Colorectal Cancer Screening In Younger Adults Increases After Guideline Changes

After the American Cancer Society (ACS) and US Preventive Services Task Force (USPSTF) lowered the recommended starting age for colorectal cancer (CRC) screening to age 45, the proportion of screenings in 45- to 49-year-olds jumped from 2.9% to 17.8%, representing a 955% increase in monthly screening volume among that age group, a new study has found.1

Screening among 45- to 49-year-olds rose nearly 10-fold in hospitals after US guideline updates, but disparities persist. | Image credit: Thitiporn - stock.adobe.com

The cohort study is published in JAMA Network Open.

“The findings of this cohort study suggest that facility-based CRC screening among adults aged 45 to 49 years increased nearly 10-fold following USPSTF guideline changes, far exceeding growth among those aged 50 to 75 years,” wrote the researchers of the study. “This rapid adoption highlights early implementation by practitioners and patients.”

In May 2021, the USPSTF issued updated guidance recommending that average-risk adults begin screening for CRC, lowering the previous starting age of 50.2 Following publication of this recommendation, real-world data from privately insured individuals aged 45 to 49 years showed a marked increase in screening uptake. However, uptake was uneven overall, with higher screening rates among people in metropolitan areas and those living in regions of higher socioeconomic status—highlighting persistent disparities despite the guideline change.

This cohort study analyzed CRC screening trends using data that captured information from more than 1350 hospitals across the US. Researchers looked at screening encounters among adults aged 45 to 75 years from 2016 through 2024, dividing the timeline into 3 periods that aligned with major guideline updates: before recommendations began shifting, during the transition period, and after screening was officially recommended starting at age 45 years.1

The researchers examined how much screening increased among those aged 45 to 49 years, how monthly volumes changed over time, and whether patterns differed by factors such as race, ethnicity, or community socioeconomic status. Socioeconomic vulnerability was assessed using an index based on where patients lived, while demographic information came from self-reported data in electronic health records.

Among more than 7.8 million CRC screenings, the share of patients aged 45 to 49 years jumped from 2.9% before the guideline changes to 17.8% afterward. The average monthly screenings for this younger group grew nearly 10-fold, a 955% increase compared with a 46% rise among those aged 50 to 75 years.

After the guideline update, most screenings in those aged 45 to 49 years were among women, non-Hispanic White individuals, those with commercial insurance, and people living in neighborhoods with average socioeconomic conditions.

“This rapid adoption highlights early implementation by practitioners and patients," wrote the researchers. "Although screening rates among adults aged 50 to 75 years increased during the study period, the accelerated growth among those aged 45 to 49 years reflected guideline integration into facility practices. Increases during the interim period across both groups may reflect public health campaigns and early uptake of the ACS recommendation before USPSTF changes.”

However, there were fewer non-Hispanic Black individuals, Medicare enrollees, and residents of high-vulnerability areas, while Hispanic representation increased, highlighting ongoing disparities in screening uptake.

The researchers acknowledged several limitations to their results. Their report only included facility-based screenings, so at-home tests and screenings at certain hospital types weren’t captured. Differences in coding and underrepresentation of smaller or rural hospitals may have limited how broadly the findings apply. Additionally, the study periods were relatively short, which may have made it harder to assess long-term trends in screening patterns.

Despite these limitations, the researchers believe the study findings demonstrate that lowering the recommended starting age for CRC screening to 45 led to a substantial increase in screenings among younger adults, even though disparities exist.

“These findings reflect CRC screening in hospitals, where guideline adoption is critical to shaping clinical practice and building momentum toward broader public health impact,” wrote the researchers. “Continued efforts to sustain this momentum may help optimize uptake. Although opportunities remain to address disparities and investigate at-home screening, this highlights the early success of facility-based guideline implementation.”

References

1. Harris AH, Murphy HR, McDowell M, et al. Facility-based uptake of colorectal cancer screening in 45- to 49-year-olds after US guideline changes. JAMA Netw Open. 2025;8(11):e2541330. doi:10.1001/jamanetworkopen.2025.41330

2. Bonavitacola J. CRC screening increases in patients aged 45 to 49 after USPSTF recommendation. AJMC®. October 7, 2024. Accessed December 1, 2025. https://www.ajmc.com/view/crc-screening-increases-in-patients-aged-45-to-49-after-uspstf-recommendation