According to the American Cancer Society, colorectal cancer is the second-leading cause of cancer-related death in the United States. In 2023, the disease is expected to cause an estimated 52,550 deaths. Studies show that receiving a clinician recommendation is the strongest and most consistent determinant of colorectal cancer screening participation.

A study by researchers at the American Cancer Society investigating the prevalence of receiving a clinician recommendation for colorectal cancer screening among underscreened adults found that most—73.2%—reported they did not receive a screening recommendation from their clinician despite having attended a wellness visit in the past year. The study also found the prevalence of receiving a clinician recommendation was lowest among marginalized racial/ethnic and socioeconomic populations. These findings were published by Bispo et al in the Annals of Internal Medicine.

Study Methodology

The researchers pooled data from the 2019 and 2021 Centers for Disease Control and Prevention National Health Interview Survey. Their analysis included 5,022 adults who were overdue for a colorectal cancer screening, according to U.S. Preventive Services Task Force guidelines, and reported having had a wellness visit with their clinician in the past year. The dependent variable was receipt of a clinician recommendation for a colorectal cancer screening, measured using a survey item in which respondents answered “yes” or “no” to the question, “In the past 12 months, did a doctor or other health professional recommend you be tested to look for problems in your colon or rectum?”

This item was administered only to respondents who did not report guideline-concordant colorectal cancer screening. The researchers estimated the prevalence of reporting a clinician recommendation for colorectal cancer screening by age, survey year, sex, race/ethnicity, education, poverty status, nativity, urban or rural residence, comorbidity burden, insurance, and usual source of care.

The researchers used logistic regression models to estimate unadjusted and adjusted prevalence ratios. Respondents with missing data were excluded. Analyses were performed using survey-weighted methods that account for the complex sampling design of the National Health Interview Survey.

Low Rates of Clinician Recommendations

The researchers found that, overall, about one-quarter (26.8%) of the respondents reported receiving a clinician recommendation for colorectal cancer screening. By sociodemographic characteristics, the prevalence ranged from less than 10% for adults without a usual source of care to 32.0% for adults with a family income 400% above the federal poverty level.

In adjusted models, the prevalence of clinician recommendation for a colorectal cancer screening was lower for non-Hispanic Asian (adjusted prevalence ratio [aPR] = 0.53, 95% confidence interval [CI] = 0.37–0.75), non-Hispanic Black (aPR = 0.76, 95% CI = 0.63–0.92), and Hispanic (aPR = 0.82, 95% CI = 0.67–1.01) adults than non-Hispanic White adults. It was lower for those with less than a high school education (aPR = 0.76, 95% CI = 0.61–0.95) than for those who completed college and lower for uninsured adults (aPR = 0.51, 95% CI = 0.38–0.68) than for those with private insurance. Estimates were similar in a sensitivity analysis that excluded respondents without insurance or a usual source of care.

Clinical Significance

“We’re missing one of the best opportunities, while visiting the doctor, to remind adults to get screened for this potentially deadly disease,” said Jordan Baeker Bispo, PhD, MPH, Principal Scientist of Cancer Disparity Research at the American Cancer Society and lead author of the study, in a statement. “These findings are alarming, as they highlight a major communication gap about colorectal cancer prevention in the clinical setting.”

Disclosure: For full disclosures of the study authors, visit acpjournals.org.