Endoscopic and stool-based colorectal cancer screening coverage among US veterans: A survey analysis using 2021 Behavioral Risk Factor Surveillance System (BRFSS) data

Abstract

Introduction: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths for the overall US population, with over 153,000 new cases annually. It is one the most diagnosed cancers in veterans and accounts for approximately 9 ​% of all cancers in this population. Methods: This cross-sectional study used weighted data from the BRFSS 2021, a nationally representative US-telephone-based survey. We assessed the rate of endoscopic and stool-based colorectal cancer screening done in the VP compared to the NVP, stratified by age of screening, insurance, health status, primary care and marital status. We used backward stepwise multivariate logistic regression analyses to then assess for potentially predictive factors. Results: A total of 117,227,096 adults were included in the study of which 11.64 ​% were veterans. We found that a higher proportion of veterans (78.44 ​%) had endoscopic CRC screening compared to non-veterans (68.62 ​%). VP were more likely to be screened compared to NVP (OR ​= ​1.32, (1.00–1.74). Only 26.45 ​% of VP in this study utilized military health coverage and are four-times likely to be screened (OR ​= ​3.64, (2.04–6.52). Lastly, both VP and NVP who were actively followed by their primary care provider (OR ​= ​2.80, (2.02–3.87) were more likely to be screened. Conclusion: A higher proportion of VP had endoscopic colorectal cancer screening, but a screening gap still exists. Active engagement with PCPs is associated with more frequent endoscopic CRC screening in veterans. We recommend more grassroots efforts to get veterans engaged with their PCPs to significantly improve screening coverage.

Keywords

• Colorectal cancer screening
• Veteran status
• Colonoscopy
• Cologuard
• VP (veteran population)
• NVP (non-veteran population)