Colorectal cancer screenings remain low for people ages 45 to 49 despite guideline change

UCLA research finds that fewer than 1 in 4 eligible younger adults completed colorectal cancer screenings after the United States Preventive Services Task Force (USPSTF) lowered the recommended screening age to 45 from 50.

The researchers had suspected that unmet social needs such as insecure access to housing, transportation, or food may have played a role in suboptimal screening rates, but their investigation found no significant differences in testing uptake for this early midlife cohort after controlling for sociodemographic and clinical covariates, leaving the barriers to testing  unclear and suggesting a need for more research into barriers and facilitators for screening.

The findings are published in the peer reviewed Journal of the National Cancer Institute.

“Amid the rising incidence of colorectal cancer (CRC) at younger age, we have identified a critical need for interventions designed to increase screening uptake among all persons between ages 45 and 49,” said lead author Dr. Katherine Chen, assistant professor of medicine in the Division of General Internal Medicine and Health Services Research at the David Geffen School of Medicine at UCLA. “Media campaigns to increase awareness of the new recommendations and health policies that enhance overall access to preventive care are likely to be needed to find more cases of colorectal cancer early when it is most treatable.”

The researchers analyzed 2022 Behavioral Risk Factor Surveillance System (BRFSS) data for adults aged 45 to 49. They found that about 22.5% of 13,300 respondents from that group had been tested since the USPSTF update, slightly higher than the 19.7% from 2021 when the USPSTF first published its new recommendation. Among those who were tested, 61% underwent a colonoscopy, 32% took a stool-based test, and 7% completed a sigmoidoscopy or CT colonoscopy.

There is some evidence from prior research that screening rates in this age group are lowest among those with lower education, lack health insurance and live in neighborhoods with lower socioeconomic status or in non-metropolitan locations.

Digging deeper, the researchers sought to determine how specific unmet needs may have influenced screening behavior. They selected three variables that social programs and policies could modify: housing insecurity, transportation insecurity, and food insecurity. They then added up the total number of those unmet social needs that were reported by each respondent.

The researchers found that in unadjusted models, each unmet social need was associated with 14% lower odds of being tested. But when they adjusted their models to incorporate covariates such as age, sex, race/ethnicity, education, income, employment, homeownership, household composition, insurance status, self-rated health status, chronic conditions, urbanicity and state, that gap disappeared.

After the adjustment, the researchers found that none of the differences in colorectal cancer testing was statistically significant. Meanwhile, among people who completed screening, use of stool-based testing rather than colonoscopy was linked with transportation insecurity, but not other unmet social needs.

“It is not yet clear whether the lack of statistically significant adjusted associations between unmet social needs and CRC testing observed in the younger screening-eligible population studied here indicates that social challenges are not a meaningful barrier to screening for this group, that early adopters of the new screening guidelines were especially motivated to overcome social barriers to testing, or that the smaller sample size of individuals who had begun testing limited our statistical power,” the researchers write.

The findings are limited by a lack of details in the data on colorectal cancer test indications and family history, unmeasured confounders, and selection and self-reporting bias.

Study co-authors are Dr. Carol Mangione and Ya-Chen Tina Shih of UCLA.

The NIH/National Center for Advancing Translational Sciences UCLA Clinical and Translational Science Institute (UL1TR001881) funded this study.