“Although clinicians overwhelmingly report that they recommend [colorectal cancer] screening to average-risk patients, limited data exist on the consistency with which they do so, and the low patient-reported prevalence in this study is alarming,” wrote investigators.
Colorectal cancer accounts for 7.8% of all new cancer cases in the United States, making it the fourth most frequent type of cancer after breast cancer, prostate cancer, and lung and bronchus cancer (2). The US Preventive Services Task Force advises colorectal cancer screening for persons aged 45-75, and adults aged 76-85 should talk to their doctor about it (3). Colorectal cancer screening tests can help prevent the disease or discover it early before it spreads to other parts of the body (4).
Jordan Baeker Bispo, Ph.D., MPH, chief scientist of cancer disparity research for the American Cancer Society, and colleagues undertook the current study to determine the prevalence of clinician recommendations for colorectal screening among underscreened adults. To accomplish this, the researchers designed their study utilizing data from 61,479 patients who completed the 2019 and 2021 National Health Interview Surveys. Patients had to be age-eligible for screening, assessed for guideline-concordant screening, not up to date with screening recommendations, and have had a wellness visit in the previous year to be eligible for the study.
Colorectal Cancer Screening
The researchers assessed whether participants had received a physician referral for colorectal cancer screening by asking, “In the past 12 months, did a doctor or other health professional recommend that you be tested to look for problems in your colon or rectum?” Only responders who did not report guideline-concordant colorectal cancer screening were asked to complete the survey. The proportion of reporting a clinician’s suggestion for screening was calculated using age, survey year, gender, race/ethnicity, education, poverty status, nativity, urban or rural domicile, comorbidity burden, insurance, and usual source of treatment. Unadjusted and adjusted prevalence ratios were estimated using logistic regression models.
The study comprised 5022 patients who were both eligible and late for colorectal cancer screening. 1425 (26.8%) of these participants reported having a clinician recommendation for colorectal cancer screening. Prevalence was lowest among patients who did not have a typical source of care (9.7%) and were uninsured (12.6%), while estimates were similar in a sensitivity analysis that excluded respondents who did not have insurance or a usual source of care.
Non-Hispanic Asian (adjusted prevalence ratio [aPR], 0.53 [95% CI, 0.37-0.75]), non-Hispanic Black (aPR, 0.76 [95% CI, 0.63-0.92]), and Hispanic (aPR, 0.82 [95% CI, 0.67-1.01] adults were less likely than non-Hispanic White adults to report a clinician recommendation for colorectal cancer screening. Furthermore, receiving a clinician recommendation was less likely for those with less than a high school education (aPR, 0.76 [95% CI, 0.61-0.95]) compared to those with a college diploma, as well as for uninsured adults (aPR, 0.51 [95% CI, 0.38-0.68]) compared to those with private insurance.
Loopholes in Colorectal Cancer Screening
“The findings highlight a major communication gap about [colorectal cancer] prevention in the clinical setting. 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 [colorectal cancer] screening and advance progress toward national screening goals,” concluded investigators.
- 1. Bispo JB, Bandhi P, Jemal A, et al. Receipt of Clinician Recommendation for Colorectal Cancer Screening Among Underscreened U.S. Adults. Annals of Internal Medicine. September 11, 2023. doi:10.7326/M23-1341
- National Cancer Institute. Cancer Stat Facts: Colorectal Cancer. Reports on Cancer. Accessed September 11, 2023. https://seer.cancer.gov/statfacts/html/colorect.html
- U.S. Preventive Services Task Force. Colorectal Cancer: Screening. Recommendation Topics. May 18, 2021. Accessed September 11, 2023. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening
- Centers for Disease Control and Prevention. United States Cancer Statistics Colorectal Cancer Stat Bite. Stat Bites. Accessed September 11, 2023. https://www.cdc.gov/cancer/uscs/about/stat-bites/stat-bite-colorectal.htm