Colorectal Cancer Screening and Health-Related Social Needs in a National Sample of US Adults

JAMA Network Open · 2026-04-09

Importance: Health-related social needs (HRSNs) may impede colorectal cancer (CRC) screening among US adults, yet population-based evidence on these associations remains limited. Objective: To examine associations between HRSNs and CRC screening uptake overall and by age group among US adults. Design, Setting, and Participants: This cross-sectional study used data from the 2023 National Health Interview Survey. Participants were US civilian, noninstitutionalized adults aged 45 to 75 years eligible for CRC screening. Age-stratified analyses were conducted for adults aged 45 to 49 years, 50 to 64 years, and 65 to 75 years. Data analysis was performed from April 2025 to February 2026. Exposures: Self-reported HRSNs, including housing instability, food insecurity, transportation barriers, and number of unmet needs. Main Outcomes and Measures: The primary outcome was being up to date with CRC screening according to US Preventive Services Task Force recommendations. Survey-weighted logistic regression models estimated adjusted odds ratios (aORs) and 95% CIs overall and by age group. Results: The analytic sample included 14 528 adults aged 45 to 75 years, and most participants were aged 50 to 64 years (6940 individuals [52.42%]), female (7788 individuals [51.36%]), insured (13 750 participants [94.07%]), and reported no unmet HRSNs (12 370 participants [85.40%]). Overall, 2158 adults (14.60%) reported at least 1 unmet HRSN. The proportion up to date with CRC screening was 63.91% (9758 adults) overall and increased with age, from 31.01% (586 adults) among adults aged 45 to 49 years to 64.24% (4539 adults) among those aged 50 to 64 years, and 80.85% (4633 adults) among those aged 65 to 75 years. In adjusted models, housing instability (aOR, 0.82; 95% CI, 0.67-0.99) and transportation barriers (aOR, 0.78; 95% CI, 0.64-0.95) were associated with lower odds of being up to date with CRC screening. Screening odds declined with increasing number of unmet HRSNs, including among adults reporting 1 unmet need (aOR, 0.84; 95% CI, 0.72-0.98). Associations were most pronounced among adults aged 50 to 64 years, among whom housing instability (aOR, 0.77; 95% CI, 0.61-0.97), transportation barriers (aOR, 0.71; 95% CI, 0.56-0.91), and reporting 1 HRSN (aOR, 0.80; 95% CI, 0.66-0.97) were associated with lower odds of being up to date with screening. Conclusions and Relevance: In this cross-sectional study, unmet HRSNs were associated with lower CRC screening uptake, particularly among adults aged 50 to 64 years. Addressing HRSNs may support age-specific strategies to improve CRC screening.

Impacts of Neighborhood Persistent Poverty and Socioeconomic Status on Hepatocellular Carcinoma Outcomes: A Large Population‐Based Cohort Study

Cancer Medicine · 2026-03-01

BACKGROUND: Hepatocellular carcinoma (HCC) survival in the United States varies sharply by neighborhood disadvantage. AIM: To determine whether residence in persistently impoverished or low-SES census tracts is independently associated with lower all-cause and HCC-specific survival. METHODS: We identified 51,323 adults with HCC using a population-based retrospective cohort from the Surveillance, Epidemiology, and End Results Research Plus Specialized Database (2006-2020). Two census tract-level socioeconomic exposures were defined: persistent poverty (≥ 20% living below the poverty line for approximately 30 years) and low SES (Yost Index first quintile). Overlap Propensity Score Weighting, combined with marginal structural models, estimated the 1-, 5-, 10-, and 15-year risks of all-cause and HCC-specific mortality. RESULTS: The median follow-up was 16 months, 6058 (11.8%) lived in persistently impoverished tracts, and 9863 (19.5%) lived in low-SES tracts. After weighting, residents of persistently impoverished areas had a 1-year all-cause mortality risk of 46.0% vs. 40.3% (RD, 5.6%; 95% CI, 4.4% to 6.9%; RR, 1.14; 95% CI, 1.11 to 1.17) and an HCC-specific mortality risk of 33.3% vs. 28.6% (RD, 4.8%; 95% CI, 3.2% to 6.3%; RR, 1.17; 95% CI, 1.11 to 1.22). Living in low-SES tracts raised 1-year all-cause mortality risk to 32.5% vs. 30.1% (RD, 4.8%; 95% CI, 3.6% to 6.0%; RR, 1.12; 95% CI, 1.09 to 1.15) and HCC-specific mortality risk to 32.5% vs. 30.1% (RD, 2.5%; 95% CI, 1.4% to 3.5%; RR, 1.08; 95% CI, 1.05 to 1.12). CONCLUSIONS: Both persistent neighborhood poverty and contemporary low SES independently contribute to significant increases in mortality risk after HCC diagnosis.

Abstract 5045: Patterns of tobacco use, cessation interventions, and lung cancer screening in rural vs. urban areas over time; a 10-year retrospective cohort study

Cancer Research · 2026-04-03

Abstract Introduction: Lung cancer rates differ across rural and urban areas, but few studies have evaluated rural-urban differences across the risk-screening continuum. We examined smoking, cessation interventions, and lung cancer screening patterns across the rural-urban continuum in a geographically defined area over 10 years. Materials and Methods: A retrospective cohort study (2014-2023) was conducted using clinical data from the Rochester Epidemiology Project, derived from healthcare encounters in a 27-county region of the midwestern United States. Patients ages 40-80 were included. We used Rural-Urban Commuting Area codes to assign residence as urban, rural, or highly rural. We examined yearly smoking prevalence, cessation intervention (pharmacotherapy, counseling), and low-dose computed tomography (LDCT) lung cancer screening. Results: Over the 10-year study period, the sample size ranged from 305,530 to 340,411 people annually with 36-38% urban, 56-57% rural, and 6-7% highly rural. Current smoking prevalence declined from 14 to 12% over the 10-year period (range=12-16%; p=0.06) and was consistently lower in urban areas (range=10-14%) than rural (range=12-17.0%) and highly rural areas (range=12-18%; p=<0.001). Among individuals who currently smoked with no history of lung cancer, yearly smoking cessation intervention ranged from 16% to 23%, increasing over the 10-year period (p=<0.001). Cessation medication (varenicline, bupropion, or nicotine replacement) prescription consistently increased overall over time but remained higher in urban than rural and highly rural areas (p=<0.001). Cessation counseling rates also increased overall over time and were similar between urban and rural areas and lower in highly rural areas (p=<0.001). Among people who had ever-smoked aged 50-80 years with no diagnosis of lung cancer, LDCT screening increased from 0.0% to 3.1% over the study period. Increases were higher in urban areas (0.0-3.6%) and similar in rural and highly rural areas (0.0-2.8% and 0.0-2.9%, respectively; p=<0.001). Among people who currently smoked, LDCT screening also increased over the study period (0.0-6.4%), with higher increases in urban (0.1-8.0%) than rural (0.0-5.7%) or highly rural (0.1-6.1%) areas (p=<0.001). After the new screening guidelines in 2021, rates in all areas increased year-on-year. Conclusion: In this cohort, we found that smoking prevalence, cessation interventions, and lung cancer screening improved from 2014-2023 across the rural-urban continuum. Unfortunately, smoking prevalence remained higher and cessation interventions and screening rates lower in rural compared to urban areas. The persistent patterns underscore the need for strategies to overcome barriers for rural residents and improve lung cancer prevention and early detection in all areas. Citation Format: Brianna Tranby, Paul A. Decker, Jiang Ruoxiang, David Midthun, Lori C. Sakoda, Melinda C. Aldrich, Debra Friedman, Adoma Manful, Oindrila Bhattacharyya, Christi Patten, Chyke A. Doubeni. Patterns of tobacco use, cessation interventions, and lung cancer screening in rural vs. urban areas over time; a 10-year retrospective cohort study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 5045.

Multicancer Detection Tests for Screening

Annals of Internal Medicine · 2025-09-15 · 8 citations

BACKGROUND: Screening for multiple types of cancer with a single blood test is potentially transformative. PURPOSE: To assess the benefits, accuracy, and harms of screening with blood-based multicancer detection (MCD) tests in asymptomatic adults. DATA SOURCES: MEDLINE, Cochrane Library, trial registries, and relevant websites through March 2025. STUDY SELECTION: Controlled studies of MCD tests (for example, cell-free DNA) in asymptomatic populations reporting cancer detection, mortality, quality of life, and harms (psychosocial, adverse events, decrease in standard-of-care screening); uncontrolled studies for harms of diagnostic evaluation; test accuracy studies. DATA EXTRACTION: One reviewer extracted data; a second checked for accuracy; 2 reviewers independently assessed risk of bias (ROB) and strength of evidence. DATA SYNTHESIS: = 109 177) reported accuracy for 19 MCD tests. Seven studies (5 with high ROB, 2 of unclear ROB) reported the accuracy of future cancer detection in asymptomatic persons followed for 1 year (prediagnostic performance); the rest estimated accuracy from high ROB case-control studies in clinically confirmed cancer cases and healthy, cancer-free, control participants (diagnostic performance). Across tests, sensitivity ranged from 0.095 to 0.998, specificity ranged from 0.657 to 1.0, and area under the curve (AUC) ranged from 0.52 to 1.0. Sensitivity and AUC were higher in diagnostic performance compared with prediagnostic performance studies. No other patterns in accuracy were discernible. One cohort study reported harms; however, these data were limited. LIMITATIONS: English-language studies only. Heterogeneity precluded quantitative synthesis of accuracy; estimates from the diagnostic performance studies may not be applicable to screening. CONCLUSION: No controlled studies are completed that report benefits of screening with MCD tests; evidence was judged insufficient to evaluate harms and accuracy. Accuracy varies by test and study design. FUNDING SOURCE: Agency for Healthcare Research and Quality. (PROSPERO: CRD42024570793).

Abstract C137: Racial/ethnic disparities in reasons for colonoscopy testing: Contribution of education level and insurance type, US adults, 2019-2023

Cancer Epidemiology Biomarkers & Prevention · 2025-09-18

Abstract Introduction: Black, American Indian/Alaska Native (AI/AN), and Hispanic individuals are more likely to be diagnosed with distant stage colorectal cancer (CRC). Racial/ethnic disparities in diagnosis stage are largely driven by gaps in screening/early detection steps, including whether testing is routine screening vs. diagnostic after symptom onset and whether there is adequate receipt of follow-up after abnormal routine screening. Identifying these unexplored gaps can help inform targeted efforts. Methods: Data from the 2019, 2021, and 2023 nationally representative National Health Interview Survey were pooled to identify 50–75-year-old individuals age-eligible for CRC screening without a prior diagnosis of colon or rectum cancer. Prevalence of self-reported colonoscopy in the past 10 years (alone or in combination with stool testing) and the main reason for this test was estimated by race/ethnicity. Reported reasons of “routine exam” or “follow-up after earlier exam or screening test” were used to operationalize preventative testing and “because of a problem” as diagnostic testing for symptom follow-up. Logistic regression models estimated adjusted prevalence ratios (aPR) comparing race/ethnic groups, adjusted for age, sex, US region, and survey year. Education level and insurance type was explored as a potential mediators to race/ethnic disparities via sequential adjustment analyses. Results: 3999 Hispanic, 28722 non-Hispanic (NH)-White, 4388 NH-Black, 1700 NH-Asian, and 567 NH-AI/AN individuals were age-eligible for CRC screening. Overall, 63.3% reported colonoscopy receipt, with about 82% of these individuals receiving the test as a “routine exam”, 5.3% as a follow-up from an earlier test or screening exam (7% when restricted to those who also had a stool test), and 9.8% “because of a problem”. Colonoscopy testing as a “routine exam” was lower in AI/AN individuals (69.1% vs. 81.6% in White individuals, aPR:0.87, 95% CI:0.8-0.94) while testing “because of problems” was higher for both AI/AN (17.2%, aPR:1.60, 95% CI: 1.20-2.13) and Hispanic (13.4%, aPR:1.30, 95% CI:1.13-1.51) individuals. Conversely, colonoscopy as "follow-up after an earlier exam or screening test" was lower in Black (3.6%, aPR:0.66, 95% CI:0.52-0.84) and Asian (3.1%, aPR:0.51, 95% CI:0.34-0.76) individuals compared to White (5.8%) individuals. Adjustment for education and insurance type attenuated but did not eliminate disparities for Hispanic, AI/AN and Black individuals, whereas adjustment did not alter the magnitude of disparities for Asian individuals. Conclusion: Gaps in whether testing was routine vs. symptom follow up were prominent for AIAN and Hispanic individuals whereas follow-up testing gaps were prominent for Black and Asian individuals. Mediation analysis suggested that improving equitable healthcare access could partially remediate disparities for Hispanic, AI/AN, and Black, but addressing other barriers (linguistic, cultural, knowledge or psychosocial) may be important for Asian individuals. Citation Format: Priti Bandi, Rebecca Landy, Jessica Star, Rebecca Siegel, Larry G. Kessler, Chyke A. Doubeni. Racial/ethnic disparities in reasons for colonoscopy testing: Contribution of education level and insurance type, US adults, 2019-2023 [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C137.

Blood-Based Tests for Multiple Cancer Screening: A Systematic Review

2025-05-14 · 3 citations

Objectives. Screening for multiple cancers in a single blood test is potentially transformative. The objective of this review was to assess the benefits, harms, and accuracy of screening with blood-based multicancer screening tests (MCST) in asymptomatic adults. Data sources. Medline, Cochrane Library, trial registries, relevant government and commercial websites through December 2024; surveillance was conducted through March 31, 2025. Study Selection. Eligible designs included controlled studies for benefit outcomes (e.g., cancer mortality, cancer detection, quality of life), controlled and uncontrolled studies for harm outcomes (e.g., psychosocial distress, adverse events, decrease in standard-of-care screening), and test accuracy studies conducted in external validation populations. Data Extraction and Synthesis. One investigator extracted data and a second checked for accuracy. Two reviewers independently rated risk of bias for included studies using predefined criteria. Results were synthesized narratively. Results. The search yielded 12,043 unique records. No controlled studies evaluated the benefits of screening. One cohort study reported that receipt of standard-of-care lung cancer screening was similar between a group that received the MCST and a group that was eligible but did not receive it (odds ratio, 1.58; 95% CI, 0.47 to 5.31). This same study reported no serious adverse events among the 108 women with false-positive results, but 101 had unnecessary radiation exposure from positron emission tomography–computed tomography scans. Twenty studies (total N=109,177) reported on test accuracy for 19 MCSTs that used various biomarkers (cell-free DNA or RNA, proteins, other) and analytic approaches. Of these, 13 high risk-of-bias studies used case-control designs to estimate sensitivity from cases with known cancer and specificity from cancer-free controls (diagnostic performance). Seven studies (5 high risk of bias, 2 unclear risk of bias) reported prediagnostic performance from testing cancer-free, asymptomatic cohorts with followup over 6 months to 1.5 years to ascertain cancer status. Accuracy outcomes varied widely across tests, subgroups, and study designs. The sensitivity for the detection of cancer ranged from 0.095 to 0.998, specificity ranged from 0.657 to 1.0, and area under the curve (AUC) ranged from 0.52 to 1.0. Sensitivity and AUC were lower in prediagnostic performance studies compared with diagnostic performance studies. Limitations. English-language studies only; heterogeneity precluded quantitative synthesis. Conclusions. We identified no controlled studies of MCSTs that reported on benefits of screening (e.g., mortality, cancer detection, quality of life), though some studies are ongoing. The accuracy of MCSTs varied by test and study design; evidence was insufficient to evaluate harms of screening.

Differences in clinical trial and FDA approval datasets: implications for clinical and policy decision-making for noninvasive colorectal cancer screening tests

Current Medical Research and Opinion · 2025-09-02

Maximizing the Benefits of Noninvasive Colorectal Cancer Screening Tests in Primary Care.

PubMed · 2025-09-01

271: RACIAL AND ETHNIC DIFFERENCES IN COLORECTAL CANCER SCREENING AND OUTCOMES IN A LARGE INTEGRATED HEALTHCARE SETTING FOLLOWING INTRODUCTION OF PROGRAMMATIC SCREENING: ASSESSMENT OF A 20-YEAR PERIOD

Gastroenterology · 2025-05-01

Addressing Gaps in Colorectal Cancer Screening: The Role of Patient Navigation and Future Directions

Clinical Gastroenterology and Hepatology · 2025-07-16 · 3 citations