P3172 - Effect of the 2018 American Cancer Society Colorectal Cancer Screening Guideline Update on Patients Presenting for Colonoscopy at an Academic Medical Center Endoscopy Unit

John Nathanson, MD¹, Gabriela Joaquin, MD², Sydney Pomenti, MD³, Anna Krigel, MD^4
1New York Prebyterian-Columbia, New York, NY; ²Columbia University Irving Medical Center, New York, NY; ³New York Presbyterian-Columbia, New York, NY; ⁴New York-Presbyterian Columbia, New York, NY

Introduction: Colonoscopy is an effective way to prevent colorectal cancer (CRC) and diagnose CRC early. Prior to 2018, guidelines recommended that most average risk patients should begin CRC screening at age 50. Since the early 2000s, CRC incidence and mortality have been decreasing for patients over the age of 50, though increasing for patients under 50 (1,2). The American Cancer Society (ACS) issued a qualified recommendation in May 2018 to begin CRC screening in all average-risk adults at age 45, rather than 50. We aimed to study the demographics of those patients who presented for screening colonoscopy after the ACS issued updated guidelines in 2018.

Methods: We identified all average-risk patients who underwent colonoscopy for CRC screening using the electronic endoscopy database at an academic medical center endoscopy unit between December 2016 and February 2020. We compared the demographics of all average-risk patients who underwent screening colonoscopy between December 2016 and May 2018 to those who underwent screening colonoscopy between June 2018 and February 2020. The two groups were compared using chi-square tests.

Results: A total of 3,540 patients had a colonoscopy before May 2018 compared to 4,248 after May 2018. 277 (6.5%) of patients < 50 had a screening colonoscopy compared to 93 (2.6%) prior to the guidelines (P< 0.001). There was an increase in patients with commercial insurance (2446 [57.6%] vs 1864 [52.7%]) and Medicaid insurance (484 [11.4%] vs 348 [9.8%]) undergoing screening colonoscopy after May 2018 (P< 0.001). There was a significant increase in both English-speaking patients (2153 [50.7%] vs 1670 [47.2%]) and Spanish speaking patients (1278 [36.1%] vs 1432 [33.7%]) (P< 0.004), and an increase in both male (1654 [38.9%] vs 1472 [41.6%]) and female (2594 [61.1%] vs 2068 [58.4%]) (P< 0.018) patients undergoing screening colonoscopy. There were no significant associations in patient race/ethnicity or marital status with regard to the ACS guidelines.

Discussion: The 2018 ACS Guideline Update on CRC screening age may have been associated with an increase in patients under age 50 (and perhaps over age 50) presenting for screening colonoscopy across demographics including sex, language, and insurance status. A higher percentage of younger patients presented for colonoscopy after the recommendations were released. More research is needed to determine who may be late adopters of more recent guidelines and need more attention from gastroenterologists and primary care providers.


Disclosures:


John Nathanson, MD¹, Gabriela Joaquin, MD², Sydney Pomenti, MD³, Anna Krigel, MD⁴. P3172 - Effect of the 2018 American Cancer Society Colorectal Cancer Screening Guideline Update on Patients Presenting for Colonoscopy at an Academic Medical Center Endoscopy Unit, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.