Understanding Colorectal Cancer Screening Gaps Among Adults Aged 45-49

The United States Preventative Task Force recommends initiating colorectal cancer (CRC) screening at age 45, but screening rates among 45-49 y-olds has been lower than older age groups. Reasons for low screening rates among younger individuals are not clear.

Using Behavioral Risk Factor Surveillance System data from 2022 to 2024, we investigated factors associated with CRC screening among adults aged 45-49; stratified analyses were conducted among the insured and uninsured. Among screened individuals, associations with undergoing endoscopy versus another screening modality were studied. We characterized preventative care behaviors including seeking primary care, time since last checkup, and completion of other age-appropriate cancer screening.

Of 50,132 individuals, 21,566 (42.6%) underwent CRC screening. Those with primary care physicians had higher odds of screening (odds ratio = 1.71; 95% confidence interval = 1.47-1.98, ref: no primary care physician), but increasing time since one's last visit was associated with decreasing odds of screening at all time intervals (5+ y ago: odds ratio = 0.29; 95% confidence interval = 0.23-0.38, ref: <1 y). Lower income, rural residence, no insurance, and lower educational attainment were associated with lower odds of screening. CRC screening was completed in only 41.3% of women who had mammograms and 48% who were screened for cervical cancer.

Uptake of CRC screening lags in adults aged 45-49, with differences in socioeconomic factors and preventative care utilization. A majority of eligible but unscreened individuals accessed other age-appropriate cancer screening tests, directing focus to patient- and provider-specific factors as potential targets for intervention.