New Data Suggest Revised Colorectal Cancer Screening Guidelines Strain Community Health Centers

New research published in Scientific Reports highlights the significant challenges faced by community health centers (CHCs) in adapting to the revised colorectal cancer (CRC) screening guidelines set forth by the US Preventive Services Task Force (USPSTF).

In May 2021, the USPSTF revised the CRC screening guidelines in response to the rising incidence of CRC in younger individuals with a grade B recommendation for screening initiation at age 45. After this revision, there were a significant number of additional adults eligible for CRC screening which may create challenges for CHCs as they are already underfunded and face various barriers to CRC screening, according to the study published online January 2, 2025.

Investigators conducted the current study to examine CRC screening rates across 10 CHCs in Massachusetts as well as estimate the additional increase in the number of average-risk adults aged 45 to 49 years following the revision of the USPSTF guidelines. A total of 70 808 individuals aged 45 to 75 years were included in the study. CRC screening was defined as being "up to date" or "not up to date" based on any of the approved screening modalities within the appropriate time frame. This included various screening methods such as colonoscopy and fecal immunochemical tests (FIT).

According to the results, the revised USPSTF CRC screening guidelines resulted in a 22.9% increase in patients eligible for screening at the participating CHCs. This increase poses a significant challenge for CHCs, which are already grappling with resource constraints. Many of these centers operate with limited funding and staffing, making it difficult to meet the heightened demand for screenings without additional support.

“Expanded financial resources should be imparted on CHCs through federal grants, and/or increased reimbursement and financial incentives from insurers to assist them in reaching this larger screening eligible population,” lead author Adjoa Anyane-Yeboa, MD, MPH, of Massachusetts General Hospital in Boston, and colleagues wrote.

The findings also showed that the overall CRC screening rate was 35.9%, with a start contrast in rates among different age groups. The screening rate was lowest among adults aged 45 to 49 years at 9.6%, and highest among those aged 55 to 75 years at 47.0%. This disparity underscores the urgent need for targeted interventions to engage younger populations in preventive care. In addition, Hispanic and White adults had the lowest CRC screening rates, whereas Asian and Black individuals had the highest.

“Future studies should include cost analyses of screening the population 45 to 49 and identify effective strategies that are low burden and do not add to the workload of CHC providers to improve screening at CHCs,” investigators concluded.

Reference: Anyane-Yeboa A, Bermudez H, Fredericks M, et al. The revised colorectal cancer screening guideline and screening burden at community health centers. Sci Rep. Published online January 2, 2025. doi:10.1038/s41598-024-83343-1