Race, ethnicity, and prior colorectal screening test use in CONFIRM colonoscopy vs fecal immunochemical testing trial participants

Background: Colorectal cancer (CRC) outcomes vary by 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 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 (including fecal immunochemical testing) use. Results: Screening test use was common (n = 28 330 [56.5%]), with more veterans reporting prior fecal occult blood testing (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 to 1.12) to have had any prior screening relative to White persons, and this finding was driven by more frequent fecal occult blood testing use relative to White persons (OR = 1.16, 95% CI = 1.10 to 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 is needed. ClinicalTrials.gov ID: NCT#05612347 (https://clinicaltrials.gov/study/NCT05612347). Published by Oxford University Press 2026. This work is written by (a) US Government employee(s) and is in the public domain in the US.