S529 Choosing Stool DNA vs Colonoscopy: Racial, Geographic, and Age Disparities in Colorectal Cancer Screening From BRFSS Data (2022–2023)

Introduction: Colorectal cancer (CRC) remains a leading cause of cancer-related mortality in the United States. Despite the proven effectiveness of screening, significant disparities persist in modality uptake especially among racial/ethnic minorities, rural residents, and younger adults. This study examined sociodemographic predictors of choosing stool DNA testing over endoscopic methods (colonoscopy/sigmoidoscopy) using pooled Behavioral Risk Factor Surveillance System (BRFSS) 2022–2023 data. Methods: We analyzed adults aged 45–75 years who reported undergoing either stool DNA or endoscopic CRC screening. Bivariate associations were assessed using chi-square tests. Multivariable logistic regression evaluated predictors of stool DNA-only use, adjusting for sex, age, race/ethnicity, residence, and insurance. Results: Among 30,932 screening-eligible respondents, 2,780 (9.0%) used stool DNA testing exclusively. Women (AOR: 1.48; 95% CI: 1.37–1.60) and rural residents (AOR: 1.23; 95% CI: 1.10–1.38) had higher odds of stool DNA use. Asians (AOR: 1.55; 95% CI: 1.18–2.03) and Hispanics (AOR: 1.49; 95% CI: 1.28–1.73) were significantly more likely than Whites to use stool DNA. Use declined steeply with age, with adults ≥70 years having nearly 80% lower odds compared to those aged 45–49. Conclusion: Stool DNA testing is more frequently adopted among rural residents, Asians, Hispanics, and younger adults, groups historically underserved by endoscopy-based screening. These trends suggest that non-invasive stool-based modalities, such as Cologuard and FIT, may serve as vital tools for bridging colorectal cancer screening gaps across marginalized populations, especially given that endoscopy-based screening tends to favor urban, White, and older populations. Public health programs should prioritize expanding access to these tests to improve equity in CRC screening and reduce the long-standing disparities tied to geography, age, and race.