Doctors May Be Less Likely to Discuss Screening Options for Colorectal Cancer With Newly Eligible Younger Adults

Younger Black patients were also less likely to have heard about screening options from their doctor than younger white patients

ATLANTA – Among surveyed U.S. adults aged 45-49, who are eligible for colorectal cancer (CRC) screening per the U.S. Preventive Services Task Force (USPSTF) recommendations, only about half reported that their doctors had discussed different options for CRC screening with them, and nearly a quarter said they never discussed CRC screening tests with a doctor at all, according to research presented at the 19th AACR Conference on The Science of Cancer Health Disparities, held October 18-21 in Atlanta.

The results of this study will be published in the Journal of General Internal Medicine.

“As of 2021, the USPSTF recommends that adults begin screening for CRC at age 45, but screening is very low at younger ages. Only about 37% of adults 45-49 years of age are up to date with current colorectal cancer screening recommendations,” said presenter Jordan Baeker Bispo, PhD, MPH, a principal scientist of cancer disparity research at the American Cancer Society. “Since screening in this age group is so low, we were curious about the extent to which younger adults are being counseled on colorectal cancer screening and the different options that are available to them for getting screened.”

She added, “We know that receiving a clinician’s recommendation to get screened is one of the strongest determinants of screening behavior, and screening also tends to increase when patients are offered alternatives to colonoscopy, like at-home stool testing.”

Baeker Bispo and colleagues analyzed data from the 2024 Health Information National Trends Survey, which included a sample of 3,626 screening-eligible adults between the ages of 45 and 75 who had no prior history of colon cancer. The key question read, “Has a doctor or other health professional ever told you there are a few different tests to detect CRC?” and the response options were, “Yes,” “No,” or “I have never discussed these tests with a doctor or other health professional.”

The researchers sorted respondents into three age groups: 45-49, 50-64, and 65-75. In the youngest age group, 50.3% of respondents reported having been told by their doctors about different CRC screening options, compared with 72.5% of respondents in the oldest age group. Respondents aged 45-49 were also more than twice as likely as respondents aged 65-75 to report never having discussed CRC screening tests with a health care professional (23.2% vs. 7%, respectively).

“This finding strongly suggests that patients who are newly age-eligible for screening are not receiving adequate information about their screening options from a health professional, and that could be contributing to low screening rates in this age group,” said Baeker Bispo.

Additionally, among the youngest age group, the researchers identified significant differences between non-Hispanic white and non-Hispanic Black respondents. While 33.2% of non-Hispanic Black respondents aged 45-49 reported having heard from their doctors about different CRC screening options, 60.7% of their non-Hispanic white counterparts reported such discussions.

The magnitude of the observed racial disparity reflects the broader racial disparities in health care access, Baeker Bispo said. “We saw that the racial disparity became statistically nonsignificant in the older patient cohorts, so it may be that race-associated barriers to health care access and screening become less pronounced as patients age into Medicare,” she said, and she stressed the importance of research into interventions that could ameliorate racial disparities in cancer screening.

Baeker Bispo acknowledged that the comparative recency of the update to the USPSTF’s guidelines may partially explain the overall disparity between older and younger patients. Clinicians’ preference for colonoscopies as the gold standard of CRC screening—potentially at the expense of mentioning alternative screening methods—could also play a role, she said.

Ultimately, clinician empowerment, Baeker Bispo said, would be key to reducing the disparity in doctor-patient communication about CRC screening options. Several interventions could help close this communication gap, she said, such as automated screening reminders with a list of available options that could be integrated into electronic health record systems.

“The findings highlight a major opportunity to improve communication about CRC screening to younger patients, which could accelerate screening uptake in this age group,” she said. “It is important for people to know their options, because the most important thing is to get screened.”

Limitations of the study include a smaller sample size and the use of self-report. Additionally, because the survey question asked about having “ever” heard about CRC screening alternatives from a health care professional, older respondents experienced a longer window of opportunity for such a discussion to occur.

The study was funded by the American Cancer Society. Baeker Bispo discloses no conflicts of interest.

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