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ACS Research Highlights

3 out of 4 People Late for Screening Say Doctor Didn't Suggest It

Researchers found that only 26% of people who were overdue for colorectal cancer screening said their doctor recommended screening in the past year.

The Challenge

There's plenty of evidence that routine screening for colorectal cancer can find cancer at an earlier stage and in some cases even prevent it by removing precancerous polyps during colonoscopy. 

Studies also show that the strongest and most consistent reason people follow through on the screening guideline is because their doctor recommended it.

Yet, screening prevalence for colorectal cancer in the United States remains low. The question is: Are doctors talking about options for screening to their patients who have an average risk of developing colorectal cancer?

The Research

Jordan Baeker Bispo, PhD, MPH, principal scientist in ACS Cancer Disparity Research, led a study published as a letter in the Annals of Internal Medicine, that used data from the 2019 and 2021 National Health Interview Survey. She and her colleagues focused on adults ages 50 to 75 who said they were not up to date with colorectal cancer screening and had a wellness visit in the past year. They found that only about 1 of 4 of these adults reported that their doctor had recommended colorectal cancer screening. That means 3 out of 4 said their doctor didn't suggest cancer screening.

The researchers found that marginalized racial/ethnic groups were more likely to self-report that in the past 2 years, their doctor had not recommended colorectal cancer screening. People with a limited education or health insurance had similar reports.

  • The prevalence of discussions with a doctor was lower for Asian (12%), Hispanic (19%), and Black (22%) adults compared to White adults (32%). It was also lower for people who were not born in the US (17%) compared to those who were (30%).
  • The prevalence of discussions with a doctor was lower for those with less than a high school diploma (17%) than those with a college degree (29%).
  • The prevalence of discussions with a doctor was lower for people without health insurance (10%) compared to people with private health insurance (28%) and lower for people who did not have a usual source of care (10%) compared to those who did (28%).

Although clinicians overwhelmingly report that they recommend colorectal cancer screening to average-risk patients, limited data exist on the consistency with which they do so, and the low patient-reported prevalence in this study is alarming. The findings highlight a major communication gap about colorectal cancer prevention in the clinical setting.

Jordan Baeker Bispo, PhD, MPH

Cancer Disparity Research, Principal Scientist

Surveillance & Health Equity Science, American Cancer Society

White woman, long brown hair, blue eyes, brown sweater, light blue shirt collar

Other ACS researchers who contributed to this publication were: Priti Bandi, PhD, Ahmedin Jemal, DVM, PhD, and Farhad Islami, MD, PhD.

Why It Matters

This report highlights the need for concerted efforts to improve screening prevalence by investing in education at the level of patients, health providers, health systems, and the general population.

To advance progress toward national screening goals, evidence-based interventions might be particularly helpful among racial/ethnic and socioeconomic subgroups shown to have the lowest prevalence of screening. Some strategies may include health systems investing in:

  • Clinician training
  • Automated point-of-care prompts
  • Educational tools for shared decision-making with clinicians and diverse patient populations
  • Community outreach