Cosmos Study

Colorectal Cancer Screening Rates on the Rise Following Guideline Expansion

March 10, 2023

Team A:Brad Fox, MDBrendan Joyce

Team B:Steve Allen, MDSam Sahakian

Key Findings

Overall, colorectal cancer screening rates increased from January 2018 through December 2022, largely due to a recent increase in screenings among 45–49-year-olds.
During the same time period, colorectal cancer diagnosis rates decreased for those over age 50, driven mostly by a decrease in diagnoses in those over age 65.
In the second quarter of 2021, national guidelines expanded to include colorectal cancer screening for 45–49-year-olds. For that age group, between Q2 2021 and Q4 2022, we observed:
- Screening rates more than double.
- Pre-cancerous polyp diagnosis rates more than double for females and triple for males.
- Colorectal cancer diagnosis rates increase by half in males but no significant increase in females.

In May 2021, the U.S. Preventative Services Task Force (USPSTF) expanded its colorectal cancer screening recommendation to include all adults aged 45 to 49. This change required private insurance and Medicare to cover the costs of screening for the expanded population, per the Affordable Care Act (ACA).^1,2

To further understand colorectal cancer screening and diagnosis rates and the potential influence of the expanded age range for screening, we reviewed records from 66,545,809 patients from 2018 through 2022. Colorectal cancer screening rates by age group and sex are shown in Figure 1. For the 45–49-year-old population, screening rates more than doubled following the change in screening guidelines and insurance coverage for colorectal cancer screening in 2021. Between Q2 of 2021 and Q4 of 2022, screenings increased from 3,386 per 100,000 patients to 8,068 per 100,000 patients in females and from 3,743 per 100,000 patients to 9,885 per 100,000 patients in males.

Figure 1

Colorectal Cancer Screening Rates

Figure 1. Quarterly rates of colorectal cancer screening per 100,000 patients stratified by sex and age group. Patients under age 45 are not currently included in USPSTF’s recommendation for colorectal cancer screenings.

Polyp diagnosis rates also increased during the same time period for 45–49-year-olds, as seen in Figure 2. Polyp diagnosis rates in this age group increased from 368 diagnoses per 100,000 patients to 954 diagnoses per 100,000 patients for females and increased from 471 diagnoses per 100,000 patients to 1,468 diagnoses per 100,000 patients for males.

Figure 2

New Polyp Diagnosis Rates

Figure 2. Quarterly rates of new polyp diagnosis per 100,000 patients stratified by sex and age group.

Overall, the rate of colorectal cancer diagnosis decreased from 2018 to the end of 2022. This was largely driven by a decrease in colorectal cancer diagnosis rates in patients aged 65 and older, as seen in Figure 3, which aligns with previous reports by the National Cancer Institute and the American Cancer Society.^3,4,5 However, in the 45–49-year-old male population, the diagnosis rate has increased since the expansion of the screening recommendation, with a rate of 34 diagnoses per 100,000 patients in Q2 2021, compared to 51 diagnoses per 100,000 patients in Q4 2022. Our findings align with recent studies that suggest colorectal cancer diagnoses decreased from 2018 to 2020 and add to these findings by including data from 2021 and 2022.^3,4,5

Figure 3

New Colorectal Cancer Diagnosis Rates

Figure 3. Quarterly rates of new colorectal cancer diagnosis per 100,000 patients stratified by sex and age group.

These data come from Cosmos, a HIPAA-defined Limited Data Set of more than 183 million patients from 193 Epic organizations including 1,119 hospitals and more than 24,700 clinics, serving patients in all 50 states and Lebanon. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions.

References

U.S. Preventive Services Task Force. Colorectal cancer: screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening. Accessed January 24, 2023.
American Cancer Society. Insurance coverage for colorectal cancer screening. https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/screening-coverage-laws.html. Accessed January 24, 2023. https://doi.org/10.3322/caac.21772. Accessed 5 Mar. 2023.
National Cancer Institute: Surveillance, Epidemiology, and End Results Program. Colon and rectum: recent trends in SEER age-adjusted incidence rates, 2000-2019. https://seer.cancer.gov/statistics-network/explorer/application.html?site=20&data_type=1&graph_type=2&compareBy=age_range&chk_age_range_1=1&chk_age_range_9=9&chk_age_range_141=141&chk_age_range_157=157&rate_type=2&sex=1&race=1&stage=101&advopt_precision=1&advopt_show_ci=on&hdn_view=0&advopt_show_apc=on&advopt_display=2#graphArea. Accessed January 24, 2023.
Fedewa, Stacey A., et al. “Changes in Cancer Screening in the US during the COVID-19 Pandemic.” JAMA Network Open, vol. 5, no. 6, 3 June 2022, p. e2215490, https://doi.org/10.1001/jamanetworkopen.2022.15490. Accessed 3 Aug. 2022.
‌Siegel, Rebecca L., et al. “Colorectal Cancer Statistics, 2023.” CA: A Cancer Journal for Clinicians, Mar. 2023, American Cancer Society. https://doi.org/10.3322/caac.21772. Accessed on March 9, 2023.