Colorectal Cancer Screening Uptake Tripled in 45-49 Age Group

Mean rates of colorectal cancer (CRC) screening tripled among average-risk individuals 45-49 years old after the U.S. Preventive Services Task Force (USPSTF) issued a recommendation encouraging screening in this group, according to a retrospective cohort study.

The mean screening rate increased from 0.50% every 2 months before the recommendation to 1.51% every 2 months afterward (P

Those in the highest socioeconomic category experienced the largest absolute increase in screening (1.25 percentage points) compared with the lowest category (0.75 percentage points), but relative changes were not significant, they said in JAMA Network Open.

By Dec. 31, 2022, screening uptake among individuals 45 to 49 years reached a level comparable to that among individuals 50 to 75 years (2.37% and 2.40%, respectively).

“The 3-fold increase in screening uptake among average-risk individuals aged 45 to 49 years reflects an accomplishment, yet evidence of widening disparities based on SDI [social deprivation index] and locality indicate that population subgroups may not be benefiting equally from this change in CRC screening recommendation,” the researchers wrote.

“Furthermore, given that only 11.5% of average-risk individuals aged 45 to 49 years during the post-recommendation period received CRC screening before the age of 50 years, targeted initiatives to improve screening in this age group are warranted to reach the national goal of screening 80% of the population in every community,” the study authors said.

In an editorial accompanying the study, Sarmad Sadeghi, MD, PhD, of the University of Southern California in Los Angeles, and Afsaneh Barzi, MD, PhD, of the City of Hope Comprehensive Cancer Center in Duarte, California, said the higher screening rates reported by Siddique and colleagues might not be entirely related to the new national recommendation.

“The increase in screening rates among individuals aged 45 to 49 for CRC reported by Siddique et al is encouraging,” they wrote. “However, it is unclear whether this increase is entirely attributable to the USPSTF recommendation — other factors, such as deferred and postponed screenings that were carried out after the height of COVID-19 restrictions, may have contributed to this significant increase.”

Sadeghi and Barzi agreed that more must be done to further increase screening rates. “To achieve a significant improvement in CRC outcomes among younger adults, widespread adoption of screening is essential,” they said. “This largely depends on interactions between patients and their primary care physicians. Understanding physicians’ practice patterns, such as their referral tendencies and test-ordering habits, can shed light on their approach to screening.”

Siddique and colleagues analyzed deidentified claims data from more than 10 million Blue Cross Blue Shield (BCBS) beneficiaries age 45-49 from 2017 through 2022. They compared absolute and relative changes in screening uptake between a 20-month period before and a 20-month period after the USPSTF recommendation was issued. They categorized May 1, 2018 to December 31, 2019 as the period before the recommendation and May 1, 2021 to December 31, 2022 as the period after.

The researchers used interrupted time-series analysis and autoregressive integrated moving average models to evaluate changes in screening rates, adjusting for temporal autocorrelation and seasonality.

The mean age of beneficiaries was 47, and 51% were female. Both males and females with average risk had significantly higher uptake of overall screening in the post-recommendation period compared with before the recommendation, but post-recommendation screening uptake did not differ significantly between them.

A key limitation of the study was it included only BCBS beneficiaries, the authors noted. Although BCBS is the largest provider of commercial health insurance, the study cohort may not be fully representative of the general U.S. population because beneficiaries tend to be younger and more socioeconomically advantaged with employer-based insurance, they explained.

Furthermore, data on ethnicity and race were available for only a subset of the BCBS beneficiaries. “Although we analyzed SDI and locality as factors that represent multiple domains of the social and physical environment, prior studies showed that [socioeconomic status] alone does not capture the pervasive association of race with health outcomes,” Siddique and colleagues said.