S257 Persistent Racial and Ethnic Disparities in Colorectal Cancer Screening: A Tell-Tale Sign for New Guidelines

Abstract

Introduction: Colorectal cancer (CRC) screening can reduce CRC incidence and mortality; however, screening participation is low in minority populations. The U.S. Preventive Services Task Force recently recommended lowering the age to initiate CRC screening from 50 to 45 years, raising concerns that implementing new guidelines will exacerbate well-known race/ethnicity disparities in screening. To address this gap, we examined temporal trends in CRC screening by age and race/ethnicity in a population-based sample. Methods: We estimated the proportion of adults (age 50-75 years) up-to-date with CRC screening using population-based data from the National Health Interview Survey. We examined temporal trends in screening during the period 2000-2018, overall and by age (50-54, 55-59, 60-64, 65-69, and 70-75 years) and race/ethnicity (White, Hispanic, Black, Asian). In parallel, we examined trends in colonoscopy use in adults age 45-49 years. Results: In adults age 50-75 years, the overall proportion up-to-date with CRC screening increased from 36.7% in 2000 to 66.1% in 2018. By 2018, screening rates were 68.7%, 64.4%, 56.5%, and 57.1% in Whites, Blacks, Hispanics, and Asians, respectively (Figure 1). The increase was significant in all race and ethnicity groups, but Hispanics and Asians remained less likely to undergo screening compared to Whites and Blacks (all P < 0.01). CRC screening was lowest among newly eligible individuals age 50-54 years. Differences in screening by race/ethnicity were concentrated in this youngest age group but disappeared over time in older groups. For example, screening rates were 51.0%, 50.0%, 35.5%, and 32.2% for adults age 50-54 years (Figure 1) and 78.4%. 78.1%, 78.1%, and 69.0% for adults 70-75 years (Figure 1F) in Whites, Blacks, Hispanics, and Asians, respectively. Hispanics and Asian Adults age 50-54 years were less likely to be screened compared to Whites and Blacks from 2000 to 2018 (all P < 0.01). In adults age 45-49 years, colonoscopy use increased from 6.5% in 2000 to 17.7% in 2018 and was lowest among Hispanics and Asians. Conclusion: CRC screening has increased over 2000 to 2018 in all racial, ethnicity and age groups. Uptake remains low in certain segments, particularly newly eligible Hispanic and Asian adults age 50-54 years. Disparities observed in adults age 50-54 years may occur in adults age 45-49 years as new recommendations are implemented. Care must be taken to ensure the benefits of CRC screening are realized equitably by all race/ethnicity and age groups.Figure 1.: Proportion of adults up-to-date with colorectal cancer screening by age and race/ethnicity group.