Middle-age adults getting less colorectal cancer screening than retirement-age adults

Specific population-based efforts to increase colorectal cancer screening are needed so that patients start at age 50 years and continue through age 75 years for the most benefit, study authors said.

In 2018, 68.8% of adults were current with colorectal screening, but screening rates were almost 16 percentage points lower among those ages 50 to 64 years than those ages 65 to 75 years.

Data from the 2018 Behavioral Risk Factor Surveillance System survey, an annual, state-based, random-digit–dialed telephone survey of the civilian, noninstitutionalized adult population, were analyzed to estimate how many adults complied with U.S. Preventive Services Task Force recommendations on colorectal cancer screening. Results appeared in the March 13 Morbidity and Mortality Weekly Report (MMWR).

The percentages of adults who had received recommended screening were 79.2% in those ages 65 to 75 years and 63.3% in those ages 50 to 64 years. The difference among the age groups was largest for those without health insurance (23.1 percentage points) and smallest among respondents who identified as non-Hispanic other/multiracial (11.1 percentage points). The percentage of respondents who were up to date was lowest among those ages 50 to 54 years (50.0%) and highest among those ages 70 to 75 years (81.3%). Increasing age was significantly associated with being up to date on screening (P<0.005)

Among those ages 65 to 75 years, reported screening prevalence was lowest among those without a regular clinician (45.6%) and highest among those who reported an annual household income of $75,000 or more (87.1%). However, 81% of respondents ages 50 to 64 years and 94% of those ages 65 to 75 years who had never been screened reported having health insurance. In both age ranges, screening was higher among women, those with health insurance, those with a regular clinician, and those living in metropolitan areas. Screening increased with increasing education and annual household income levels.

In a state-by-state breakdown, Massachusetts had the highest percentage of all adults ages 50 to 75 years and ages 50 to 64 years who were current with colorectal cancer screening (76.5% and 72.1%, respectively). Wyoming had the lowest percentages (57.8% and 51.5%, respectively). Rhode Island had the highest percentage of adults ages 65 to 75 years who were up to date (84.9%), and Wyoming had the lowest (68.5%).

The study authors noted that prevalence might be overestimated because the survey did not specify whether tests were done for screening or diagnosis, data were self-reported and not validated, and response rate was low (49.9%). They wrote that concerted efforts are needed to inform younger patients about the benefits, insurance coverage, and methods of colorectal cancer screening so that they begin at age 50 years.