facility base
The cohort study analyzed 7 802 606 people.
monthly average
“The 2018 ACS and the 2021 USPSTF recommended screening at age 45 for average-risk individuals, which expanded eligibility to approximately 20 million adults ages 45 to 49. However, absolute utilization remains low. Although increased screening has been noted among privately insured individuals, little facility-based, all-payer evidence exists on the impact of guideline changes,” the authors wrote.
This study examined three time periods corresponding to major guideline updates: before the change (prior to the American Cancer Society’s 2018 recommendation to begin screening at age 45), during (June 2018 to May 2021), and after the change (after the change).
Key Takeaways
- Dramatic use of a young screening group. Following the 2021 USPSTF guideline change, facility-based CRC screening among adults ages 45 to 49 increased 955%.
- Rapid adoption of guidance. The rate of all CRC screening among people aged 45 to 49 years increased from 2.9% before the guideline change to 17.8% after the change.
- The rate of increase significantly exceeded that of the older age group. During the same period, the number of screenings for those aged 45 to 49 increased by 955%, while the number of screenings for those aged 50 to 75 increased by only 46%.
- Demographic gaps persist. Post-change screening of younger age groups showed decreased representation of non-Hispanic blacks, Medicare enrollees, and residents of high-vulnerability communities compared to the pre-change period.
- Guideline changes address increased incidence. The incidence of CRC among adults under 50 years of age increased by 2.4% annually from 2012 to 2021.
Demographic patterns. In the post-change period, most screened individuals aged 45 to 49 years were female (57.0%), non-Hispanic white (53.3%), had commercial insurance (74.2%), and were from areas of average socioeconomic disadvantage (59.5%).
Compared to the pre-change period, the post-change period showed statistically significant differences across race, ethnicity, payer, and vulnerable groups. Non-Hispanic black representation decreased by 4.1 percentage points, Medicare enrollees decreased by 2.3 percentage points, and individuals in high-vulnerability areas decreased by 1.6 percentage points. The proportion of Hispanics increased by 7.4 percentage points.
Research context. Colorectal cancer remains the second leading cause of cancer-related death in the United States. While the incidence rate among adults over 65 years of age has decreased, the rate among those under 50 years of age has increased by 2.4% per year from 2012 to 2021.
The guidelines expanded the screening target to approximately 20 million adults aged 45 to 49. The ACS recommended screening at age 45 for average-risk individuals in 2018, and the USPSTF followed in 2021.
“These findings reflect CRC screening in hospitals, where guideline adoption will be important in shaping clinical practice and building momentum toward broader public health impact,” the researchers concluded. “Continued efforts to maintain this momentum can help optimize uptake. While opportunities remain to address gaps and explore at-home testing, this highlights the early success of implementing facility-based guidance.”
Limitations and Implications. This study was limited to facility-based screening and did not capture at-home testing or differentiate by hospital type. Variations in coding practices and underrepresentation of small or rural hospitals may affect generalizability. The relatively short study interval may limit assessment of long-term patterns.
Lead author Alyssa H. Harris, MPH, of Vizient Inc and Northern Illinois University, and colleagues noted that the increase in the interim period in both age groups may reflect public health campaigns and early adoption of ACS recommendations before the USPSTF changes.
The authors said opportunities remain to address and investigate gaps.
reference: Harris AH, Murphy HR, McDowell M, Wright ME, Hughes MC. Utilization of facility-based colorectal cancer screening among people aged 45 to 49 years after changes in U.S. guidelines. JAMA Netw Open. 2025;8(11):e2541330. doi:10.1001/jamanetworkopen.2025.41330
