Study shows 'major communication gap' about colorectal cancer screening

Key takeaways:

• Of those overdue for colorectal cancer screening, 26.8% said their clinician recommended they get screened.
• Disparities exist for people in low socioeconomic groups and underrepresented racial populations.

Just over a quarter of patients overdue for colorectal cancer screening received a recommendation from their clinician to get screened, according to the results of research published in Annals of Internal Medicine.

Although routine screening can prevent and help detect early colorectal cancer (CRC), more than one-third of adults are overdue, Jordan A. Baeker Bispo, PhD, MPH, a principal scientist of cancer disparity research at the American Cancer Society, and colleagues wrote.

In 2021, the U.S. Preventive Services Task Force lowered the recommended age to start CRC screening to 45 years — 5 years younger than the age at which the ACP recommends CRC screening. Since then, screening rates more than doubled among adults aged 45 to 49 years.

“Screening for CRC in the United States is largely opportunistic, with patient uptake typically mediated by receipt of a screening recommendation during routine care,” the researchers wrote. “Receiving a clinician recommendation is the strongest and most consistent determinant of CRC screening participation. Lack of clinician recommendation may contribute to low uptake of CRC screening, but the magnitude of this problem is unknown.”

So, Baeker Bispo and colleagues conducted a study to approximate the prevalence of clinician recommendations for CRC screening among adults in the U.S. who are overdue for screening based on the USPSTF’s guidelines.

To determine the prevalence of clinician recommendations for CRC screening, the researchers used pooled, nationally representative data from 5,022 people in the 2019 and 2021 National Health Interview Survey.

They found that 26.8% of participants reported receiving a CRC screening recommendation. They also observed disparities in care, a finding that was “consistent with historical disparities and contemporary patterns of CRC screening participation.”

For example, the prevalence of CRC screening recommendations ranged from less than 10% for those who did not have a usual source of care to 32% for those with a family income that was more than 400% of the federal poverty level.

There were also racial disparities; the prevalence of CRC screening recommendations was lower for Black people (adjusted prevalence ratio [aPR] = 0.76; 95% CI, 0.63-0.92), Hispanic people (aPR = 0.82; 95% CI, 0.67-1.01) and Asian people (aPR = 0.53; 95% CI, 0.37-0.75) than for their white counterparts.

Considering “clinicians overwhelmingly report that they recommend CRC screening to average-risk patients,” Baeker Bispo and colleagues wrote that “the findings highlight a major communication gap about CRC prevention in the clinical setting.”

“Barriers to providing effective counseling on CRC screening include time and resource constraints, prioritization of acute care needs, and clinician preference for colonoscopy over alternative methods,” they wrote. “At the systems level, investing in clinician training, automated point-of-care prompts, educational tools for shared decision-making with diverse patient populations, and community outreach may improve patient-clinician communication about CRC screening and advance progress toward national screening goals.”