Knowledge, Attitudes, and Perceptions Around Colorectal Cancer Screening and Risk Among 20-49 Year Olds

The incidence of colorectal cancer (CRC) diagnosed before age 50 is rising. CRC screening rates are suboptimal, and there are substantial diagnostic delays among those with red flag symptoms. We aimed to assess the knowledge of blood in stool as a red flag for CRC, fear of screening procedures, and perceived trust in doctors among younger individuals, including associated factors.

We performed an analysis of a nationwide exploratory survey of 747 individuals 20-49 years old. We also assessed factors associated with knowledge of blood in stool as a red flag for CRC, fear of screening procedures, and perceived trust in doctors as representative questions from each domain of accurate knowledge, positive attitude, and trusted sources of health information, respectively, using multivariable logistic regression, with adjustment for false discovery rate.

76% agreed that CRC screening should be performed, but only 16% were aware that CRC screening should start at age 45. 56% would ask their provider about CRC risk in the setting of rectal bleeding. Almost half of the participants feared CRC screening tests. Most participants trusted health information from medical providers (86%); less than 1/3 of participants trusted health information from news anchors (28.1%), celebrities (23.3%), social media Figs. (10.1%), and faith-based leaders (25.7%). Use of social networking sites (Odds Ratio 2.02, 95% Confidence Interval 1.41-2.89) was independently associated with accurate knowledge of blood in the stool as a red flag for CRC.

There are still critical gaps in knowledge and intention toward CRC screening among 20-49 years old. Future research should focus on tailoring content, route, and sources of motivational education to improve screening in younger audiences.