Unmet social needs and colorectal cancer testing at 45-49 since the 2021 USPSTF recommendation

In 2021, the United States Preventive Services Task Force (USPSTF) lowered the recommended starting age for colorectal cancer (CRC) screening from 50 to 45 for average-risk individuals. However, screening uptake among younger adults has been slow, and little is known about how social factors influence screening behaviors in this early-midlife cohort. This study examined associations between unmet social needs and CRC testing and modality among adults aged 45-49 following the updated USPSTF recommendation.

This cross-sectional analysis of 2022 Behavioral Risk Factor Surveillance System data included adults aged 45-49 years. Outcomes included any CRC testing since the USPSTF recommendation update and initial modality (stool-based test vs colonoscopy) among tested individuals. Primary predictors included past-year housing, transportation, or food insecurity and total number of unmet social needs. Weighted binary logistic regression models were adjusted for sociodemographic and clinical confounders.

Among 13 251 respondents aged 45-49, 22.5% had initiated CRC testing since the USPSTF recommendation update. Food insecurity and increased number of unmet social needs were associated with lower CRC testing uptake in unadjusted models. However, there were no significant differences in CRC testing by social needs status in adjusted models. Among those tested, transportation insecurity was associated with lower use of colonoscopy in adjusted models.

Among younger, newly screening-eligible adults, there were no significant differences in CRC testing uptake after controlling for sociodemographic and clinical covariates. Further investigation is needed to understand barriers and facilitators to CRC screening uptake in this population and guide interventions to reduce early-onset CRC morbidity and mortality.