J Cancer Prev.  2021 Dec;26(4):298-303. 10.15430/JCP.2021.26.4.298.

Primary Care Provider Knowledge and Practice in Risk Assessment for Early Age Onset Colorectal Cancer: Opportunities for Improvement

  • 1Division of Gastroenterology & Hepatology, University of Colorado Anschutz Medical Center, USA
  • 2Center for Innovative Design & Analysis, University of Colorado School of Public Health, Aurora, CO, USA
  • 3Division of Gastroenterology & Hepatology, Denver Health Hospital Authority, Denver, CO, USA
  • 4Division of General Internal Medicine, University of Colorado Anschutz Medical Center, USA
  • 5Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA


Colorectal cancer (CRC) incidence and mortality are rising in individuals under age 50, termed early age onset (EAO) CRC. Lower endoscopy is recommended for all patients with unexplained iron deficiency anemia (IDA) or hematochezia to assess the EAOCRC. For those without symptoms, professional societies recommend decreasing the age to start screening from 50 to 45. Primary care provider (PCP) knowledge and practices around EAO-CRC risk assessment and screening are unknown. We conducted a survey study in May, 2020 of multi-specialty PCPs from three large medical systems to assess PCP knowledge, risk stratification practices and barriers/facilitators they face to offer CRC screening in patients < 50. We conducted univariate analysis to assess factors associated with knowledge and diagnostic practices. Response rate was 27.7% (196/708). Although 77.6% of respondents were aware that EAO-CRC incidence is increasing, only 42.9% knew that EAO-CRC mortality is also increasing. Of note, 91.8% recommend starting average risk screening at age 50. For 40- to 49-year-old patients present with unexplained IDA or hematochezia, 71.9% and 50.5% of respondents, respectively, recommend a diagnostic colonoscopy. Trainees were less likely to be aware of rising EAO-CRC mortality (odds ratio, 0.42; 95% CI, 0.21 to 0.82) and non-internal medicine providers were less likely to recommend CRC screening in those with a first-degree relative with CRC (odds ratio, 0.82; 95% CI, 0.72 to 0.93). Ongoing education efforts will be required to improve recognition and management of high-risk symptoms, particularly among non-internists and trainees.


Colorectal neoplasms; Early detection of cancer; Gastrointestinal hemorrhage; Iron deficiencies; Primary health care
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