Race, ethnicity, and prior colorectal screening test use in CONFIRM colonoscopy vs fecal immunochemical testing trial participants
BACKGROUND: Colorectal cancer (CRC) outcomes vary by both race and ethnicity, and screening test use may contribute to this variation. We examined the association of race, ethnicity, and associated factors with CRC screening test use in a setting where financial barriers to screening are mitigated. METHODS: Survey information was gathered from US Veteran participants (N = 50,125) when enrolled into a randomized trial comparing screening colonoscopy to annual fecal immunochemical testing (FIT) in the prevention of CRC mortality. The primary exposures of interest were the participants' self-identified race and ethnicity, with adjustment for variables capturing access to care. Multivariable logistic regression, stratified by site and age, was used to assess the relationship between exposures of interest and prior use of any CRC screening test, prior colonoscopy, and prior fecal occult blood test (FOBT, including FIT) use. RESULTS: Screening test use was common (N = 28,330, 56.5%) with more Veterans reporting prior FOBT (N = 20,386, 40.7%) than prior colonoscopy (N = 12,671, 25.3%). In multivariable analysis, Black participants were more likely (odds ratio (OR), 1.06; 95% confidence interval (CI) 1.01-1.12) to have had any prior screening relative to White persons and this finding was driven by more frequent FOBT use relative to White persons (OR, 1.16; 95% CI 1.10-1.23). There was no association between Hispanic ethnicity (relative to White persons) on the primary outcomes. CONCLUSIONS: In this cohort, prior screening test use was common, with observed variation in overall test use by race, but not ethnicity. Further study of CRC screening test use in diverse populations are needed. CLINICALTRIALS.GOV ID: NCT#05612347.
Authors
- Grant D. Huang (ORCID: https://orcid.org/0000-0002-1217-0002)
- Susan F. Goldsmith
- Barbara J. Del Curto
- John Lieb
- Erik C. von Rosenvinge (ORCID: https://orcid.org/0000-0002-1862-7288)
- Adnan Said (ORCID: https://orcid.org/0000-0001-9944-4071)
- Amelia E. Underwood
- György Baffy (ORCID: https://orcid.org/0000-0002-8334-0400)
- Ronald Fernando
- Priscilla Magno
- Andrew M. Kaz (ORCID: https://orcid.org/0000-0003-4366-351X)
- Katarina B. Greer (ORCID: https://orcid.org/0009-0002-5676-3464)
- Jason A. Dominitz (ORCID: https://orcid.org/0000-0002-8070-7086)
- Tassos C. Kyriakides (ORCID: https://orcid.org/0000-0001-8913-108X)
- Hugo Pinillos
- Peter Guarino
- Alexander M. Sy (ORCID: https://orcid.org/0000-0001-8630-6622)
- Timothy J. O’Leary (ORCID: https://orcid.org/0000-0002-2435-9136)
- Doris H. Toro (ORCID: https://orcid.org/0000-0001-7580-5100)
- Fadi Antaki (ORCID: https://orcid.org/0000-0002-2273-9346)
- Andrew J. Gawron (ORCID: https://orcid.org/0000-0002-8968-6998)
- Ildiko Halasz
- Andrew Lacasse
- Claudio Tombazzi
- Brian A. Sullivan (ORCID: https://orcid.org/0000-0002-7098-6261)
- Petr Protiva (ORCID: https://orcid.org/0000-0002-5566-8820)
- Rajarajeshwari Ramachandran (ORCID: https://orcid.org/0000-0001-5367-869X)
- Emily Carter Paulson (ORCID: https://orcid.org/0000-0002-5037-6298)
- Douglas J. Robertson (ORCID: https://orcid.org/0000-0002-5934-3388)
- Stacy B. Menees (ORCID: https://orcid.org/0000-0002-5891-4118)
- Martin Tobi
- William M. Tierney
- Minh Q. Ho
- Nancy Ho
- Sonia Yoon
- Kyle P. Lehenbauer
- Jeffrey Gill
- Michael Yao
- Devang Prajapati
- Sameer D. Saini
- Stephan Goebel
- Edward Sun
- Divya Bhatt
- Margaret Kinnard
- Kittichai Promrat
- Dipendra Parajuli (ORCID: https://orcid.org/0000-0001-5241-5943)
- David Lieberman
- Alexander Beed
- Endashaw Omer
- Tilak Shah
- Divyanshoo Rai Kohli (ORCID: https://orcid.org/0000-0002-7801-0044)
- Natalia Khalaf
- Beata Planeta
- Mitchell Schubert
- Jed Olson
- Jill Elwing
- Joseph R Pisegna
- Helen Wong
- Samuel B Ho
- Marcos Pedrosa
- Heiko Pohl
- Swati G Patel
- Ioannis Anastasiou
- Kathy Boardman
- Farrukh Merchant
- Deborah A Fisher
- Shanaz Sultan
- Phillip Schoenfeld
- Prateek Sharma
- Meaghan Larson
- Kerry Brandt Dunbar
- Folasade P May
- Ranjan Mascarenhas
- Charles J Kahi
- Mazen Jamal
- Andy J Mengshol
- Mohammad Madhoun
- Aasma Shaukat
- Paul Feldman
- Thomas F Imperiale
- Rachel Koppelman
- the CONFIRM Study Group
- Dennis H Sullivan
- Samir Gupta
Institutions
- Dartmouth College (US)
- University of Minnesota (US)
- Oregon Health & Science University (US)
- University of Washington (US)
- VA NY Harbor Healthcare System (US)
- UC San Diego Health System (US)
- VA Office of Research and Development (US)
- Portland VA Medical Center (US)
- University of California San Diego (US)
- VA Connecticut Healthcare System (US)
- Fred Hutch Cancer Center (US)
- VA Puget Sound Health Care System (US)
- VA San Diego Healthcare System (US)
- Vaccine Research Institute of San Diego (US)
- Richard L. Roudebush VA Medical Center (US)
- Minneapolis VA Health Care System (US)
- White River Junction VA Medical Center (US)
- Department of Veterans Affairs (AU)
- Indiana University School of Medicine
- Indiana University – Purdue University Indianapolis (US)
- New York University (US)
Publication Details
- Journal
- JNCI Cancer Spectrum
- Published
- 2026-08-26
- DOI
- https://doi.org/10.1093/jncics/pkag080
- Primary Topic
- Colorectal Cancer Screening and Detection
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- U.S. Department of Veterans Affairs
- Office of Research and Development