Colorectal cancer screening prevalence remains low among younger adults

Cancer Prevention and Research Institute of Texas and NIH supported the study. Murphy reports personal fees from Freenome outside the submitted work. Please see the study for all other authors’ relevant financial disclosures.

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Colorectal cancer screening prevalence remained low in 2018 among U.S. adults aged 50 to 54 years vs. 70 to 75 years, with the younger group exhibiting larger disparities by race/ethnicity, education level, income and insurance.

The findings, published in Cancer Epidemiology, Biomarkers & Prevention, indicate a need to ensure all groups realize the benefits of colorectal cancer screening, especially the newly eligible adult population aged 45 to 49 years, researchers noted.

Colorectal cancer screening prevalence

Rationale and methods

“The USPSTF updated their guidelines in May 2021 to recommend average-risk colorectal cancer screening starting at age 45 years vs. the previous start age of 50 years,” Caitlin C. Murphy, PhD, MPH, associate professor in the department of health promotion and behavioral sciences at The University of Texas Health Science Center School of Public Health, told Healio. “To anticipate some of the challenges implementing screening programs when eligibility is expanded to age 45 years, we examined patterns of screening among adults aged 50 to 54 years who were once the youngest age group eligible for screening.”

Photo of Caitlin Murphy

Caitlin C. Murphy

Murphy and colleagues evaluated data of 80,220 individuals aged 50 to 75 years included in the National Health Interview Survey between 2000 and 2018. They estimated colorectal cancer screening prevalence for each survey year by age, race/ethnicity, educational attainment, family income and health insurance, and compared increases in screening prevalence in 5-year age groups: 50 to 54, 55 to 59, 60 to 64, 65 to 69 and 70 to 75.

Colorectal cancer screening, defined as receipt of last recommended test within the recommended timeframe, served as the primary outcome.

Key findings

Results showed an overall increase in the prevalence of colorectal cancer screening, from 36.7% in 2000 to 66.1% in 2018. In 2018 alone, researchers observed the lowest screening prevalence among those aged 50 to 54 years (47.6%), as well as among Hispanic individuals (56.5%), Asian individuals (57.1%), those with less than a high school degree (53.6%), members of low-income families (56.6%) and those without insurance (39.7%).

Of note, screening prevalence increased from 28.2% in 2000 to 47.6% in 2018 among those aged 50 to 54 years and from 46.4% to 78% among those aged 70 to 75 years. Researchers noted smaller increases in prevalence by race and ethnicity, educational attainment, family income and health insurance among those aged 50 to 54 years vs. aged 70 to 75 years.

Limitations of the study included the self-reporting of screening behaviors via survey and a lack of data concerning individuals with increased colorectal cancer risk.


“Our findings are especially relevant to the new USPSTF guidelines that recommend average-risk screening to begin at age 45 years. The persistent and worsening disparities we observed in adults aged 50 to 54 years may extend to those aged 45 to 49 years as they become eligible for screening,” Murphy said. “Extra care must be taken to ensure that expanding screening to younger ages does not negatively impact efforts to eliminate disparities in colorectal cancer screening and outcomes, nor jeopardize efforts to increase screening initiation among older adults who remain unscreened.”

Future research is needed to identify screening preferences, barriers and perceptions unique to younger adults, Murphy added.

“Additional research is also needed to adapt evidence-based interventions to increase screening participation in this age group,” she said. “It is important that screening programs consider the barriers unique to younger adults, ensuring the benefits of screening are equally realized by all population groups.”


  • Liu PH, et al. Cancer Epidemiol Biomarkers Prev. 2022;doi:10.1158/1055-9965.
  • Eligible younger Americans less likely to meet recommended colorectal cancer screening guidelines and face greater disparities (press release). Available at: www.aacr.org/about-the-aacr/newsroom/news-releases/eligible-younger-americans-less-likely-to-meet-recommended-colorectal-cancer-screening-guidelines-and-face-greater-disparities/. Published June 29, 2022. Accessed June 29, 2022.

For more information:

Caitlin C. Murphy, PhD, MPH, can be reached at caitlin.c.murphy@uth.tmc.edu.

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