Low Colorectal Cancer Screening Rates: US Adults 45-49 (2023)

March 20, 2026 Ananya Mittal - World Editor

Colorectal cancer screening rates remain a significant public health concern in the United States, particularly among adults aged 45 to 49. Recent data indicates that less than half of this age group is up to date on recommended screenings, raising concerns about potential delays in diagnosis, and treatment. This finding underscores the need for targeted interventions to improve screening uptake within this newly eligible population.

Expanding the Screening Window and Persistent Gaps

For years, screening guidelines generally recommended starting colorectal cancer screenings at age 50. However, recognizing the increasing incidence of colorectal cancer in younger adults, the American Cancer Society updated its guidance in 2018 to recommend screening begin at age 45. This shift aimed to catch more cases at earlier, more treatable stages. Despite this change, uptake among those aged 45-49 remains low. A recent analysis of 2023 data, published in Preventive Chronic Disease, highlights this challenge. The study, led by researchers at the Centers for Disease Control and Prevention (CDC), found that although most adults are current with breast and cervical cancer screenings, colorectal cancer screening lags significantly, with roughly one-third of eligible adults not adhering to recommendations. CDC data shows this trend.

Understanding Colorectal Cancer and Screening Options

Colorectal cancer develops in the colon or rectum. It often begins as precancerous polyps, which can be removed during a screening colonoscopy, preventing cancer from developing. Screening tests aim to detect these polyps or early-stage cancers, when treatment is most effective. Several screening options are available, including:

  • Colonoscopy: A visual examination of the entire colon using a flexible tube with a camera.
  • Stool-based tests: These tests seem for signs of cancer in a stool sample, such as blood or abnormal DNA. Examples include the fecal immunochemical test (FIT) and stool DNA test (Cologuard).
  • CT colonography (virtual colonoscopy): Uses X-rays to create images of the colon.

The choice of screening test should be made in consultation with a healthcare provider, considering individual risk factors and preferences.

The Link Between Screening Rates and Mortality

Research consistently demonstrates a strong correlation between colorectal cancer screening rates and mortality. A study published in PubMed analyzed data from 1999 to 2024, revealing a significant decline in age-adjusted colorectal cancer mortality rates as screening rates increased. The study found that screening rates rose from 41.5% in 1999 to 76.3% in 2023, coinciding with a decrease in mortality from 69.3 to 40.7 per 100,000 people. The researchers projected that if screening rates reached 100%, the age-adjusted mortality rate could fall to 18.91 per 100,000. However, the study similarly highlighted persistent disparities, with lower screening rates among American Indians/Alaskan Natives and uninsured individuals.

Disparities in Access and Uptake

The CDC report and other research consistently point to disparities in colorectal cancer screening. Access to healthcare, financial hardship, and other barriers disproportionately affect certain populations. Non-Hispanic White individuals consistently demonstrate higher screening rates (80.1% in 2023, according to the PubMed study) compared to other racial and ethnic groups. Individuals without health insurance have significantly lower screening rates (33.02% in 2023) than those with insurance (78.13%). These disparities underscore the need for targeted interventions to address systemic barriers to screening.

What the Numbers Don’t Notify Us

While the data clearly shows a correlation between screening and reduced mortality, it’s important to remember that correlation does not equal causation. Other factors, such as improvements in treatment and lifestyle changes, may also contribute to declining mortality rates. The study relied on self-reported data from the National Health Interview Survey, which may be subject to recall bias. The findings also don’t account for the potential impact of the COVID-19 pandemic on screening rates, which were known to have declined during that period. AJMC reported on the impact of the pandemic on screening rates.

Looking Ahead: Improving Screening Rates

Public health efforts to increase colorectal cancer screening are ongoing. Future monitoring of screening rates will be crucial to assess the impact of interventions and identify areas for improvement. The CDC and other organizations are working to develop and implement evidence-based strategies to address barriers to screening, including increasing awareness, improving access to affordable screening options, and tailoring interventions to specific populations. Equity-focused interventions are particularly important to address disparities and ensure that all individuals have the opportunity to benefit from colorectal cancer screening.

Next Steps: Ongoing Surveillance and Intervention Evaluation

The CDC continues to monitor cancer screening rates through surveys like the National Health Interview Survey and the Behavioral Risk Factor Surveillance System (BRFSS). These data will inform future guidance updates and help evaluate the effectiveness of ongoing interventions. Researchers are also exploring innovative approaches to increase screening uptake, such as mail-in stool tests and telehealth consultations. Continued investment in research and public health programs is essential to further reduce the burden of colorectal cancer.