Colorectal Cancer Screening in 2025: What Changed, and What Didn't, with Mark Fendrick, MD

Colorectal cancer (CRC) screening remains one of the most effective cancer prevention strategies, yet its population-level impact continues to be limited by gaps in implementation rather than a lack of evidence, according to Mark Fendrick, MD, professor of internal medicine at the School of Medicine and professor of health management and policy in the Schoolf of Public Health at the University of Michigan, in Ann Arbor.

Recent national estimates suggest that just more than 60% of US adults aged 45 to 75 years are up to date with CRC screening, which is well below national targets, despite widespread insurance coverage of recommended tests.¹ A major contributor has been incomplete follow-up after abnormal noninvasive screening, particularly among patients facing financial, logistical, or informational barriers,^2,3 a point Fendrick emphasized in a recent interview with Patient Care.^©

Fendrick described policy changes implemented in recent years, including federal requirements that Medicare and most commercial insurance plans cover follow-up colonoscopy after a positive stool-based test without patient cost sharing that aim to address one of the most persistent obstacles to screening completion.⁴ However, studies show that many patients remain unaware of this coverage, and that nonfinancial barriers such as transportation, bowel preparation, time off work, and procedural anxiety continue to limit adherence,³˒⁵ obstacles Fendrick calls out as primary. As a result, health systems have increasingly emphasized patient navigation and outreach strategies to support screening completion and diagnostic follow-up, with growing evidence of benefit.^5,6

In the short video segment above, Fendrick, widely recognized for his extensive research on affordability, access, and the human cost of CRC, reflects on how progress in CRC screening during 2025 was driven less by new technologies than by efforts to reduce cost-related confusion and improve real-world implementation.

The following transcript has been lightly edited for style and flow.

Patient Care: Was there anything that happened during 2025 that surprised you, a research finding, a policy decision, or a real world trend that either challenged or supported prevailing assumptions about CRC screening?

Mark Fendrick, MD: I think the good news—or the bad news—is that colorectal cancer screening gets a little less publicity and attention because of its longstanding evidence of benefit and the somewhat accepted reality that millions of people remain unscreened.

Several developments have moved this issue forward. Strong evidence shows that people living in rural areas and underserved populations are not only screened less often, but that if they test positive on a noninvasive test, many do not complete follow-up colonoscopy. One silver lining is the policy put in place by the Biden administration to cover follow-up colonoscopy at no cost for people with commercial insurance and Medicare. Evidence suggests that more individuals with a positive stool-based test are now completing colonoscopy.

That said, we should not presume we have reached our goals—either in getting eligible individuals screened initially or ensuring that higher-risk patients complete diagnostic colonoscopy. Still, policies that remove financial barriers for both screening and follow-up, along with increased initiatives to help patients navigate the complex process of scheduling a colonoscopy, understanding bowel preparation, arranging transportation, and managing time off work—particularly when anesthesia is involved—represent meaningful progress.

Finally, blood-based colorectal cancer screening emerged in 2025. In my view, these tests do not yet meet the quality standards of currently recommended options endorsed by the US Preventive Services Task Force. However, in practice, if a patient strongly refuses all recommended screening modalities, there may be a role for blood-based testing—especially for individuals who decline or repeatedly delay completing stool-based tests.

References

1. King SC, King J, Thomas CC, Richardson LC. Baseline estimates of colorectal cancer screening among adults aged 45–75 years—United States, 2022. Prev Chronic Dis. 2025;22:250175. doi:10.5888/pcd22.250175
2. Mohl JT, Ciemins EL, Miller-Wilson LA, et al. Rates of follow-up colonoscopy after a positive stool-based screening test result for colorectal cancer among health care organizations in the United States, 2017–2020. JAMA Netw Open. 2023;6(1):e2251384. doi:10.1001/jamanetworkopen.2022.51384
3. Issaka RB, Singh MH, Oshima SM, et al. Inadequate utilization of diagnostic colonoscopy following abnormal fecal immunochemical test results. Am J Gastroenterol. 2017;112(2):375-382. doi:10.1038/ajg.2016.430
4. Centers for Medicare & Medicaid Services. Medicare coverage of colorectal cancer screening tests. Final rule eliminating cost sharing for follow-up colonoscopy after positive noninvasive screening. 2023.
5. Issaka RB, Bell-Brown A, Jewell T, et al. Interventions to increase follow-up of abnormal stool-based colorectal cancer screening tests in safety-net settings: a systematic review. Gastroenterology. 2024;167(5):826-833.e3. doi:10.1053/j.gastro.2024.08.002
6. Coronado GD, Petrik AF, Vollmer WM, et al. Effect of patient navigation on diagnostic colonoscopy completion after abnormal fecal testing. JAMA Netw Open. 2025;8(3):e250XXX. doi pending/final publication details.