Po-Hong Liu

Supplementary Data from Persistent Disparities in Colorectal Cancer Screening: A Tell-Tale Sign for Implementing New Guidelines in Younger Adults

Background:In May 2021, the U.S. Preventive Services Task Force began recommending initiating colorectal cancer screening at age 45 (vs. 50) years.Methods:We estimated prevalence of colorectal cancer screening (by colonoscopy, sigmoidoscopy, CT colonography, or stool-based tests) in adults ages 50 to 75 years using data from the National Health Interview Survey in 2000, 2003, 2005, 2008, 2010, 2013, 2015, and 2018. For each survey year, we estimated prevalence by age, race/ethnicity, educational attainment, family income, and health insurance. We also compared increases in prevalence of screening from 2000 to 2018 in 5-year age groups (50–54, 55–59, 60–64, 65–69, and 70–75 years).Results:Overall, prevalence of colorectal cancer screening increased from 36.7% in 2000 to 66.1% in 2018. Screening prevalence in 2018 was lowest for age 50 to 54 years (47.6%), Hispanics (56.5%), Asians (57.1%), and participants with less than a high school degree (53.6%), from low-income families (56.6%), or without insurance (39.7%). Increases in prevalence over time differed by five-year age group. For example, prevalence increased from 28.2% in 2000 to 47.6% in 2018 (+19.4%; 95% CI, 13.1–25.6) for age 50 to 54 years but from 46.4% to 78.0% (+31.6%; 95% CI, 25.4%–37.7%) for age 70 to 75 years. This pattern was consistent across race/ethnicity, educational attainment, family income, and health insurance.Conclusions:Prevalence of colorectal cancer screening remains low in adults ages 50 to 54 years.Impact:As new guidelines are implemented, care must be taken to ensure screening benefits are realized equally by all population groups, particularly newly eligible adults ages 45 to 49 years.See related commentary by Brawley, p. 1671

Nationwide datasets are frequently used to examine cancer trends and outcomes in the U.S. Understanding the strengths and limitations of the commonly used Surveillance, Epidemiology, and End Results (SEER) Program and the National Cancer Database (NCDB) is important when designing studies and interpreting results. We used colorectal cancer (CRC) as a case study to compare information available. We identified 575,128 (SEER) and 1,578,046 (NCDB) adults diagnosed with CRC between 2004 and 2021. The distribution of age, tumor location, stage, and treatment did not meaningfully differ between SEER and NCDB. SEER represents racially and ethnically diverse populations, including a higher proportion of Hispanic (11.7% vs 5.8%) and Asian/Pacific Islander (8.6% vs 3.3%) persons. SEER includes more information on area-level characteristics, such as county-level measures of poverty, unemployment, and migration and census tract-level measures of socioeconomic status. Age-adjusted incidence, mortality rates, and cause-specific survival are only available in SEER, facilitating detailed analyses of racial, ethnic, and socioeconomic differences in cancer incidence and mortality. NCDB provides information on tumor characteristics and treatment not available in SEER, including microsatellite instability, KRAS mutation, palliative treatment, unplanned readmissions, and 30-day mortality after surgery, facilitating analyses of treatment effectiveness and outcomes. Five-year overall survival was similar in SEER (55.6%) vs NCDB (57.5%).

This figure depicts reasons for unsatisfactory FIT based on type of FIT

This table shows results of sensitivity analysis - Factors associated with subsequent testing within 9 months among patients with unsatisfactory fecal immunochemical test

This figure depicts CRC screening programs at Parkland over the study period

This table tabulates reasons for unsatisfactory FIT based on free-text responses entered by laboratory technician in EHR

This table shows subsequent testing patterns within 15 months after an unsatisfactory FIT

This table shows subsequent testing patterns within 15 months after an unsatisfactory FIT