Colorectal cancer screening and detection following USPSTF recommendations for ages 45-49: Insights from a large EHR cohort.

Abstract

3623 Background: Rising colorectal cancer (CRC) incidence in relatively younger adults prompted the US Preventative Services Task Force (USPSTF) to recommend screening in average-risk adults aged 45-49 in May 2021. While screening has increased for ages 45-49, differences in polyp and CRC detection by age group are unclear. Methods: Using a subset of Truveta Data, we identified patients aged 40-64, with no prior history of CRC, who underwent CRC screening procedures (colonoscopy or sigmoidoscopy) between 2018 and 2024, and for whom an associated report was available. Truveta Data contains de-identified electronic health record (EHR) data from a collective of US health care systems. Screening outcomes were extracted from pathology reports using natural language processing, including findings of polyps (tubular adenoma/adenomatous polyp, hyperplastic polyp, tubulovillous adenoma, sessile serrated adenoma, traditional sessile adenoma, juvenile polyp, and inflammatory polyp), adenocarcinoma, and benign/normal colonic mucosa. For patients with multiple screenings, the first was used. Family history of CRC and related syndromes (e.g., Lynch, Peutz-Jeghers) were similarly extracted from notes. Patient characteristics and screening outcomes were described by 5-year age band, before and after May 2021 USPSTF recommendations. Results: Of85,062 patients aged 40-64 who underwent CRC screening, 46,168 had first screening records in May 2021 or earlier (‘pre period’) and 38,894 after (‘post period’). In the pre period, 4,270 (9%) patients were aged 45-49, compared to 7,403 (19%) in the post period. Sex balance improved for the 45-49 age group (56% were female pre vs. 50% post; p < 0.05), compared to younger and older age groups (40-44: 57% vs. 57%, 50-54: 48% vs. 48%, 55-59: 51% vs.49%, 60-64: 50% vs. 49%; < 0.05 for 55-59 only). Adenomatous polyp findings increased for all age groups, but to the greatest degree for the 45-49 group (45-49: 45.7% pre vs. 53.4% post; p < 0.01) compared to other groups (40-44: 33.1% vs. 35.9%, 50-54: 58.3% vs. 59.9%, 55-59: 60.4% vs. 62.5%, 60-64: 63.2% vs. 64.5%; all p < 0.05). In contrast, adenocarcinoma findings occurred less frequently for ages 45-49 (2.1% pre vs. 1.0% post, p < 0.01), while remaining stable in both younger and older groups (40-44: 1.6% vs. 1.4%, 50-54: 1.2% vs. 1.1%, 55-59: 1.4% vs. 1.6%, 60-64: 1.3% vs. 1.3%; all p > 0.05). Conclusions: Following 2021 USPSTF CRC screening recommendations for average-risk adults aged 45-49, sex balance in screening increased, findings of adenomatous polyps increased, and findings of adenocarcinoma declined in this group. These results may reflect expected decreases in adenocarcinoma detection with expansion of screening to average-risk adults, or suggest that recommendations contributed to earlier detection of pre-cancerous polyps, before progression to adenocarcinoma. Additional studies are needed to explore complex causal relationships.