Key takeaways:
- Total colonoscopy volume is projected to decline from 27 million to 22.3 million over the next decade.
- Colonoscopy remains the most cost-effective CRC screening tool, followed by stool tests and blood tests.
CHICAGO — The number of annual colonoscopies performed in the U.S. is projected to decline over the next decade as use of noninvasive colorectal cancer screening options continues to rise, data presented at Digestive Disease Week showed.
While colonoscopy remains the gold standard in CRC screening and prevention, the rise in use of noninvasive tests is giving average-risk patients new ways to screen for cancer, Lyndon V. Hernandez, MD, MPH, a gastroenterologist at GI Associates, told Healio.
Colonoscopies are also still the most cost-effective screening method for colorectal cancer, results of a cohort study conducted by Hernandez and colleagues showed.
However, when compared with colonoscopy, stool tests are nearly twice as cost-effective as the newer blood tests, according to the study.
“The recent approval of blood tests really made a lot of gastroenterologists concerned because it’s such an easy test to do,” Hernandez said.
“We really expect that to change the landscape of cancer screening. Fortunately, in our model, we saw a drop but not a significant drop [in total colonoscopies performed], because when a lot of these tests turn positive, it will lead to more procedures and colonoscopies.”
Hernandez and colleagues used a cohort Markov model to follow 1 million adults aged 45 to 75 years in yearly cycles to project U.S. annual test volumes for CRC screening strategies while comparing cost-effectiveness.
The study used registry and epidemiologic data to evaluate test performance, compliance with colonoscopy after positive tests with noninvasive strategies and costs of each testing method.
From 2026 to 2035, total annual colonoscopy volume is projected to decline from 27 million to 22.3 million, while screening colonoscopy volume is expected to drop from 13 million to 8.3 million. Both diagnostic colonoscopies (8 million per year) and surveillance colonoscopies (6 million per year) are projected to hold steady.
Meanwhile, time-series trends project stool test volume to increase from 4.7 million to 7.8 million per year and blood test volume to increase from 2.9 million to 6.1 million during that time.
Using colonoscopy — which demonstrated the lowest cost per quality-adjusted life year (QALY) — as the cost-effectiveness reference, researchers found that stool test strategies yielded an incremental cost-effectiveness ratio (ICER) of $11,500 per QALY, while blood test strategies had an ICER of $21,400 per QALY.
Researchers noted that the model used in the study did not fully capture the totality of a variety of factors impacting CRC screening, including uptake, payer-level incentives, policy changes and patterns of referring.
Although these projections show a probable decline in total colonoscopy volume, follow-up on positive results from blood or stool tests should sustain procedural volume and will be crucial in improving outcomes over the next decade.
“There’s still a subset of patients who refuse to get a colonoscopy despite being positive,” Hernandez said. “We’re missing that subset of patients. If we improve the compliance rate of these patients, that would make a huge difference.
“We need to collaborate with hospital systems and primary care doctors to improve that compliance rate,” he added. “Using large language models to alert primary care doctors about who has not done their colonoscopy after a positive blood or stool test would be good. There’s a lot of room for improvement.”
For more information:
Lyndon V. Hernandez, MD, can be reached at lhernan@mcw.edu .
Sources/Disclosures
Source:
Hernandez LV, et al. Colorectal cancer screening with colonoscopy, stool, and blood testing: Long-term cost-effectiveness and projected procedure volumes. Presented at: Digestive Disease Week; May 2-5, 2026; Chicago.
Disclosures:
Hernandez reports stock ownership in Iterative Health and SanaHeal. Please see the study for all other authors’ relevant financial disclosures.
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