USPSTF Guidelines Effectively Boost Preventive Screening Access

Guidance around preventive screening access works, with new data in the Epic Research showing that colorectal screening rates went up after the USPSTF lowered the age for recommendation.

These findings could have implications as the US faces a problem in preventive screening access, although supportive patient outreach strategies will also be necessary.

The researchers looked at changes in colorectal screening access after a May 2021 recommendation from the US Preventative Services Task Force (USPSTF) stating that colorectal screening recommendations should also include all adults ages 45 to 49.

USPSTF recommendation is notable because it triggers insurance coverage from private insurance and Medicare, helping patients overcome at least the cost barriers they sometimes experience in preventive care access.

Adding in those guidelines helped improve the rate of colorectal cancer screening, which is helpful for early cancer detection.

The researchers looked at over 66 million health records from between 2018 through 2022 to look at changes over time, finding that across the entire study period, the rate of colorectal cancer screening access increased. This increase was largely driven by those ages 45 to 49 who started to access preventive screening at much higher rates.

Between Q2 of 2021 and Q4 of 2022, during which the USPSTF guidelines were expanded, the number of screenings more than doubled. Among female patients ages 45 to 49 years old, screening rates rose from 2,286 per 100,000 patients to 8,068 per 100,000 patients. For males, those figures were 3,743 per 100,000 patients all the way up to 9,885 per 100,000 patients.

These cancer screenings helped clinicians catch irregularities, the data furthered. After the USPSTF guideline change and subsequent boost in utilization, the researchers noted a doubling in pre-cancerous polyp diagnoses among female patients; for males, the pre-cancerous polyp diagnosis rate tripled. Males also saw a one-half increase in colorectal cancer diagnosis rates, but there was no change among female patients.

Still, these findings indicate that policy moves like expanding cancer screening recommendations from the USPSTF can have a positive impact on patient care access. The overall increase in cancer screening access was driven almost entirely by folks ages 45 to 49, the researchers said.

This is good news for a country that’s still grappling with lapses in preventive care access sparked by the COVID-19 pandemic, but the data shows it’ll take more than expanding screening guidelines to address this problem. After all, there are still care gaps to worry about.

For example, although younger patients newly recommended to get a colorectal cancer screening are largely getting the procedure, older adults who have long fallen into USPSTF’s guidelines are not following suit.

Most age groups—45-49, 50-64, and 65 plus—largely stopped getting their colorectal cancer screenings around March 2020, the data showed. Rates were particularly low among that youngest age group, but numbers soared starting in 2021, again, because of the USPSTF guidelines.

But for those over age 50, colorectal cancer screening rates have not recouped their numbers. Although preventive care access has rebounded some since the initial drop in 2020, access rates still slightly trail pre-pandemic numbers.

Filling in those care gaps, plus continuing to boost preventive care access among younger patients, will require a tailored patient outreach approach. Some healthcare organizations have had luck using data analytics and automated patient outreach messaging to get folks back in for care.

Finishing that last mile to get to pre-pandemic preventive screening rates will require wraparound policies that address other care access barriers, like cost, transportation, and other social determinants of health.