Investigators called attention to low patient-reported levels of clinician recommendation for colorectal cancer screening during wellness visits, noting the prevalence was lowest among those without insurance and without a usual source of care.
Results from a recent analysis are sounding the alarm on an apparent lack of screening recommendations for patients overdue for colorectal cancer screenings.
The analysis, which examined a cohort of more than 5000 adults overdue for colorectal cancer screening, suggested less than 30% of patients received a recommendation for screening during their wellness visit, with this rate falling to less than 15% among those without a usual source of care and the uninsured.1
“Although clinicians overwhelmingly report that they recommend [colorectal cancer] screening to average-risk patients, limited data exist on the consistency with which they do so, and the low patient- reported prevalence in this study is alarming,” wrote investigators.1
According to the National Cancer Institute, colorectal cancer represents 7.8% of all new cancer cases in the US and is the fourth most common type of cancer behind breast cancer, prostate cancer, and lung and bronchus cancer.2 The US Preventive Services Task Force recommends colorectal cancer screening for adults age 45-75 years and suggests adults age 76-85 years discuss screening with their doctor.3 Screening tests can prevent colorectal cancer or aid in early detection before it spreads to other parts of the body.4
The current study was led by Jordan Baeker Bispo, PhD, MPH, principal scientist of cancer disparity research for the American Cancer Society, and a team of colleagues with the intent of estimating the prevalence of clinician recommendations for colorectal screening among underscreened adults. To do so, investigators designed their study using data from 61,479 patients who completed the 2019 and 2021 National Health Interview Survey. To be included in the study, patients were required to be age-eligible for screening, assessed for guideline-concordant screening, not up to date with screening guidelines, and have had a wellness visit in the past year.1
Investigators measured receipt of a clinician recommendation for colorectal cancer screening by asking participants “In the past 12 months, did a doctor or other health professional recommend that you be tested to look for problems in your colon or rectum?”. The survey was administered only to respondents who did not report guideline-concordant colorectal cancer screening. Investigators estimated the prevalence of reporting a clinician recommendation for screening by age, survey year, sex, race/ethnicity, education, poverty status, nativity, urban or rural residence, comorbidity burden, insurance, and usual source of care. Logistic regression models were used to estimate unadjusted and adjusted prevalence ratios.1
In total, 5022 patients who were eligible and overdue for colorectal cancer screening were included in the analysis. Of these participants, 1425 (26.8%) reported receiving a clinician recommendation for colorectal cancer screening. Prevalence was lowest among patients without a usual source of care (9.7%) and who were uninsured (12.6%), although investigators pointed out estimates were similar in a sensitivity analysis excluding respondents without insurance or a usual source of care.1
In adjusted models, the prevalence of reporting a clinician recommendation for colorectal cancer screening was lower among non-Hispanic Asian (adjusted prevalence ratio [aPR], 0.53 [95% CI, 0.37-0.75]), non-Hispanic Black (aPR, 0.76 [95% CI, 0.63-0.92]), and Hispanic (aPR, 0.82 [95% CI, 0.67-1.01]) adults than non-Hispanic White adults. Additionally, receipt of a clinician recommendation was less likely for those with less than a high school education (aPR, 0.76 [95% CI, 0.61-0.95]) relative to those who completed college as well as for uninsured adults (aPR, 0.51 [95% CI, 0.38-0.68]) compared to their counterparts with private insurance.1
“The findings highlight a major communication gap about [colorectal cancer] prevention in the clinical setting. At the systems level, investing in clinician training, automated point-of-care prompts, educational tools for shared decision making with diverse patient populations, and community outreach may improve patient–clinician communication about [colorectal cancer] screening and advance progress toward national screening goals,” concluded investigators.1
1. Bispo JB, Bandhi P, Jemal A, et al. Receipt of Clinician Recommendation for Colorectal Cancer Screening Among Underscreened U.S. Adults. Annals of Internal Medicine. September 11, 2023. doi:10.7326/M23-1341
2. National Cancer Institute. Cancer Stat Facts: Colorectal Cancer. Reports on Cancer. Accessed September 11, 2023. https://seer.cancer.gov/statfacts/html/colorect.html
3. U.S. Preventive Services Task Force. Colorectal Cancer: Screening. Recommendation Topics. May 18, 2021. Accessed September 11, 2023. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening
4. Centers for Disease Control and Prevention. United States Cancer Statistics Colorectal Cancer Stat Bite. Stat Bites. Accessed September 11, 2023. https://www.cdc.gov/cancer/uscs/about/stat-bites/stat-bite-colorectal.htm