Most U.S. Adults Overdue for Colorectal Cancer Screening Report not Receiving Screening Recommendation From Doctor; More in Marginalized Populations

In a new study led by researchers at the American Cancer Society (ACS), most adults (73.2 %) in the United States overdue for colorectal cancer screening (CRC) reported that they did not receive a screening recommendation from their clinician despite having attended a wellness visit in the past year. The report also showed the prevalence of receiving a recommendation was lowest among marginalized racial/ethnic and socioeconomic groups. The findings were published today in the Annals of Internal Medicine.

“Recent studies show more than a third of U.S. adults are overdue for colorectal screening, even though screening can prevent the disease and detect it at early stages when the prognosis is most favorable,” said Dr. Jordan Baeker Bispo, principal scientist, cancer disparity research at the American Cancer Society and lead author of the study. “These findings are alarming as they highlight a major communication gap about CRC prevention in the clinical setting.”

For the study, the authors pooled data from the 2019 and 2021 National Health Interview Survey. The analysis included adults overdue for CRC screening (per U.S. Preventive Services Task Force guidelines) who reported having had a wellness visit in the past year. The dependent variable was receipt of a clinician recommendation for CRC screening, measured using a survey item in which respondents answered “yes” or “no” to the question, “In the past 12 months, did a doctor or other health professional recommend that you be tested to look for problems in your colon or rectum?” Scientists estimated the prevalence of reporting a clinician recommendation for CRC screening by age, survey year, sex, race/ethnicity, education, poverty status, nativity, urban or rural residence, comorbidity burden, insurance, and usual source of care.

The study showed, that of 5022 adults who were eligible and overdue for CRC screening and had a wellness visit in the past year, only about a quarter of these adults (26.8%) reported receiving a clinician recommendation for CRC screening. By sociodemographic characteristics, the prevalence was lower for non-Hispanic Black (22%), Hispanic (19%) and non-Hispanic Asian (12%) adults compared to non-Hispanic White adults (32%). The report also showed the prevalence was lower for those with less than a high school education compared to those with a college education or more (17% vs. 29%); the uninsured compared to those with private insurance (13% vs. 31%); those who did not have a usual source of care compared to those who did (10% vs. 28%); and those born outside the U.S. compared to those born in the U.S. (17% vs. 30%).

“We’re missing one of the best opportunities, while visiting the doctor, to remind adults to get screened for this potentially deadly disease,” Bispo added. “Investing in clinician training, automated point-of-care prompts, educational tools for shared decision making with diverse patient populations, and community outreach may improve patient–clinician communication about CRC screening and advance progress toward national screening goals.”

“This study underscores the need to adequately fund programs like the Centers for Disease Control and Prevention’s Colorectal Cancer Control Program (CRCCP), which serves those at high risk for colorectal cancer and works to increase awareness of and access to screening to reduce the disease burden in the U.S.,” said Lisa A. Lacasse, president of the American Cancer Society Cancer Action Network (ACS CAN). “We urge Congress to increase funding for this program to reduce barriers to colorectal cancer screening, significantly improve screening rates and save more lives.”

This story was published by the American Cancer Society on September 11, 2023. It is republished with permission.