New data shows that one-third of adults are overdue routine screening for colorectal cancer (CRC), and that there are disparities in underrepresented racial populations and low socioeconomic groups. Since the recommended age to start CRC screening was lowered to 45 years by the U.S. Preventive Services Task Force (USPSTF) in 2021, screening rates have more than doubled in those aged 45–49 years. However, uptake is mostly mediated by clinician recommendation, and lack of this may lead to low uptake.
A research team analysed nationally representative data from the 2019 and 2021 National Health Interview Survey, including 5,022 people, to determine the prevalence of clinical recommendation to undergo screening among adults who are overdue screening according to the USPSTF guidelines. Results showed that 26.8% of people had received a screening recommendation; however, there were disparities in care, consistent with patterns of participation to screening and with historical disparities. Prevalence for screening recommendations were 32% in those with a family income 400% higher than the federal poverty level, compared to less than 10% for those without a usual source of care. Furthermore, they noted higher prevalence for White people compared to Asian people (adjusted prevalence ratio [aPR]: 0.53; 95% confidence interval [CI]: 0.37–0.75), Black people (aPR: 0.76; 95% CI: 0.63–0.92), and Hispanic people (aPR: 0.82; 95% CI: 0.67–1.01).
Jordan Baeker Bispo, principal scientist of cancer disparity research at the American Cancer Society, and colleagues wrote: “The findings highlight a major communication gap about CRC prevention in the clinical setting.” The team highlighted barriers that may contribute to lack of effective counselling, such as clinician preference for colonoscopy over alternative methods, prioritisation of acute care needs, and time and resource constraints. They further underlined which improvements at the systems level could help reach national screening goals, including educational tools for shared decision-making with diverse populations, automated point-of-care prompts, investing in clinician training, and community outreach to improve patient-clinician communication.
