CRC screenings among adults ages 45-49 have skyrocketed. Now comes the hard part.

A new Vizient-Northern Illinois University study — titled “Facility-Based Uptake of Colorectal Cancer Screening in 45- to 49-Year-Olds After US Guideline Changes” — that was recently published on JAMA Network Open shows just how strongly health systems responded. Using data from more than 1,000 U.S. hospitals in the Vizient Clinical Data Base, researchers found a 948% monthly volume change in CRC screenings among adults aged 45 to 49 after the guideline change — compared with a 46% increase among those aged 50 to 75.

That surge highlights how quickly providers and patients can adopt new practices when guidelines, reimbursement and awareness align. Once the USPSTF recommendation became covered under the Affordable Care Act, hospitals and clinicians rapidly integrated it into their workflows. But the findings also spotlight persistent disparities — screening was higher among white, commercially insured and lower-vulnerability populations, while rates were lower among Black, Medicare and high-vulnerability groups.

Here, Alyssa Harris, associate principal, analytics and insights, who is lead author of the study and a PhD candidate at Northern Illinois University, and Madeleine McDowell, MD, senior principal, intelligence, discuss what drove these shifts and how hospitals can continue to expand equitable access to colorectal cancer screening.

Why did you decide to look at the impact of CRC screening guideline changes among 45- to 49-year-olds?

Harris: This really brought together my academic and professional interests. At Vizient, I’ve always been drawn to studying adoption — how something new, like a technology or a guideline, changes practice patterns.

When I started my PhD program in 2023, it had been two years since the USPSTF lowered the recommended screening age to 45. That timing gave us a good window to evaluate how that shift was playing out. The question was how the guideline change itself was being adopted, who’s getting screened now that eligibility expanded and how quickly are systems catching up?

McDowell: With our Impact of Change forecast, we pay attention to how shifts like this affect volume and demand. Guideline changes always matter; they shape what physicians do. When Alyssa suggested this study, I knew it would be really valuable to quantify that impact. And I was especially interested because compliance with colon cancer screening can be difficult even in older populations, so I wondered what uptake would look like in a younger group.

Were you surprised by what the data showed?

Harris: Not really. We saw what we expected — that there was a jump after the USPSTF guideline, but not much after the American Cancer Society’s (ACS) 2018 recommendation. And that makes sense, because under the Affordable Care Act, anything rated “A” or “B” by the USPSTF must be covered. Once that happened, you had both the policy and the payment piece, and that’s when we saw the increase.

When we looked at demographics, I wasn’t surprised there either. Colonoscopy isn’t an easy procedure — it requires prep, sedation, transportation. So, the groups most likely to get screened tended to be white, commercially insured and from lower-vulnerability neighborhoods.

We always see that official guidelines move the needle — once physicians have that backing, they adopt it. I expected a big increase in screenings, but I also knew we’d still be far from full compliance. It’s progress, but there’s a long way to go.

Madeleine McDowell, MD

Senior Principal,
Intelligence

What made the Vizient Clinical Data Base a good fit for this study?

Harris: The CDB is a really powerful tool because it’s an all-payer view of the patterns and near real-time access. Many datasets have a two- or three-year lag or focus on a single payer, but the CDB captures data across hundreds of hospitals and payers nationwide. That breadth and recency allowed us to see what was happening quickly after the guideline change.

McDowell: And the national lens is important — more than 1,300 hospitals across the country, not just one region or market. It gives a strong, representative picture of how facilities responded.

How did you separate the effects of the ACS and USPSTF guideline changes?

Harris: We divided the timeline into three periods — pre-change, interim and post-change — to isolate the impact. The ACS recommendation in 2018 didn’t carry the same policy weight, but I still wanted to capture whether it had any early effect. By separating the periods, we could see that while there was some uptick after ACS, the real shift happened after the USPSTF guideline went into effect and coverage was mandated.

McDowell: That design really helped pinpoint what was driving change. It showed clearly that the USPSTF update was the major factor in increasing screening uptake.

The study found differences by race, payer and socioeconomic vulnerability. How can health systems act on those findings?

This comes down to how health systems communicate and connect with patients. You can only get screened if you’re plugged into primary care — and younger adults just aren’t as likely to have that relationship. So, it’s about making sure messaging resonates across all patient groups and tailoring outreach to reach those less likely to come in for preventive care.

Alyssa Harris

Associate Principal,
Analytics and Insights

McDowell: Education is huge. People need to understand why the procedure is worth the effort — that colonoscopy isn’t just diagnostic, it’s preventive. It can remove precancerous polyps and actually prevent disease progression.

What best practices helped hospitals implement the new guidelines?

Harris: A big one is EMR integration. When screening reminders are built into order sets and wellness visit workflows, it normalizes the process and helps providers identify eligible patients automatically. There also have been major pushes from professional societies — webinars, toolkits, awareness campaigns — to make sure providers know what’s changed.

McDowell: Access was another big focus. Health systems had to look at expanding endoscopy capacity, hiring more gastroenterologists and creating smoother referral pathways. Some made it effortless for patients — if they said yes to screening, the referral went straight to scheduling. Systems also worked on financial transparency, explaining what’s covered and what isn’t. That reassurance helps people follow through.

Is this another case for expanding ambulatory capacity?

McDowell: Absolutely. The more systems can increase access in ambulatory settings — closer to home, easier to schedule — the better they can meet the growing demand for screenings. It’s a lesson that applies across preventive services, not just colorectal cancer.

What’s the key takeaway from the study for health systems?

Harris: Health systems should really applaud themselves for responding so quickly. This was a massive change, and the adoption we saw was remarkable. But now it’s about the next step — looking at who’s still not being screened and finding ways to reach them.

McDowell: This study is one example of many where identifying high-risk populations and strengthening primary care access will be critical. Workforce limitations and short well visits make it hard to cover everything, but systems must make preventive care a top priority.

What’s next for your research?

Harris: I’m planning to look more closely at at-home CRC screenings and other emerging modalities. They won’t replace colonoscopy, but they can help reach patients who are hesitant or unable to complete a facility-based procedure. I’m also interested in analyzing rural versus urban hospitals and identifying where the biggest disparities still exist.

McDowell: And we should learn from success stories — look at where screening rates are improving, understand what those health systems are doing right and apply those lessons to more challenging populations.

Final thoughts?

Harris: The big picture is that when evidence, policy and systems align, change happens fast. But equity has to be the next frontier.

McDowell: We’ve shown the system can respond. Now it’s time to make sure that response reaches everyone.

Read the published study to learn more about the CRC screening findings, and explore the Vizient data and digital solutions that deliver actionable insights to health systems.