Colorectal cancer screening in adults aged 45–49: provider availability, CT colonography access, and screening rates

Abstract

Background: The US Preventive Services Task Force updated its colorectal cancer (CRC) screening guidelines in 2021, recommending screening for adults aged 45–49. This study aimed to evaluate CRC screening prevalence among this newly eligible population and assess its association with healthcare provider supply and CT colonography facility availability in 2022. Methods: Using 2022 Behavioral Risk Factor Surveillance System data (n = 25,592), we estimated CRC screening prevalence among adults aged 45–49 and the prevalence of different screening modalities across various sociodemographic factors. We examined associations between screening rates and state-level healthcare provider supply using 2021–2022 Area Health Resources File data. Spearman rank-order correlations assessed relationships between provider supply, CT colonography facility availability, and screening prevalence. Results: Overall CRC screening prevalence was 34.5% (95% CI: 33.4%–35.8%). Endoscopic tests were most common (74.9%), followed by stool-based tests (9.3%) and CT colonography (0.5%). Significant variations in screening modalities were observed across sociodemographic factors. Gastroenterology physician supply positively correlated with overall CRC screening prevalence (ρ = 0.42, P = 0.002) and endoscopy screening prevalence (ρ = 0.38, P = 0.005). CT colonography facility availability weakly correlated with CT colonography screening prevalence (ρ = 0.15, P = 0.316), although this was not significant. Conclusions: CRC screening rates among newly eligible adults aged 45–49 appear to be suboptimal in 2022. Disparities in screening methods across sociodemographic factors highlight potential access barriers, particularly for endoscopic tests. The association between gastroenterology physician supply and screening rates emphasizes the importance of addressing projected workforce shortages. Targeted efforts are needed to increase CRC screening uptake in this age group and ensure equitable access to screening services.