Colorectal Cancer Screening Uptake Across Age Groups in an Academic Health System.
Level 3 - non-randomized controlled study
Retrospective cohort study using electronic health record data.
PubMed 42201273 · doi:10.1016/j.amepre.2026.108365
What was done
A retrospective cohort study was conducted using electronic health records from insured, average-risk adults aged 45 to 75 years receiving care within the University of California San Diego Health System between 2021 and 2023. Researchers evaluated colorectal cancer screening adherence and modality, individual sociodemographic factors, and ZIP code-level social vulnerability measures. Screening adherence by calendar year was compared between adults aged 45 to 49 years and 50 to 75 years using multivariable Poisson regression with robust standard errors.
What was found
Screening adherence among adults aged 45 to 49 years increased from 20% in 2021 to 46% in 2023. Adherence likelihood in this group was lower than in adults aged 50 to 75 years across all years: in 2021, adjusted prevalence ratio (aPR) was 0.27 (95% CI 0.25 to 0.29); in 2022, aPR was 0.45 (95% CI 0.43 to 0.48); and in 2023, aPR was 0.59 (95% CI 0.56 to 0.62). Colonoscopy was the primary screening modality, though stool-based testing among adults aged 45 to 49 years increased from 3% in 2021 to 9% in 2023. Screening adherence increased across all racial and ethnic groups from 2021 to 2023, leaving existing screening disparities unchanged.
Why it matters
Following updated guidelines lowering the screening initiation age to 45, real-world adherence in younger adults more than doubled over three years. However, uptake continues to trail older cohorts, and baseline racial and ethnic disparities persist.
Limits
The total sample size is not reported in the abstract. The study is limited to a single academic health system and restricted to insured, average-risk patients, limiting generalizability to uninsured populations or community practice settings. Screenings completed outside the health system may not have been captured.
Cited by
- context Only about 20% of eligible adults aged 45 to 49 are actually obtaining screening colonoscopies.