Lila J. Finney Rutten, PhD, MPH1, Philip Parks, MD, MPH2, Emily Weiser, MPH2, Chun Fan, MS1, Debra J. Jacobson, MS1, Gregory D. Jenkins, MS1, Xuan Zhu, PhD1, Joan M. Griffin, PhD1, Paul J. Limburg, MD, MPH1; 1Mayo Clinic, Rochester, MN; 2Exact Sciences Corporation, Madison, WI
Introduction: For most professional organizations in the US, including the US Preventive Services Task Force, age 50 years is the historical threshold for initiating average risk colorectal cancer (CRC) screening. In 2018, in response to increasing CRC incidence and mortality in younger patients, the American Cancer Society issued a qualified recommendation to begin average-risk CRC screening at age 45 years. Provider recommendation is the most consistent factor associated with CRC screening; thus, it is critical to understand clinician perspectives on the appropriate age for initiation. Methods: We implemented a web survey with an online panel of primary care clinicians (PCCs) and gastroenterologists (GIs) to assess CRC screening knowledge, attitudes, and behaviors. Data were collected from November-December, 2019. Clinicians were asked: “Should the age to begin CRC screening for patients at average risk of developing CRC be lowered from age 50 to age 45?” We evaluated bivariate (Chi-square) and multivariable (logistic regression) associations of clinician- and practice-level factors associated with agreement. Results: Survey responses were received from 814 PCCs and 159 GIs. The survey completion rate was 25.3% for PCCs and 29.6% for GIs. Respondents who indicated specialties other than primary care or gastroenterology (n=13) and those who reported that they do not recommend CRC screening to their average risk patients or if they reported a CRC mode preference other than gFOBT, FIT, Cologuard, or colonoscopy (n=42) were excluded from our analyses, resulting in a total analytic sample of n=938. While 38.1% of PCCs agreed with lowering the screening initiation age to 45 years, 75.5% of GIs agreed (p< .0001). In multivariable analyses, GIs were over 5 times (OR=5.30; 95% CI 3.54-7.93) more likely than PCCs to endorse lowering the CRC screening initiation age to 45 years. Other factors found to be independently associated with preference for earlier initiation included seeing more than 25 patients per day (vs. fewer) and suburban (vs. urban) location of clinic (Table 1). Discussion: In this national survey, GIs expressed stronger support for initiating average-risk CRC screening at a younger age, compared to PCCs. These data emphasize the need for collaboration between PCCs and GIs to define and discuss the public health implications of earlier-onset CRC screening and ensure that patients receive consistent messaging and optimal evidence-based care.
Table 1. Characteristics of primary care clinicians and gastroenterologists based on agreement to lowering CRC screening start age to 45.
Disclosures: Lila Finney Rutten: Exact Sciences – Other Financial or Material Support, LJFR offers scientific input to research studies through a contracted services agreement between Mayo Clinic and Exact Sciences.. Philip Parks: Exact Sciences – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds). Emily Weiser: Exact Sciences – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds). Chun Fan indicated no relevant financial relationships. Debra Jacobson indicated no relevant financial relationships. Gregory Jenkins indicated no relevant financial relationships. Xuan Zhu indicated no relevant financial relationships. Joan Griffin indicated no relevant financial relationships. Paul Limburg: Exact Sciences – Other Financial or Material Support, PJL serves as Chief Medical Officer for Exact Sciences through a contracted services agreement with Mayo Clinic. PJL and Mayo Clinic have contractual rights to receive royalties through this agreement..