Colorectal Cancer Test Completion among Adults Aged 45 to 75 in an Integrated Healthcare System: A Retrospective Analysis.
Level 3 - non-randomized controlled study
Retrospective cohort study analyzing electronic health record data over time
PubMed 41679770 · doi:10.1158/1055-9965.EPI-25-1512
What was done
Researchers conducted a retrospective cohort study using electronic health records from an integrated academic-community health system with an organized screening program. They evaluated colorectal cancer (CRC) test completion and test modality (colonoscopy, fecal immunochemical test [FIT], FIT-DNA, CT colonography, or flexible sigmoidoscopy) among screening-eligible adults aged 45 to 75 years between 2021 and 2024, following the 2021 USPSTF recommendation lowering the initial screening age to 45.
What was found
Across approximately 80,000 eligible adults annually, overall CRC test completion rose from 61.8% in 2021 to 70.8% in 2024. The largest increase occurred in the 45- to 49-year-old group, where completion increased from 25.6% to 51.7%. Colonoscopy and FIT were the most utilized modalities; in adults aged 45–49, FIT completion increased by 12.2% and colonoscopy by 14.2%. FIT-DNA use rose slightly while flexible sigmoidoscopy declined. Racial and ethnic disparities in test completion narrowed over the study period.
Why it matters
This study shows real-world adoption of lower-age CRC screening recommendations within an organized health system, driven by combined access to non-invasive stool testing and colonoscopy. However, screening in 45- to 49-year-olds (51.7%) still lags well behind older cohorts and national 80% targets.
Limits
The abstract does not report total cumulative sample size, exact confidence intervals, or specific subgroup completion percentages for racial and ethnic categories. Findings reflect a single integrated academic-community system with organized screening outreach and may not generalize to fragmented care settings or uninsured populations.
Cited by
- context Only about 20% of eligible adults aged 45 to 49 are actually obtaining screening colonoscopies.