Abstract A111: Evaluation of colorectal cancer screening uptake: Multiple cross-sectional analyses from BRFSS 2021-2024 in the newly eligible population aged 45-49

Abstract

In 2021, colorectal cancer (CRC) screening guidelines were updated to recommend screening beginning at age 45 for adults at average risk, expanding eligibility to millions of additional Americans. Whether this change translated into higher screening rates across the United States, and if the improvements were consistent across different populations, remains unclear. This study evaluated national trends in CRC screening among newly eligible adults aged 45-49 from 2021 through 2024. We analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS), a large, nationally representative survey of U.S. adults (n = 587,859; 54,065 in the newly eligible group). Self-reported CRC screening rates among newly eligible adults were compared across survey years (2021–2024). We also examined differences in screening by demographic characteristics, income, and health behaviors using statistical models to evaluate changes over time across multiple cross-sectional surveys. Self-reported CRC screening increased significantly over the study period, from 34.5% (95% CI 31.2–37.9%) in 2021 to 49.8% (95% CI 49.2–50.4) in 2024 (Chi-Square, p<0.001). However, improvements were not uniform across population groups. Women and non-Hispanic adults were more likely to report screening in later years, while screening among Hispanic adults also showed improvement over time (ANOVA, p<0.001). Income remained a strong predictor of screening, with the largest gains observed among higher-income individuals and more limited improvement among lower-income groups (ANOVA, p<0.05). Tobacco users were consistently less likely to report screening than non-users, despite overall increases in screening (ANOVA, p<0.05). Screening patterns also varied substantially across states, suggesting differences in implementation and uptake of the updated screening recommendations. CRC screening among adults newly eligible under the updated guidelines increased substantially between 2021 and 2024, but important disparities remain. Geographic variation and persistent differences by income and tobacco use suggest that expanded eligibility alone may not be sufficient to achieve equitable screening. Continued surveillance and targeted interventions will be important to improve screening participation among underserved populations and reduce disparities in CRC prevention. Jesus M. Luevano, Hwanseok Choi, Brian Rivers, Julia Liu. Evaluation of colorectal cancer screening uptake: Multiple cross-sectional analyses from BRFSS 2021-2024 in the newly eligible population aged 45-49 [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr A111.