Colorectal Cancer Screening Uptake Rises Among US Adults Aged 45-49, JAMA Study Evaluates Changes

A study published Sept. 2 in JAMA found that colorectal cancer screening uptake among U.S. adults aged 45 to 49 increased to 34.5% in 2022. The rise follows updated guidelines from the American Cancer Society and the U.S. Preventive Services Task Force recommending screening begin at age 45 to address rising colorectal cancer rates in younger adults, the authors said.

It found that 34.5% (95% confidence interval, 33.4% to 35.8%) of this group reported undergoing colorectal cancer screening. This marks an increase from earlier years, reflecting changes in screening guidelines issued by the American Cancer Society in 2018 and the U.S. Preventive Services Task Force (USPSTF) in 2021, which lowered the recommended starting age for screening from 50 to 45.

The study, led by Jessica Star and colleagues and published Sept. 2 in JAMA, analyzed 2022 data from the Behavioral Risk Factor Surveillance System (BRFSS) involving 25,592 adults aged 45 to 49.

Additional analysis from a UCLA study using a subset of 13,300 BRFSS respondents in 2022 found a screening rate of 22.5%, up from 19.7% in 2021. The majority of screening tests were endoscopic, comprising 74.9% of procedures. Among screened individuals, 61% underwent colonoscopy, 32% completed stool-based testing, and 7% had sigmoidoscopy or CT colonography. CT colonography accounted for only 0.5% of screenings, with limited facility availability cited as a factor, according to the JAMA study.

The rising colorectal cancer screening rates correspond with increasing incidence rates in younger adults. Data from 2004 to 2019 showed a 1.1% annual increase in colorectal cancer detection among adults aged 45 to 49, followed by a sharper 12% annual rise from 2019 to 2022. The increase is attributed in part to earlier detection through expanded screening, the authors noted. Incidence has also risen by 1.6% per year since 2004 among adults aged 20 to 39 and by 2% to 2.6% annually since 2012 in the 40-44 and 50-54 age groups.

The study highlighted disparities in screening uptake and modalities across sociodemographic groups. Access barriers, particularly for endoscopic tests, were evident, with stool-based testing more commonly reported among individuals facing transportation insecurity. However, after adjusting for sociodemographic and clinical factors, no significant differences in screening uptake were observed. The researchers also examined state-level healthcare provider supply using the 2021-2022 Area Health Resources File, finding correlations between gastroenterology physician availability and screening prevalence. They emphasized the importance of addressing projected workforce shortages to meet increased demand for endoscopic procedures in the newly eligible population.

A randomized trial involving 20,509 participants aged 45 to 49 compared outreach strategies to improve screening rates. Mailed fecal immunochemical test (FIT) outreach achieved a 26.2% screening rate, outperforming portal-based active choice interventions, which yielded rates between 14.5% and 17.4%. The study’s lead author, Dr. Katherine Chen, called for enhanced media campaigns and policy measures to increase awareness and access to colorectal cancer screening among younger adults.

The updated guidelines from the American Cancer Society and USPSTF aimed to address the rising incidence of colorectal cancer in younger populations, with the USPSTF first publishing the recommendation for screening starting at age 45 in 2021. Despite increases in screening uptake, the rates remain below optimal levels, underscoring ongoing challenges in healthcare delivery and patient engagement. The studies collectively suggest that improving provider supply, reducing access barriers, and implementing effective outreach strategies are critical components in increasing colorectal cancer screening among adults aged 45 to 49.