Tag Archive for: screening

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Colon Cancer Risk in Cystic Fibrosis: A Patient Shares Her Experience

By Anna Payne

Thank you to the Cystic Fibrosis Research Institute for letting us share this blog with our audience!

Last year, at the age of 34, I was living in a place of hope. I was thriving on Trikafta, working full time, serving as elected Supervisor for Middletown Township in Bucks County Pennsylvania, and acting as Vice-Chair of the Pennsylvania Rare Disease Advisory Council. For the first time in a long time, I had hope for a future of a “healthy” life. I had big dreams and a lot of things I wanted to accomplish. But then I found a mass in my groin, and after a long, painful and circuitous diagnostic journey, that included numerous invasive tests and long waits between them, I received the news no one wants to hear. “You have Stage 4 colon cancer.”

Known as the “silent cancer,” colorectal cancer remains the third leading cause of cancer-related deaths in the U.S. among the general population. Those with cystic fibrosis have a significantly higher risk of colon cancer than the general population. For those with CF who have not had a transplant, their risk of colon cancer is five to ten times higher, while individuals with CF post-lung transplant have twenty times the risk as the general population.

What makes us especially vulnerable is that colon cancer symptoms can and often do mimic issues that we CF survivors experience daily. More research is needed to determine exactly why we’re at such elevated risk for the disease, but it’s believed to be linked to a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene.

The most effective tool for preventing this silent disease is a colonoscopy. Colon cancer always starts in the form of polyps, which if found early can be removed prior to becoming malignant. Colonoscopies are recommended for the general population at 45, yet despite our highly elevated risk, the current recommendation for a first screening colonoscopy for a person with CF is 40. That’s too late and must change. Screenings can prevent about 60 percent of colorectal cancer deaths.

I was 34 years old when diagnosed; I had few symptoms and no known family history. Colon cancer grows slowly, and it’s possible it’s been in me for years. I initially sensed that something was wrong when I had minor digestive issues. They persisted, but I second-guessed myself. Then I found a mass in my groin about the size of a dime.

After an inconclusive ultrasound, and while waiting for an appointment with a general surgeon, the lump grew to the size of a walnut. I went to my CF team for help. They found a bowel blockage, a common condition for those with cystic fibrosis known as Distal Intestinal Obstruction Syndrome, or DIOS. We hoped a colon cleanse would clear the blockage, but deep down I knew it was something more serious.

After a CAT scan and a biopsy of the groin mass, came the bad news. Cancer. I burst into tears. A PET scan then revealed the cancer had spread to other organs, including my ovaries, liver – which had 14 lesions – and lymph nodes.

After thriving on modulators, I have been transformed by cancer back into that sick, little vulnerable girl with CF who spent many nights curled up in a hospital bed, unsure of her future. I am now undergoing aggressive chemotherapy, requiring me to be outfitted with a take-home pump. Five times a week, I’m hooked up to an IV pole at home, on fluids to help me re-hydrate. Chemotherapy leaves me fatigued and immunocompromised, susceptible to infections and viruses that can be deadly.

Naturally, that’s required me to adjust my social life, relying on a network of friends. Work has taken a backseat to the battle at hand, but my supportive employer allows me to work remotely — as much as I’m able. My wonderful colleagues have carried the load in my absence. I miss them. I’ve even come to miss the 45-minute commute to my office with a stop to get a hot tea at Dunkin’.

Simple joys like eating — which most of us take for granted — are now a chore. I eat for calories, not pleasure. My diet changed drastically, and I no longer enjoy foods I’d grown up eating, such as macaroni and cheese and steak. If you looked in my cabinets now, you’d mainly find massive amounts of Fruit Loops and Apple Jacks.

I was shocked when my platinum blonde hair – with blue streaks – fell out in clumps. Losing hair is traumatic – it’s about body image, one’s sense of self, and feeling normal. Many have told me not to worry, that it will grow back, but I have no idea how long I will be on chemo, and whether that is true. While I have multiple wigs that allow me to feel like a different superstar each day, and a wide array of knitted hats, I often scrap these so I can emulate my idol, the Rock.

As a little girl, I spent a lot of time inpatient at St. Christopher’s Hospital for Children in Philadelphia. Watching the Rock on the weekly Smackdown was a great escape. Amazingly, the Rock learned about my diagnosis and sent me a heartfelt video wishing me luck in my fight. It’s been viewed millions of times on his Instagram page, and has allowed me to feel less isolated, with a virtual connection to countless people who channel their positivity toward me.

Prior to my diagnosis with colon cancer, I planned to travel across the globe. I wanted to hold a koala bear in Australia and visit Costa Rica. I planned to run for higher elected office. I had hopes and dreams that have been put on pause. I live in a world of uncertainty. Once again, I am learning to be comfortable living in the uncomfortable.

As science improves and evolves, so should our thinking. Cancer screenings must become a normal routine for cystic fibrosis adults, and the sooner the better. My hope is that the recommended age for a first colonoscopy will be lowered to 25 years for those with CF.

But you don’t have to wait for that to happen. If you have symptoms, don’t write them off as the usual CF GI issues. Go and get screened. You may end up saving your own life.

 

Image credit: David Sánchez-Medina Calderón from Pixabay
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Serving the Underserved: Transportation, Physician Access for CRC Prevention

By Deepthi Nishi Velamuri

Colorectal cancer (CRC) remains a serious health issue in the U.S. It is the second most common cause of cancer-related deaths in both men and women, and it is the third most frequently diagnosed cancer. An average of 50,000 Americans die from CRC each year. However, CRC is quite treatable if diagnosed early through routine screenings for average- and high-risk adults. The incidence and mortality rates associated with this disease are being reduced through public health initiatives, such as awareness campaigns and improving access to screenings. To prevent and identify CRC in its earliest stages, people must fully comprehend the risk factors, symptoms, and significance of regular screening.

The studies in the infographic below were presented at Digestive Disease Week 2023 and were focused on understanding the factors that impact screening rates for CRC in the U.S. The researchers delved into various aspects such as patient education, healthcare policies, socioeconomic disparities, and the effectiveness of screening methods and aimed to enhance screening efforts, raise awareness, and develop targeted interventions to increase screening rates.

 

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Artificial Intelligence–Aided Endoscopy: A Cost Effective Way to Improve CRC Detection

The applications of artificial intelligence (AI) goes beyond social media: scientists have found that it can be used to help physicians identify adenomas during screening. In Singapore, scientists affiliated with the Lee Kong Chian School of Medicine and Sengkang General Hospital evaluated the one year performance of AI colonoscopy and its impact on colorectal cancer (CRC) screening.

Adenoma Detection Rate (ADR) is the ratio of the number of colonoscopies that detect an adenoma to the total number of colonoscopies performed. Adenoma Detected Per Colonoscopy (ADPC) is the average number of adenomas detected per colonoscopy performed. These measures were used to determine the effectiveness of this emerging tool. This is not a new concept, however. Computer-aided detection (CADe) has previously been shown to  improve ADPC rate by 22%. More information regarding this previous study can be found here. 

AI Adds Value and Is Cost-Effective

Using a database of colonoscopy images, the GI Genius™ Intelligent Endoscopy Module is able to identify lesions that are potential polyps. The researchers recognize that there is a learning curve for providers to utilize the technology and there may be fatigue associated with using the technology for too long. Another risk involved is a longer procedural time due to the need for analyzing the results.

In order to determine if the benefits outweigh the costs, researchers used a prospective cohort study with CADe colonoscopies and traditional ones. They measured the polyp detection rate (PDR) which was the ratio of polyp-detected colonoscopies to the total number performed. Once these polyps were assessed in a lab via polypectomy, the ADR and ADPC rates were calculated.

Out of 843 CADe colonoscopies, the AI registered 1,392 hits with 71% of polypectomies being adenomatous. In the CADe group, the PDR was 45.6%, the ADR was 32.4%, and the ADPC was 2.08. Additionally, the mean procedural time for AI-aided colonoscopies and non-AI aided colonoscopies were not statistically significant, with the former taking an average of 19.9 minutes and the latter, 19.7 minutes.

Considering the cost of using AI assistance, the polypectomy rates increased revenue by more than $ US100,000 over the course of one year of AI-usage. This covered the subscription cost of the technology with $20,000 remaining. The study maintained that the AI-aided technology improved both ADR and PDR. Endoscopists also did not ignore the device prompts, indicating “adoption fatigue” was not an issue in this population. 

Leveraging technology to improve CRC screenings ranges from social media advocacy to using AI in screening. As we look to the future of screening, technology may be a solution to improve CRC detection rates and decrease morbidity.

 

Kaylinn Escobar is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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CDC Report: Why Do Certain Populations Never Screen for Colorectal Cancer?

Cancer screening remains a powerful tool. Even limited screening has long-term benefits compared to no screening  and can lower the risk of cancer and related deaths. A recent study by researchers at the CDC compared data on adults who reported they had not received a colorectal cancer (CRC) screening test between 2012 and 2020 using information from the Behavioral Risk Factor Surveillance System (BRFSS). The study identified various trends, most notably that 22 states did not meet the CDC’s Healthy People 2020 goal of 70.5% adults screened for CRC.

The sample was limited to adults aged 50 to 75 years, with up to date screenings defined as one of the following:

  • Home stool-blood test within the past year
  • Sigmoidoscopy within five years with fecal occult blood test or within one year with fecal immunochemical test
  • Colonoscopy within ten years

The ‘never screened’ numbers were a composite of those who answered no to being screened or those who were not up to date. Those who declined to answer or reported uncertainty were excluded. Overall, the study identified:

  • A 5.8% decrease in unscreened adults between 2012 and 2020 
  • States with the largest improvements were also those with the largest unscreened population in 2012 

 

Despite these improvements, CRC screening goals have yet to be met and may be difficult to meet with the new Healthy People 2030 standards. The target of 74.4% screened may have been a challenge to meet, possibly further exacerbated by the COVID-19 pandemic.

Researchers noted that including just two more questions on the BRFSS in 2020, the percentage of up to date screenings increased to 71.6%. These two questions enquired about:

  • Stool DNA testing
  • Computerized tomographic colonography

It is important to note that the National Colorectal Cancer Roundtable—a membership organization established by the CDC and the American Cancer Society—has set its goal to 80% screening rates across the country.

Study authors recognized recall bias and an inability to distinguish between screening versus diagnostic tests as major study limitations. Additionally, social desirability bias and a low response rate may have also affected the results. However, financial factors and health disparities may also describe the differences between states.

Following implementation of the Affordable Care Act, researchers at the American Cancer Society found that CRC screening among low-income adults across the U.S. increased by up to 8%, with the greatest increases observed in early Medicaid expansion states. They also noted that a majority of those who were never screened also lived in a state without expansion (South Dakota). 

Nonfinancial factors such as health disparities were studied in a mixed-methods analysis conducted at the Virginia Commonwealth University’s School of Medicine. Here, researchers noted that participants of gender-specific and race-specific focus groups brought forth nuanced concerns regarding screening. This included lack of awareness of both the disease and the screening, lack of physician recommendation that is clear and rational, and fear of being diagnosed and complications associated with testing. These concerns, if unaddressed, may limit others from seeking out CRC screening.

To read more about the Healthy People 2030 CRC screening standards and the current progress, visit Healthy People 2030.

 

Kaylinn Escobar is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation. 

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Have Colonoscopy Rates Among 45-49 Year Olds Improved After Guideline Change?

Initiating regular screening at the recommended age and time interval is key to preventing and early diagnosis of colorectal cancer (CRC). An early CRC diagnosis improves survival. The American Cancer Society (2018) and the U.S. Preventive Services Task Force (2020) recommended that CRC screening should start at 45 instead of 50 years, in reaction to the growing incidence of CRC among younger people. 

All major U.S. guidelines now endorse average-risk CRC screening at 45 years of age. However, there are concerns that endoscopic capacity may be strained, that low-risk persons may self-select for screening, and that calculations of the adenoma detection rate may be diluted. 

A new study supports the recommendation that colonoscopies should start at age 45, not 50 years. In this study, researchers compared colonoscopy volumes and lesion detection rates in the U.S. healthcare system before (October 2017 to December 2018) and after (January 2019 to August 2021) the new guidelines were issued. They included 7,990 patients who had undergone colonoscopies from October 2017 through August 2021: 4,266 first-time colonoscopies and 3,724 re-screening colonoscopies. 

Researchers found that:

  • After the screening age for colonoscopy was lowered, younger people were more likely to undergo the procedure
  • Among people ages 45 to 49, first-time screening rates increased from 3.5% in the period before guidelines were changed to 11.6% after they were updated 
  • First-time colonoscopies were still largely performed in patients ages 50 to 54 in both time periods, while re-screening colonoscopies showed a shifting trend toward older ages
  • Patients ages 60 to 64 were the most likely to undergo re-screening during both time periods 

They concluded that in our healthcare system in the early contemporary era of updated CRC screening guidelines, screening colonoscopy volume among 45- to 49-year-old patients has increased modestly, and lesion detection rates in 45- to 49-year-old patients have not decreased as might have been seen if low-risk persons were self-selecting for screening. The authors acknowledged that their findings were based on a single healthcare system and that national data will be important to assess the impact of the revised guidelines. 

 

Kitty Chiu is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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Patient Preference Key to Success of Colorectal Cancer Screening Programs

Colorectal cancer (CRC) screening is a vital preventative method to detect and remove a polyp and to diagnose cancer before it advances to an incurable stage. CRC screening options include endoscopy and stool-based testing. Now a new study that surveyed unscreened individuals at average risk for CRC has found that people have a preference for the stool-based screening option. 

The third most diagnosed cancer in the U.S., over 5 million people worldwide currently live with CRC. One method of CRC screening is a colonoscopy, which detects swollen, abnormal tissues, polyps, or cancer in the large intestine (colon) and rectum. Another form of CRC screening is the fecal immunochemical test (FIT). FIT is one of the most widely used CRC screening methods globally and is an affordable screening tool for studying large populations. FIT detects hidden blood in stool, a potential early sign of cancer, and it has an overall 95% diagnostic accuracy for CRC. 

It is estimated that 106,180 new colon cancer cases and 44,850 new rectal cancer cases will be diagnosed in the U.S. in 2022. With the screening age for CRC for average-risk adults lowered to 45 years, we need a better understanding of what the various age groups may prefer as a screening option to improve compliance and screening rates. 

The new study that was published has found that individuals in the 40-49 age group and those ≥50 years prioritized test modality above effectiveness when choosing their screening test. The findings of this study demonstrate that:

  • Both 40-49-years-old and ≥50-year-old age groups preferred FIT-fecal DNA every three years
  • The second preferred test for both age groups was a colon video capsule, or capsule endoscopy, every five years 
  • Regarding only the USPSTF tier 1 tests, both age groups preferred an annual FIT over a colonoscopy every ten years
    • 68.9% of 40-49-year-olds and 77.4% of ≥50-year-old participants preferred an annual FIT

These results conflict with current CRC screening approaches in the U.S., where colonoscopy is the screening test customarily used. Furthermore, these findings prompt the modification of current CRC screening guidelines and suggest that healthcare providers consider sequential-based screening procedures where FIT is offered before colonoscopy. The results, however, are consistent with a 2007 study, which supports the effectiveness of providing FIT before colonoscopy—the percentage of patients that were up-to-date with screening increased by almost 50% between 2000 and 2015 when they were offered direct-to-patient annual FIT outreach with colonoscopy. 

Scheduling delays and longer waiting times for colonoscopies have increased as millions of newly eligible individuals need a colonoscopy, all of which can strain resources and delay access and early screening for patients, especially for those at greater risk for CRC. Sequential approaches for CRC screening, such as those that offer FIT before colonoscopy, can help acknowledge and adjust to the increased need for screening and the lack of resources and help prioritize access to colonoscopy for those at greater risk for CRC.

 

Sahar Alam is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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Medicaid Expansion May Have Improved Diagnosis of Early-Stage CRC

Health insurance coverage is an important determinant of access to health care. Most people in the U.S. receive health insurance through their employers and many others qualify for government insurance programs like Medicare (generally for those >65 years) or Medicaid (for low-income families/individuals). The 2010 Affordable Care Act mandated preventive screening coverage for those who are enrolled in Medicaid and provided support to participating states. A cross-sectional cohort study has now revealed that after Medicaid expansion in 2014, the proportion of patients diagnosed and treated at Commission on Cancer–accredited facilities increased within expansion states and decreased in non-expansion states. 

This study evaluated whether the proportion of patients diagnosed with early-stage colorectal cancer (CRC) changed over time within states that expanded Medicaid, compared with non-expansion states. The authors queried the multicenter registry data from the National Cancer Database (2006-2016) and identified a total of 10,289 patients in expansion states and 15,173 patients in non-expansion states. They found:

  • A 0.9% annual increase in the number of individuals diagnosed with early-stage CRC in expansion states after 2014 
  • A 0.8% annual reduction in the number of individuals diagnosed with with early-stage CRC in non-expansion states after 2014 
  • By 2016, the absolute difference in the propensity-adjusted proportion of early-stage CRC was 8.8% 

Similarly, a study published in the Journal of American Surgeons also found that Medicaid expansion has had a notable impact on the diagnoses of early-stage CRC compared to non-expansion states. 

Improved insurance coverage following Medicaid expansion may have facilitated access to screenings and earlier diagnoses. 

For more information on insurance coverage for CRC screening, please visit: Insurance Coverage for Colorectal Cancer Screening. 

 

Kitty Chiu is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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Ryan Reynolds Documents a “Potentially Life-Saving” Colonoscopy After Losing a Bet

A friendly bet resulted in a potentially life-saving procedure for actors Ryan Reynolds and Rob McElhenney. Reynolds bet McElhenney that if he learned to speak Welsh, Reynolds would let a camera crew document him as he underwent a colonoscopy. In partnership with Lead from Behind, Reynolds documented and shared his experience on YouTube. 

Both Reynolds and McElhenney turned 45-years-old this year. In May 2021, the US Preventive Services Task Force (USPSTF) revised the colorectal cancer (CRC) screening age for average-risk adults to 45 years instead of 50. Reynolds noted in his video description, “I made a bet. I lost. But it still paid off.” Reynolds’ colonoscopy, conducted by Jonathan LaPook, MD, a gastroenterologist with NYU Langone’s Colon Cancer Screening and Prevention Program, resulted in the detection and removal of an “extremely subtle polyp” on the right side of his colon. McElhenney also decided to undergo a colonoscopy, which resulted in the identification of three polyps. Dr. LaPook emphasized, “This [colonoscopy] saves lives. Pure and simple.”

Importance of Colorectal Cancer Screening

Colorectal cancer (CRC) is the third most diagnosed cancer and over 5 million people worldwide currently live with CRC. According to the American Cancer Society, the lifetime risk of developing CRC is 1 in 23 for men and 1 in 25 for women, and recent research indicates an increased incidence of CRC among individuals younger than 50 years of age. There will be an estimated 106,180 new colon cancer cases and 44,850 new rectal cancer cases in the United States in 2022. While CRC screening rates have significantly improved over the past 20 years, only 65%-70% of age-eligible individuals achieve screening nationally. Screening is a significantly effective and preventive method to detect CRC before it advances to an incurable stage. 

When to Schedule a Colonoscopy

The American Cancer Society and USPSTF recommend screening should begin at 45 years for average-risk adults. Individuals who are at a higher risk of developing CRC may need to be screened earlier.

What to Expect During a Colonoscopy

A colonoscopy detects swollen, abnormal tissues, polyps, or cancer in the large intestine (colon) and rectum. Before a colonoscopy, patients are required to empty their colon by following a specific diet recommended by their doctor, taking a prescribed laxative, and adjusting any daily medications as instructed by their doctor. On the day of the procedure, a long, flexible tube (colonoscope) is inserted into the patient’s rectum under anesthesia. A tiny camera at the tip of the tube allows the doctor to view the colon. If polyps and abnormal tissues are detected, they can be removed during the colonoscopy itself, just like in Reynolds’ and McElhenney’s procedures. According to the American Society for Gastrointestinal Endoscopy, more than 40% of adults over the age of 50 years have precancerous polyps in the colon.  

What Are Colorectal Cancer Symptoms?

CRC may not cause symptoms immediately. Screening is the most effective method to detect and remove polyps before they advance into malignant disease. Speak to your doctor if you are 45 or older, have a family history of CRC, or notice any abnormal symptoms.

Remember: CRC survival is 90% if detected at an early stage when the cancer is localized and has not spread to other sites or organs.

Sahar Alam is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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Study Finds Risk-Stratified Colorectal Cancer Screening Is Feasible and Cost-Effective

Colorectal cancer (CRC) is the third most common cancer diagnosis and the second most common cause of cancer death globally. The American Cancer Society estimates that there will be 106,180 new colon cancer cases and 44,850 new rectal cancer cases in the United States in 2022. Early detection and consistent screening reduce CRC incidence and mortality. A recent randomized controlled trial that analyzed the feasibility, adherence, yield, and related costs of various screening modalities found that a risk-adapted approach is feasible and cost-favorable for population-based screening. 

Current guidelines recommend standardized screening plans for specific age groups, with colonoscopy recommended every 10 years and a fecal immunochemical test (FIT) between 1-3 years. Implementation of risk-stratified screening can potentially allow for more frequent screening and earlier detection of CRC at a population level. This would especially be beneficial for individuals who are at higher risk of CRC. Additionally, risk-stratified screening can help health practitioners detect and introduce plans for CRC treatment at earlier stages.

The National Health Service Breast Screening Programme (NHSBSP) recently investigated the potential benefits, costs, and effectiveness of risk-stratified breast cancer screening with BC-Predict, a platform that collects self-reported risk factor information for breast cancer, analyzes the self-reported information, and invites high-risk or moderate-risk women to a conversation about prevention and early detection options. BC-Predict was found to have the potential to reduce breast cancer mortality due to early screening. It also reduced screening in women who are at lower risk, minimizing the number of false positive test results in lower-risk women. The results from this analysis are pertinent to risk-stratified screening for CRC and support the implementation of a risk-adapted approach in CRC screening.

What Did the Study Find?

More than 19,000 participants in the TARGET-C trial conducted in six cities in China were placed into one of the screening arms in a 1:2:2 ratio: 

  • One-time colonoscopy (n=3,883)
  • Annual fecal immunochemical test (FIT) (n=7,793)
  • Annual risk-adapted screening (n=7,697).

The detection rate of advanced colorectal neoplasia, CRC, and advanced precancerous lesions were the main outcomes that were monitored. The follow-up to trace the rate of advanced colorectal neoplasia for all participants was conducted over a 3-year study period. 

Over three screening rounds, the participation rates for colonoscopy, FIT, and risk-adapted screening arms were 42.4%, 99.3%, and 89.2%, respectively. The costs to the for detecting one advanced neoplasm, presented as both Chinese Yuan (CNY) and US dollar, using a package payment format were:

  • CNY6,928 ($1,004) for one-time colonoscopy
  • CNY5,821 ($844) for annual fecal immunochemical test (FIT)
  • CNY6,694 ($970) for annual risk-adapted screening.

These findings underscore the value of a risk-adapted approach for CRC screening for feasibility and cost-effectiveness, as well as for allowing for more frequent screening and earlier detection of CRC for individuals with a high or moderate risk for CRC.

 

Sahar Alam is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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Disparities and Multilevel Barriers for Colorectal Cancer Screening May Extend to Younger Populations

In May 2021, the US Preventive Services Task Force (USPSTF) revised the colorectal cancer (CRC) screening age for average-risk adults to 45 years. However, stakeholders are concerned about the lack of awareness, access, and motivation among the younger age group to get screened. Now, a new research study has found that the prevalence of CRC screening remained lowest for individuals ages 50 to 54 years old and young adults (age<50) experienced smaller increases in screening prevalence over time, regardless of race, ethnicity, education, income, and insurance coverage. 

An investigation using population-based data from the National Health Interview Survey (NHIS), an annual, cross-sectional survey of the U.S. population conducted by the National Center for Health Statistics at the U.S. Centers for Disease Control and Prevention, studied CRC screening participation using surveys from multiple years. A sample of 80,220 participants ages 50 to 75 years old was analyzed for CRC screening participation. For each survey year, the prevalence of CRC screening was estimated for age, race, ethnicity, educational attainment, family income, and health insurance.

Racial, ethnic, and socioeconomic disparities influence screening rates. Despite the prevalence of CRC screening increasing from 36.7% in 2000 to 66.1% in 2018, screening prevalence was observed to be the lowest for:

  • Participants ages 50 to 54 years old
  • Hispanic populations (56.5%)
  • Asian populations (57.1%)
  • Participants with less than a high school degree (53.6%)
  • Participants from low-income families (56.6%)
  • Participants without insurance (39.7%) 

This may be the result of a lack of concern for cancer and cancer screening among younger adults and their healthcare providers, limited access to healthcare, absence of or limited insurance coverage, and other priorities for young adults, such as work and family. Disparities in screening rates can potentially extend to adults ages 45 to 49 as the new USPSTF recommendations are implemented. Multilevel barriers, such as patient-, provider-, and system-level factors, impact the completion of CRC screening for young adults (age<50), creating disparities and inequities in CRC screening. The administration of new CRC screening guidelines must acknowledge and account for multilevel disparities in screening programs to ensure all populations have equal access to CRC screening and benefit from CRC screening, especially newly eligible adults ages 45 to 49 years old. 

The benefits and outcomes of the updated USPSTF guidelines to extend CRC screening to ages 45 to 49 years old have been debated by clinicians and researchers. Concerns about the updated guidelines include redirecting endoscopic resources away from higher-risk and older patients, resulting in a more significant exacerbation of health disparities. Another criticism is that adults ages 45 to 49 years old who participate in screening may be less likely to belong to groups at higher CRC risk. 

One benefit of expanding CRC screening to the 45-49 age group is to increase the screening participation rate among older populations. Awareness of CRC screening may also increase, resulting in newly eligible adults having more time to schedule their first screening test. However, the impact of screening among those in the 45-49 age group on disparities, benefits, and participation of older adults may take several years to be fully recognized and understood, as the USPSTF’s effect on insurance coverage only occur in mid-2022.

Sahar Alam is a Colon Cancer Prevention Intern with the Colon Cancer Foundation.

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