Colorectal Cancer Test Completion among Adults Aged 45 to 75 in an Integrated Healthcare System: A Retrospective...

In 2021, the US Preventive Services Task Force (USPSTF) lowered the recommended age for colorectal cancer screening from 50 to 45 years. This study examined colorectal cancer test completion and test modalities used among adults 45 to 49 years of age compared with those 50 years and older.

We conducted a retrospective cohort study using electronic health records from an integrated academic-community health system that implemented organized screening. Adults 45 to 75 years of age eligible for colorectal cancer screening between 2021 and 2024 were included. Outcomes were colorectal cancer test completion and test modality: colonoscopy, fecal immunochemical test (FIT), FIT-DNA, CT colonography, or flexible sigmoidoscopy.

Approximately 80,000 adults were eligible for screening annually. Colorectal cancer test completion increased from 61.8% (2021) to 70.8% (2024), with the largest increase in the 45- to 49-year age group (25.6% to 51.7%). Colonoscopy and FIT were the most used modalities; among 45 to 49 year olds, FIT increased by 12.2% and colonoscopy by 14.2%. FIT-DNA use increased slightly, whereas flexible sigmoidoscopy use declined. Racial and ethnic disparities in colorectal cancer test completion decreased across groups.

Following the 2021 USPSTF recommendation, colorectal cancer test completion improved across all age groups, especially in adults 45 to 49 years of age. Colonoscopy and FIT use predominated. Ongoing efforts are needed to improve screening among younger adults to reach the 80% national screening goal.

This study demonstrated that expanding colorectal cancer testing to 45 to 49 year olds led to increased uptake of colonoscopy and FIT. It highlights how organized outreach and providing options in screening modalities can improve colorectal cancer test completion across several patient populations.