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From the Journals

USPSTF Recommendation Boosts Colorectal Cancer Screening Rates

A nationwide study of over 10 million privately insured individuals found that colorectal cancer screening uptake among 45- to 49-year-olds tripled after the 2021 USPSTF recommendation, with 13.9% receiving screening before age 50.

Conexiant

A nationwide cohort study of over 10 million privately insured individuals found that colorectal cancer screening uptake increased significantly among those aged 45 to 49 years after the U.S. Preventive Services Task Force issued its recommendation in May 2021 encouraging screening in this age group.

In the study, published in JAMA Network Open, investigators analyzed de-identified claims data from Blue Cross Blue Shield beneficiaries aged 45 to 49 years across the United States between January 1, 2017, and December 31, 2022.

The study compared colorectal cancer screening uptake between a 20-month period preceding (May 1, 2018, to December 31, 2019) and a 20-month period following (May 1, 2021, to December, 31, 2022) the U.S. Preventive Services Task Force (USPSTF) recommendation. The investigators categorized the 72 months from January 1, 2017, through December 31, 2022, into 36 consecutive 2-month periods.

The study cohort included 10.2 million distinct beneficiaries aged 45 to 49 years (mean age = 47.04 years, 51.04% female). Bimonthly mean numbers of average-risk beneficiaries were 3.2 million in the prerecommendation period and 2.9 million in the postrecommendation period.

Among the key findings included:

  • Mean bimonthly screening uptake increased from 0.50% to 1.51% among average-risk patients (P < .001).
  • The absolute change in screening uptake was 1.01 percentage points (95% confidence interval [CI] = 0.62–1.40 percentage points) for average-risk patients.
  • Beneficiaries residing in areas with the highest socioeconomic status experienced the largest absolute change in screening (1.25 percentage points, 95% CI = 0.77–1.74 percentage points).
  • After the recommendation, screening uptake increased fastest among those in areas with highest socioeconomic status (0.24 percentage points every 2 months, 95% CI = 0.23–0.25) and metropolitan areas (0.20 percentage points every 2 months, 95% CI = 0.19–0.21).
  • Overall, 13.9% of beneficiaries aged 45 to 49 years during the postrecommendation period received colorectal cancer (CRC) screening prior to age 50.

Screening modalities and trends:

  • In the prerecommendation period, colonoscopy accounted for 41.3% of all screening tests followed by fecal immunochemical test (FIT) at 32.2% and fecal occult blood test at 24.6%.
  • In the postrecommendation period, colonoscopy remained the most common modality (52.7%) followed by stool DNA test (25.0%) and FIT (16.2%).
  • During the first wave of the COVID-19 pandemic (March and April 2020), screening was almost eliminated in this age group but recovered to prepandemic levels by September 2020.

Subgroup analyses revealed:

  • Females had higher uptake in the postrecommendation period (1.56% vs 1.46% among males), but the difference was not statistically significant (P = .69).
  • Beneficiaries in the highest socioeconomic status (SES) areas had significantly higher uptake (1.84%) compared with those in the lowest SES areas (1.19%) in the postrecommendation period (P = .02).
  • Metropolitan residents had higher uptake compared with nonmetropolitan residents in both periods (0.53% vs 0.38% prerecommendation, 1.59% vs 1.11% postrecommendation).
  • No statistically significant differences were observed between White beneficiaries and other racial/ethnic groups in the postrecommendation period. However, race and ethnicity data were only available for 35.2% and 32.1% of the beneficiaries during the prerecommendation and postrecommendation periods, respectively.

The study used interrupted time-series analysis and autoregressive integrated moving average (ARIMA) models to evaluate changes in screening rates, adjusting for temporal autocorrelation and seasonality.

ARIMA model results showed:

  • Overall cohort: Screening uptake increased 0.19 percentage points (95% CI = 0.18–0.20) every 2 months after the recommendation.
  • Highest SES areas: 0.24 percentage points (95% CI = 0.23–0.25) increase every 2 months.
  • Lowest SES areas: 0.14 percentage points (95% CI = 0.12–0.15) increase every 2 months.
  • Metropolitan areas: 0.20 percentage points (95% CI = 0.19–0.21) increase every 2 months.
  • Nonmetropolitan areas: 0.16 percentage points (95% CI = 0.15–0.17) increase every 2 months.

The investigators identified CRC screening using claims for fecal occult blood test, FIT, stool DNA test, flexible sigmoidoscopy, double-contrast barium enema, colonoscopy, and computed tomography colonography. To distinguish screening from diagnostic procedures, only outpatient procedures were included, and individuals with claims for gastrointestinal symptoms within 3 months preceding the period were excluded.

The Social Deprivation Index, a composite measure of area-level deprivation based on seven demographic characteristics from the American Community Survey, was calculated using beneficiaries' zip code of residence. Beneficiaries' locality was categorized as metropolitan or nonmetropolitan using rural-urban commuting area codes.

While the study provided comprehensive data on CRC screening uptake following the USPSTF recommendation, limitations included the lack of race and ethnicity data for a significant portion of the cohort and the focus on privately insured individuals, which may not be fully representative of the general U.S. population.