Impact of 2021 United States cancer screening guideline changes on racial and ethnic differences in patient-reported adherence to age-appropriate colorectal cancer screening.

Abstract

10546 Background: In 2021, the US Preventive Services Task Force and the US Multi-Society Task Force on Colorectal Cancer updated screening guidelines to recommend that average-risk colorectal cancer (CRC) screening should begin at age 45. We used nationally representative survey data to assess CRC screening among patients across racial/ethnic groups ages 45-49 and 50+ before and after the 2021 guideline changes. Methods: 2019-2023 biannual data from the National Health Interview Survey (NHIS) was used to select individuals aged ≥45 years old who responded regarding receipt of appropriate CRC screening. Patients with prior history of CRC or missing data were excluded. Survey-adjusted percentages were used to characterize differences in CRC screening adherence by racial/ethnic group. Multivariable logistic regression models adjusting for age, gender, year, marital status, and geography generated adjusted odds ratios (aORs) with 95% CI to examine associations of race/ethnicity and CRC screening adherence. Results: 188,620 patients met inclusion criteria. Overall, patients aged ≥50 had similar CRC screening prevalence before and after guideline changes (58% vs. 61% pre- and post-change) while patients aged 45-49 years had a 10% increase in appropriate screening (21% vs 31% pre- and post-change); largest screening increase was in Non-Hispanic Black (13.92% increase) and Non-Hispanic Asian patients (12.76%) while smallest increase was noted in Hispanic patients (7.05% increase). Prior to guideline changes, among patients 45-49 years old, Asian patients (aOR: 0.45 95%CI: 0.24-0.86) were less likely to report cancer screening compared to non-Hispanic White patients. After guideline changes, among patients 45-49 years old, patients identifying as Asian (aOR: 0.56 95% CI 0.34-0.92) and Hispanic (aOR: 0.62 95% CI 0.41-0.94) were less likely to report age-appropriate cancer screening compared to non-Hispanic White patients, while there was no difference for non-Hispanic Black patients (aOR: 1.31 95% CI 0.91-1.89). Year-age interaction was significant (p < 0.001), while year-race interaction was not significant. Conclusions: Our study highlights that while patient-reported adherence to CRC screening increased among patients 45-49 years old after updated screening guidelines, screening disparities were observed among Asian and Hispanic patients. Guidelines had a distinct impact on pts aged 45-49 in relation to pts ≥50 who were not impacted by the changes. The time-race interaction was not significant, suggesting no evidence of improvement in the degree of disparity. Patient reported CRC screening rates after guideline changes among pts 45-49 is lagging compared to pts ≥50; further work is needed to implement the updated guideline recommendations and improve screening adherence.