Online Interest in Colorectal Cancer Screening in Florida

Colorectal cancer is the third most common cancer worldwide and the second most common cause of cancer death for men and women combined. This article provides an overview of Google Trends data regarding “colorectal cancer screening,” “fecal occult blood test,” and “colonoscopy” in Florida and offers specific suggestions on how to improve colon cancer screening.

Abstract

Objective

Colorectal cancer (CRC) is the third most common cancer worldwide and the second most common cause of cancer death for men and women combined. It is estimated that in 2024, 53,010 people will have died from CRC. The objective of this study was to analyze online interest in CRC screening in Florida.

Methods

Google Trends was queried for “colorectal cancer screening,” “fecal occult blood test,” and “colonoscopy” from 2004 to the present. The relative search volume (RSV) ranged from 0 to 100, with 0 meaning no interest and 100 signifying maximum popularity.

Results

Google Trends analysis revealed variations in interest for CRC screening, fecal occult blood test as a screen, and colonoscopy across Florida metropolitan areas. Gainesville consistently ranked high for all three terms. Interest peaked for screening in 2009 and 2022, for fecal occult blood test in 2024, and for colonoscopy in 2007. Related search terms focused on screening guidelines, procedures, and preparation.

Conclusions

Google Trends can provide a useful tool for evaluating interest in Florida for CRC screening, which is important because there are screening disparities across Florida counties compared with national and state averages. By identifying areas with lower search interest, healthcare providers and public health organizations can target community interventions based on the specific barriers faced by residents in each metropolis.

Key Points

• Florida’s colorectal cancer (CRC) screening rate of 71.7% is lower than the national average of 71.9%, and the state ranks 27th nationwide.

• There were regional differences across Florida concerning search interest on the terms “colorectal cancer screening,” “fecal occult blood test,” and “colonoscopy.”

• CRC screening interventions can include a culturally targeted educational program with concordant care, a mailed test, a reminder telephone call, patient navigation, spiritually based educational letters, and more.

Colorectal cancer (CRC) is the third most common cancer worldwide and the second most common cause of all cancer death, making it a major global health concern.¹ In 2022, it was estimated that there were more than 1.9 million new cases of CRC, including anal cancers, resulting in 904,000 deaths.² In 2020, the summative cost of CRC treatment was $24.3 billion, much higher than the prior $22.3 billion in 2020.³ CRC comprises 11.6% of the total cost spent on cancer treatment, making it the second most expensive cancer to manage.⁴ CRC care can be divided into three phases: the initial year after diagnosis, the continuing care phase, and the end-of-life phase the year before death.⁴ The average per-patient medical costs were highest in the end-of-life phase ($110,100), followed by the initial phase ($66,500) and then the continuing care phase ($6,200), accentuating the importance of early CRC screening.⁴

In the United States alone, the American Cancer Society estimated that 53,010 people would die from CRC in 2024.² Several factors have been linked to CRC risk, including genetic predispositions such as familial adenomatous polyposis and mismatch repair gene deficiencies, lifestyle factors such as excessive fat intake and sedentary behavior, and associated medical conditions like ulcerative colitis and colonic polyps.^5–9

Florida ranked third for projected new CRC cases in 2024 among all US states (11,920), trailing California (16,170) and Texas (12,260).² In addition, the estimated deaths for CRC for 2024 in Florida was 3980.² The incidence rate of CRC in Florida was 38.7 and 29.1/100,000 individuals for males and females, respectively, underscoring the widespread impact of the disease across the state’s population and the importance of early detection and treatment.²

Screening for CRC is a critical tool needed for early detection and treatment, yet screening rates remain suboptimal. Several studies have highlighted the association between CRC screening and reduced mortality.^10–14 Nationally, the screening rates for CRC in 2021 were estimated to be 69.9% for individuals between the ages of 50 and 75 years, 10.1% lower than the goal set by the American Cancer Society National Colorectal Cancer Roundtable Campaign of 80% in Every Community.^15,16 Florida’s CRC screening rate of 71.7% (95% confidence interval 69.6–74.4) is lower than the national average of 71.9%, and the state ranks 27th nationwide.¹⁷ Given that Florida was projected to have the third-highest number of CRC cancer cases in 2024, the state screening rate must be significantly higher to address the public health challenge. The rate of CRC screening in Florida is influenced by various factors, including discrepancies between urban and rural areas, socioeconomic disparities, limited access to resources, and limited education about the importance of screening.¹⁸ Furthermore, Florida is ranked 41st in health care nationally, and high insurance costs, a high rate of uninsured residents, a physician shortage, and the determination not to expand Medicaid coverage contribute to this low ranking.¹⁹ Improving CRC screening in Florida could lead to early detection, thereby improving treatment outcomes, decreasing the economic burden, and ultimately reducing advanced-stage incidence and mortality.

The objective of this study was to compare CRC screening awareness across the densest populated cities in Florida by analyzing search interest related to CRC screening using Google Trends (Google, Mountain View, CA) data. Identifying metropolitan areas with low search interest and, by inference, potentially lower screening rates, can help guide targeted interventions to prioritize awareness efforts and address barriers to CRC screening. Ultimately, these findings contribute to enhancing public health interest aimed at improving CRC screening rates, thereby decreasing CRC incidence and mortality through focused prevention strategies.

METHODS

This cross-sectional study used Google Trends to analyze public interest in CRC screening across the most densely populated metropolitan areas of Florida. Ethical approval was not required because no individually identifiable information was gathered, processed, or analyzed in this research. This platform was queried using three key search terms: “colorectal cancer screening,” “fecal occult blood test” (FOBT), and “colonoscopy” from 2004 to the present (as of October 11, 2024). For each search term, data on four metrics were downloaded: “interest over time,” “interest by metro,” “relative search volume index” (RSV), and “related search queries.” Interest over time provided insight into temporal trends in CRC screening awareness. Interest by metro allowed for stratification of the search volume based on location. Related search queries provided other search terms that are frequently associated with the terms searched for. RSV was used to measure the relative popularity of key search terms on a scale of 0 to 100, with 0 signifying no interest and 100 signifying maximum interest.

RSV was selected as the primary outcome due to its role as a key indicator for the measurement of search term popularity. RSV data were extracted for each search term within 10 major metropolitan regions in Florida: “Jacksonville,” “Ft Myers-Naples,” “Tampa-St. Petersburg (Sarasota),” “West Palm Beach-Ft Pierce,” “Gainesville,” “Mobile AL-Pensacola (Ft Walton Beach),” Tallahassee-Thomasville GA,” “Panama City,” “Orlando-Daytona Beach-Melbourne,” and “Miami-Ft Lauderdale.” The results were then used to compare the relative levels of public interest in CRC screening across Florida’s largest urban centers with the goal of identifying areas where public health efforts could have the most impact for targeted screening.

RESULTS

Our analysis revealed that the five metropolitan areas with the highest Google Trends search volume for “colorectal cancer screening” were Gainesville (RSV 100), Tallahassee (RSV 87), Miami-Ft Lauderdale (RSV 50), Ft Myers-Naples (RSV 50), and West Palm Beach-Ft Pierce (50) (Fig. 1). For “FOBT,” the top 5 metropolitan areas were Gainesville (RSV 100), Tallahassee-Thomasville (RSV 80), Miami-Ft Lauderdale (RSV 60), Ft Myers-Naples (RSV 60), and Jacksonville (RSV 60) (Table 1). In terms of interest in “colonoscopy,” the top regions were Jacksonville (RSV 100), West Palm Beach-Ft Pierce (RSV 92), Gainesville (RSV 92), Tampa-St. Petersburg (Sarasota) (RSV 84), and Panama City (RSV 84).

Fig. 1.

Density maps based on relative search volumes for metropolitan regions in Florida for various colorectal cancer screening terms.

Table 1.

Google Trends RSVs for Floridian metropolitan regions for various CRC screening terms

The peak times with highest number of searches for CRC screening, FOBT, and colonoscopy were May 2009, April 2024, and July 2007, respectively (Fig. 2). The average interest in CRC screening was 6.32, meaning that the term had 6.32% of the search volume during that month compared to its peak popularity, and there was a peak again in October 2022, with a popularity value of 72. The average interest for FOBT was 9.59, and the average interest for colonoscopy was 15.02. The term colonoscopy had additional peaks of popularity in December 2009 (92) and September 2010 (80).

Fig. 2.

Interest over time in colorectal cancer screening terms in Florida.

The most frequently related queries for CRC screening were as follows: “screening for colorectal cancer”; “colon cancer screening”; “colorectal screening guidelines”; “colorectal cancer screening guidelines”; “colorectal cancer screening test”; “colonoscopy”; “what is colorectal cancer screening”; “colorectal cancer screening age, colorectal cancer screening International Classification of Diseases, Tenth Revision”; and “United States Preventive Services Task Force.” Moreover, for an FOBT, the top 10 related queries were “positive fecal occult blood test,” “what is a fecal occult blood test,” “colonoscopy,” “fecal occult blood test kit,” “fecal immunochemical test,” “FOBT,” “guaiac test,” “guaiac fecal occult blood test,” “fecal occult blood test,” “fecal occult blood test instructions,” and “complete blood count test.” The top 10 related queries for a colonoscopy were as follows: “after colonoscopy,” “after a colonoscopy,” “what is a colonoscopy,” “colonoscopy endoscopy,” “colonoscopy dr,” “colonoscopy diet,” “day before colonoscopy,” “colonoscopy near me,” “how long does colonoscopy take,” and “colonoscopy test.”

DISCUSSION

The results of this study highlight the regional differences in interest in CRC screening across Florida, as measured by Google Trends. Notably, Gainesville ranked highest in regard to interest in CRC screening and FOBT and third in interest for colonoscopy. This interest may partly be due to the University of Florida Health Project CONTINUITY, a program that uses community screening navigation to increase access for residents to CRC screening. In addition, as part of an adherence improvement project at the University of Florida Internal Medicine Clinics, one study found a positive association between receiving a patient reminder either alone (relative risk 1.62; P < 0.001) or in combination with a clinician reminder (relative risk 1.55, P = 0.006) with completion of a CRC screening test.²⁰ Receiving such reminders could be driving Google searches about CRC screening among residents in Gainesville; however, it is likely that the high interest in Gainesville is multifactorial, given that patient reminder programs are set in place in other cities in Florida as well. Tallahassee-Thomasville had fairly high rates of CRC screening and FOBT searches, yet it scored somewhat lower for colonoscopy searches. Ft Myers-Naples ranked fourth for CRC screening and FOBT, and it ranked sixth for colonoscopy. Given the high average age in Naples (66.90 years), there may be a significant interest in CRC screening within this metropolitan area. Older adults are at an increased risk for CRC, as the median age of diagnosis in sporadic cancer is older than 65 years, making preventive measures like screening particularly important.²¹ In addition, this median average age falls within the US Preventive Services Task Force recommendation that individuals aged 45 to 75 years should undergo CRC screening.²² Orlando-Daytona Beach was ninth in interest for all three search terms, suggesting that there may be social determinants of health or gaps in public health messaging that should be addressed or additional factors affecting interest in online screening education.

CRC screening, particularly through FOBTs and colonoscopy, is essential for the early detection of neoplastic changes in the colon. The physiologic rationale behind screening is that early-stage CRC often is asymptomatic, and early detection significantly reduces mortality. For an FOBT, the patient undergoes stool collection and then the sample is monitored for a chemical or immunochemical reaction based on guaiac or antibodies, respectively.²³ If there is a change denoting that there is bleeding in the gastrointestinal system, then a colonoscopy is indicated to determine the source of the bleeding.

Previously, one study evaluated the utility of Google Trends data as it pertains to cancer screening data from the Behavioral Risk Factor Surveillance System, finding a correlation of 0.55.²⁴ This suggests that Google Trends data can be used to enhance the effectiveness of existing cancer screening surveillance systems. In addition, in metropolitan regions with low CRC screening interest, healthcare providers, institutions, and organizations should conduct focus group interviews and surveys to understand the specific reasons contributing to the low level of interest. Thereafter, multiple interventions based on the reasons identified should be created.

For example, if transportation is a significant barrier for CRC screening for a particular group/region, then an intervention improving transportation to and from CRC screening sites should be created. Interventions can include integrating Medicaid-based Florida Non-Emergency Medical Transportation, Lyft Pass for Healthcare, and Modivcare into CRC screening appointment planning for patients who may need mobility assistance. Moreover, CRC screening sites may have limited hours that may not work for patients who are working multiple jobs to care for their families. By providing a variety of screening days and hours, we can increase CRC screening completion while ensuring the utmost care for patients. In addition, bolstering the Florida Colorectal Cancer Control Program to improve provider performance in delivering or offering CRC screening can better empower patients to complete their CRC screenings.

CRC screening interventions in Florida also should incorporate evidence-based strategies to improve adherence and uptake. Specifically, two systematic reviews analyzed published studies, predominantly randomized controlled trials, and compared the various CRC screening interventions. They found that successful interventions included a culturally targeted educational program with concordant care, a mailed test, a reminder telephone call, an educational video, a questionnaire, a brochure, patient navigation, spiritually based educational letters from medical practices, education from a trilingual instructor, office system changes, and a computerized educational program.^25,26

Future investigations should correlate Google Trends data with CRC patient screening data to determine whether low interest correlates to low completion rates, conducting longitudinal studies to monitor how interest and screening rates evolve over time in these metropolitan regions after interventions, and creating multilanguage mobile applications to increase awareness and engagement with CRC prevention, particularly in areas with poor healthcare infrastructure.

CONCLUSIONS

This study underscores the disparities in CRC screening awareness across Florida’s metropolitan areas, as evidenced by Google Trends data. Although Gainesville and Tallahassee-Thomasville demonstrated heightened interest in CRC screening, FOBT, and colonoscopy, other regions exhibited lower levels of engagement. It is possible that local screening and healthcare access provided by academic healthcare institutions in the Gainesville and Tallahassee region were successful, although it is concerning that low search rates were seen in large metropolitan areas with multiple academic institutions, such as the Miami-Ft Lauderdale region. These findings highlight the need for tailored interventions to address barriers to CRC screening in specific areas, including assessment of factors related to cultural differences that may need special attention, access to health care, and preventive healthcare education. Collaborations across institutions and healthcare systems for further investigation and targeted screening efforts are essential in regions identified as at risk or below average. By implementing targeted public health campaigns, improving access to care, and leveraging evidence-based strategies, Florida can significantly enhance CRC screening rates. This, in turn, will contribute to early detection, improved treatment outcomes, and reduction in CRC-related morbidity and mortality. Ultimately, a more informed and engaged Floridian population regarding CRC screening will be instrumental in mitigating the significant public health burden of this disease.