{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T20:08:24Z","timestamp":1792958904512,"version":"4.5.0"},"reference-count":46,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>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.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate possible changes in the use of different CRC screening modalities among average-risk individuals aged 50 to 75 years in the US.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>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.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Invasive and noninvasive CRC screening modalities.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>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.<\/jats:p><\/jats:sec>Results<\/jats:title>In this retrospective cohort study of 24\u202f973\u202f642 distinct beneficiaries (mean [SD] age, 57.36 [4.27] years; 12\u202f789\u202f413 female [51.21%]), the use of colonoscopy (mean [SD], 1.29% [0.09%] to 1.14% [0.07%]; P<\/jats:italic>\u2009&amp;lt;\u2009.001) and fecal immunochemical test (FIT) decreased between the 2 periods (mean [SD], 0.54% [0.03%] to 0.38% [0.07%]; P<\/jats:italic>\u2009&amp;lt;\u2009.001). However, stool DNA test use increased (mean [SD], 0.19% [0.13%] to 0.61% [0.16%]; P<\/jats:italic>\u2009&amp;lt;\u2009.001). Males had higher use of colonoscopy than females (mean [SD], 1.21% [0.07%] vs 1.07% [0.07%]; P<\/jats:italic>\u2009&amp;lt;\u2009.001), whereas females had higher use of stool DNA test than males (mean [SD], 0.68% [0.16%] vs 0.55% [0.15%]; P<\/jats:italic>\u2009&amp;lt;\u2009.001) and FIT (mean [SD], 0.43% [0.08%] vs 0.33% [0.05%]; P<\/jats:italic>\u2009&amp;lt;\u2009.001). 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<\/jats:italic>\u2009&amp;lt;\u2009.001) and stool DNA test (mean [SD], 0.65% [0.17%] vs 0.48% [0.13%]; P<\/jats:italic>\u2009&amp;lt;\u2009.001) and lower use of FIT (mean [SD], 0.36% [0.09%] vs 0.48% [0.06%]; P<\/jats:italic>\u2009&amp;lt;\u2009.001). Metropolitan area residents, compared with nonmetropolitan area residents, more frequently underwent colonoscopy (mean [SD], 1.18% [0.08%] vs 0.97% [0.06%]; P<\/jats:italic>\u2009&amp;lt;\u2009.001) and FIT (mean [SD], 0.41% [0.08%] vs 0.25% [0.04%]; P<\/jats:italic>\u2009&amp;lt;\u2009.001); however, their use of stool DNA test were similar (mean [SD], 0.61% [0.16%] vs 0.64% [0.16%]; P<\/jats:italic>\u2009=\u2009.51).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>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.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.38578","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T15:00:34Z","timestamp":1761058834000},"page":"e2538578","source":"Crossref","is-referenced-by-count":4,"title":["Changes in Colorectal Cancer Screening Modalities Among Insured Individuals"],"prefix":"10.1001","volume":"8","author":[{"given":"Sunny","family":"Siddique","sequence":"first","affiliation":[{"name":"Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Folasade P.","family":"May","sequence":"additional","affiliation":[{"name":"Division of Digestive Diseases, University of California Los Angeles Devid Geffen School of Medicine, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura V. 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