinical workflows and patient outcomes.
A discrete choice experiment surveying over 1,200 adults aged 45 to 75 revealed an overwhelming patient preference for non-invasive screening methods over traditional colonoscopy. Approximately 75% favored home-based stool DNA or blood tests when informed about the nature of these options, including test frequency, sensitivity, and specificity. This trend underscores a widespread patient inclination toward convenience and less intrusive procedures despite acknowledging the superior diagnostic accuracy of colonoscopy.
Conversely, physicians overwhelmingly preferred colonoscopy as the initial screening modality for their patients, with 95% endorsing it despite receiving parallel information on alternative tests. This stark divergence between clinical recommendation and patient preference poses a critical challenge for shared decision-making. Physicians’ emphasis on colonoscopy likely reflects its dual diagnostic and therapeutic capability, particularly in identifying and removing adenomatous polyps that are precursors to malignancy.
Understanding these preferences is vital because patient adherence to screening recommendations is inextricably linked to test acceptability and perceived invasiveness. Noninvasive tests, while generally less sensitive, offer the potential to engage patients who would otherwise forgo screening entirely. However, an important caveat exists: positive results from noninvasive tests mandate timely colonoscopy follow-up to confirm diagnoses and enable polyp removal. Thus, the screening process must be framed as a continuum rather than a singular diagnostic act.
Further compounding the issue, logistical challenges inherent to colonoscopy—including bowel preparation, appointment scheduling, sedation requirements, and the need for accompaniment—often deter patients from completing recommended follow-up evaluations. Addressing these barriers, as well as fostering patient commitment to completing the full screening cascade, remains a pivotal area for intervention in clinical practice settings.
The federal policy enacted in January 2023 provides a landmark approach to bridging financial barriers by mandating zero out-of-pocket costs for follow-up colonoscopies after abnormal stool test results. Prior to this, patients often faced substantial copays, deductibles, and coinsurance charges that disincentivized completing the necessary colonoscopy. By removing these financial impediments, the policy aims to enhance adherence to the diagnostic cascade, thereby improving early detection rates.
Analysis of national insurance claims encompassing over 10 million colonoscopies from 2022 to late 2023 reveals a 41% relative increase in follow-up procedures triggered by abnormal stool-based tests after the policy’s implementation. Notably, this increase occurred without a commensurate rise in the total number of colonoscopies performed monthly, suggesting a redistribution of procedures toward diagnostic confirmation rather than an overall procedural surge.
This shift is particularly significant given the constrained availability of colonoscopy appointments nationwide, where increasing demand from expanded screening eligibility and pandemic-related backlogs has already stretched resources thin. Efficient allocation of colonoscopy services to patients with positive noninvasive test results enhances the clinical utility and cost-effectiveness of colorectal cancer screening programs.
From a public health perspective, these findings advocate for integrated screening strategies that acknowledge patient preferences while ensuring rigorous follow-up protocols. Incorporating patient education about the importance of follow-up colonoscopy and providing navigational assistance may increase adherence to the full screening continuum, resulting in higher rates of polyp removal before malignant transformation.
Importantly, the studies were supported by Exact Sciences, a major player in the colorectal cancer screening market, which develops and markets the Cologuard stool DNA test among other diagnostic options. Although the funding source introduces potential conflicts of interest, the research methodology was inclusive of multiple screening modalities, including newer blood-based assays and traditional fecal immunochemical tests (FIT), providing a broad perspective on preferences and utilization trends.
The implications extend beyond simple modality preference to encompass health policy, insurance design, and clinical workflow optimization. They underscore the growing recognition that removing financial barriers and accommodating patient choice can synergistically enhance colorectal cancer screening completion, potentially leading to earlier cancer detection and reduced mortality.
In conclusion, this body of research offers compelling evidence that patient-centered approaches paired with supportive health policies have a tangible impact on optimizing colorectal cancer screening processes. Bridging the gap between physician recommendations and patient preferences, along with eliminating cost-sharing for follow-up diagnostics, emerges as a pragmatic pathway to improve outcomes in this pressing area of cancer prevention.
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Subject of Research: People
Article Title: Patient and physician preferences among colorectal cancer screening tests: updated predictions from a discrete choice experiment
News Publication Date: 1-Nov-2025
Web References:
https://www.tandfonline.com/doi/full/10.1080/03007995.2025.2576596
https://www.tandfonline.com/doi/full/10.1080/03007995.2025.2577763
Keywords: Cancer screening, Health care, Health care policy, Health care delivery, Health care costs
