title: Trends in colorectal cancer test use among vulnerable populations in the United States.
abstract: BACKGROUND
  Evaluating trends in colorectal cancer (CRC) screening use is critical for understanding screening implementation, and whether population groups targeted for screening are receiving it, consistent with guidelines. This study examines recent national trends in CRC test use, including among vulnerable populations.
  
  
  METHODS
  We used the 2000, 2003, 2005, and 2008 National Health Interview Survey to examine national trends in CRC screening use overall and for fecal occult blood test (FOBT), sigmoidoscopy, and colonoscopy. We also assessed trends by race/ethnicity, educational attainment, income, time in the United States, and access to health care.
  
  
  RESULTS
  During 2000 to 2008, significant declines in FOBT and sigmoidoscopy use and significant increases in colonoscopy use and in the percentages of adults up-to-date with CRC screening occurred overall and for most population subgroups. Subgroups with consistently lower rates of colonoscopy use and being up-to-date included Hispanics; people with minimal education, low income, or no health insurance; recent immigrants; and those with no usual source of care or physician visits in the past year. Among up-to-date adults, there were few subgroup differences in the type of test by which they were up-to-date (i.e., FOBT, sigmoidoscopy, or colonoscopy).
  
  
  CONCLUSIONS
  Although use of CRC screening and colonoscopy increased among U.S. adults, including those from vulnerable populations, 45% of adults aged 50 to 75-or nearly 35 million people-were not up-to-date with screening in 2008.
  
  
  CONCLUSIONS
  Continued monitoring of CRC screening rates among population subgroups with consistently low utilization is imperative. Improvement in CRC screening rates among all population groups in the United States is still needed.
authors.affiliation: Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892-7344, USA. klabundC@mail.nih.gov
authors.forename: Carrie N
authors.initials: CN
authors.lastname: Klabunde
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Cronin
authors.forename: Nancy
authors.initials: N
authors.lastname: Breen
authors.forename: William R
authors.initials: WR
authors.lastname: Waldron
authors.forename: Anita H
authors.initials: AH
authors.lastname: Ambs
authors.forename: Marion R
authors.initials: MR
authors.lastname: Nadel
mesh_terms: D000368:Aged; D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D009780:Occult Blood; D012812:Sigmoidoscopy / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology