One-Third of US Adults Aged 45-49 Were Up-to-Date on Colorectal Cancer Screening in 2023

New data published in JAMA showed significant increases in colorectal cancer (CRC) screening uptake among US adults aged 45 to 49 years, aligning with updated guidelines recommending earlier screening to combat rising CRC incidence in this age group.

Between 2019 (before the American Cancer Society and US Preventive Services Task Force [USPSTF] lowered the recommended starting age) and 2023, the share of US adults aged 45 to 49 who were up-to-date with CRC screening jumped from 20.8% to 33.7%, according to a cross-sectional analysis of National Health Interview Survey (NHIS) data.

Colonoscopy remained the dominant modality (27.7%) in 2023, but the absolute increase was largest for stool-based testing, which more than quintupled to 7.1% over the study period, according to first author Jessica Star, MA, MPH, of the American Cancer Society, and colleagues.

"From 2019 to 2023, CRC screening increased among US adults aged 45 to 49 years, consistent with a previous report among certain commercially insured adults aged 45 to 49 years in late 2021-2022," Star and colleagues wrote. "This trend is encouraging because screening reduces CRC mortality, mostly through the detection and removal of potentially precancerous lesions."

Investigators compared CRC screening prevalence in 2019, 2021, and 2023 NHIS waves. The nationally representative household survey achieved response rates of 59.1%, 50.9%, and 47%, respectively. Logistic regression adjusted for age, sex, race and ethnicity, education, and region to generate adjusted prevalence ratios (APRs).

Researchers found colonoscopy prevalence among adults aged 45-49 increased from 19.5% in 2019 and 17.8% in 2021 to 27.7% in 2023 (APR 1.43, 95% CI 1.26–1.62). Similarly, stool-based testing rose from 1.3% in 2019 and 2.7% in 2021 to 7.1% in 2023, corresponding to an APR of 5.37 (95% CI, 3.36–8.57).

Screening for adults aged 50 to 75 years remained largely stable, suggesting no reduced access for older individuals. Yet the possible lack of progress among lower-educated and uninsured individuals may foreshadow widening disparities," Star and colleagues concluded. "Strategies to improve screening include mailed fecal immunochemical testing interventions, timely referrals by primary care physicians, and delegation of select average-risk screening referrals to nonphysicians."

Source: Star J, Siegel RL, Smith RA, et al. Trends in colorectal cancer screening in US adults aged 45-49 years. JAMA. Published online August 4, 2025. doi:10.1001/jama.2025.10618