Patient preferences for a blood-based colorectal cancer screening test show many unscreened adults favor blood options

A US survey of 1,009 adults aged 40–75 who were not up-to-date with colorectal cancer screening found two groups: 39.4% prioritized how the test is performed while 60.6% prioritized test accuracy; simulations showed many respondents preferred a hypothetical blood test and that preference grew as test accuracy improved.

A national online survey examined how people who are not up-to-date with colorectal cancer (CRC) screening weigh different test options, including a hypothetical blood-based test. The study combined background information on existing screening methods and a choice-based conjoint analysis to show trade-offs people make among attributes such as test modality, accuracy, and frequency. Respondents saw randomized test profiles and were told a positive noninvasive result would require a follow-up colonoscopy. The research was approved by an institutional review board and used statistical models to estimate preferences. Key findings: - The study analyzed responses from 1,009 US adults aged 40–75 who were not current with CRC screening. - Latent class analysis identified two groups: 39.4% who primarily prioritized test modality, and 60.6% who placed greater weight on accuracy for detecting CRC and advanced adenomas. - In simulations, many respondents in both groups preferred a blood test every three years over stool tests or colonoscopy; the proportion preferring blood rose as modeled blood-test accuracy increased (for example, in one scenario 65.1% of the modality-prioritizing group and 53.0% of the accuracy-prioritizing group preferred a blood test every 3 years). - With a modeled blood test at 80% CRC sensitivity and low AA sensitivity, 23.7% of respondents preferred a blood test every 3 years, and this preference increased at higher assumed accuracies; modeled thresholds showed blood tests become the top choice when AA accuracy crossed specific levels depending on CRC sensitivity. - The authors note that a positive noninvasive test requires confirmatory colonoscopy and report the study was supported by Freenome, with some authors having advisory roles or prior employment ties to companies in the field. Summary: The survey indicates many people who are overdue for CRC screening would choose a blood-based option over stool tests or colonoscopy in modeled scenarios, and that test accuracy strongly influences those choices. The authors report that availability of blood-based tests and clearer communication about test performance and follow-up pathways are relevant for how these options might fit into screening programs; further research and tools to present test differences were recommended by the investigators.