Uptake of colorectal cancer (CRC) screening increased nationwide after the 2021 US Preventive Services Task Force (USPSTF) recommendation that encouraged screening in this younger age group, but this rise was uneven based on socioeconomic status and locality, according to new data.

Findings from a nationwide cohort study of more than 10.2 million privately insured individuals aged 45 to 49 years showed that mean screening uptake increased among those at average risk for CRC from 0.50% before the 2021 recommendation to 1.51% after the recommendation (

 < .001), “representing an absolute change of 1.01 percentage points, but no significant relative change” researchers wrote in the study published online October 3, 2024, in 

In addition, after the USPSTF recommendation was issued, 

 uptake increased fastest among average-risk beneficiaries living in areas with the highest socioeconomic status (SES) and metropolitan areas, according to the study results.

In May 2021, the USPSTF issued a grade B recommendation for CRC screening in adults aged 45 to 49 years, which was the 

first time the USPSTF recommended CRC screening

“Despite these efforts, screening remains below the national target of 80% among adults aged 45 years or older, with particularly low screening observed among individuals aged 45 to 49 years; those identifying as American Indian or Alaska Native, Asian, or Hispanic; individuals born outside the US; and individuals with income below 100% of the federal poverty level,” first author Sunny Siddique, MPH, a researcher in the Department of Chronic Disease Epidemiology at Yale School of Public Health, and colleagues wrote.

Siddique and coauthors continued: “We conducted one of the first and largest studies to identify possible disparities in screening in this age group as well as recent rates in screening uptake after the recommendation was issued.”

Investigators used deidentified commercial claims data from Blue Cross Blue Shield (BCBS) Axis to identify average-risk individuals aged 45 to 49 years across the US. They included 10 221 114 beneficiaries (mean age, 47 years; 51.04% women) and compared uptake 20 months before (May 2018-December 2019) and 20 months after (May 2021-December 2022); the USPSTF recommendation.

Of the cohort, 25.43% were White, 2.65% were Black, 3.86% were Hispanic, 1.15% were Asian, 0.15% were Native American or Pacific Islander, and 66.76% had unknown race and ethnicity, according to the study.

As previously stated, between the prerecommendation and postrecommendation periods, mean CRC screening uptake increased from 0.50% to 1.51% (

 < .001) among average-risk beneficiaries. Although these individuals had a higher absolute change in screening compared to high-risk beneficiaries (1.01 percentage points [95% CI 0.62-1.40] vs 0.21 [95% CI 0.02-0.40]), average-risk persons had no significant relative change in screening (202.51%; 95% CI −30.59% to 436.87%).

Investigators also observed that compared with average-risk beneficiaries living in areas with the lowest SES, those residing in places with the highest SES had the largest absolute change in CRC screening (1.25 percentage points [95% CI 0.77-1.74] vs 0.75 [95% CI 0.47-1.02]). However, relative changes were not significant (214.01% [95% CI, –30.91 to 461.15] vs 167.73% [95% CI, –16.3 to 352.63]).

Screening uptake increased the fastest after the USPSTF recommendation among those living in areas with the highest SES (0.24 percentage points every 2 months, 95% CI 0.23-0.25), as well as among those in metropolitan areas (0.2 percentage points every 2 months, 95% CI 0.19-0.21).

In addition, 11.5% of average-risk beneficiaries aged 45 to 49 years received CRC screening in the postrecommendation period, which suggests that “targeted initiatives to improve screening in this age group are warranted to reach the national goal of screening 80% of the population in every community,” researchers wrote.

In the subgroup analysis of average-risk beneficiaries with data on race and ethnicity, results showed significant increases in screening between the 2 periods in each group.

A main limitation of the study was that it only included BCBS beneficiaries, Siddique and colleagues noted. Although BCBS is the largest provider of commercial health insurance, the cohort may not be fully representative of the general US population because those beneficiaries are usually younger and more socioeconomically advantaged with employer-based insurance. Also, data on race and ethnicity were only available for a subset of the population, “undermining our ability to thoroughly evaluate the potential influence of these demographic factors,” Siddique et al stated. Future studies should continue to examine changes in CRC screening patterns among diverse population subgroups, investigators added.

USPSTF colorectal cancer screening recommendation and uptake for individuals aged 45 to 49 years

Published online October 3, 2024. doi:10.1001/jamanetworkopen.2024.36358

Articles

Increases in CRC screening were higher in high socioeconomic status and metropolitan areas, according to a new large cohort study. 

US Colorectal Cancer Screening Increased Three-Fold among Adults Aged 45-49 Years, but Disparities Persist

Among adults with moderate or severe symptoms of irritable bowel syndrome (IBS), more than 70% of those who followed either of 2 dietary interventions had a statistically significant reduction in symptoms after 4 weeks compared to 58% of those receiving optimized pharmacotherapy, according to study findings published in 

The Lancet Gastroenterology and Hepatology.

After 6 months, when participants in the dietary change groups had partially returned to previous eating patterns, nearly two-thirds continued to report significant relief of symptoms, prompting study authors to suggest that dietary interventions might be an effective approach to first-line IBS treatment.

IBS is described as a disorder of gut-brain interactions that affects approximately 4% of the adult population. While symptoms include chronic or recurrent abdominal discomfort and irregular bowel habits, results of routine clinical tests and investigations are normal, study authors wrote.

 Specific dietary modifications are typically used as first-line treatment with appropriate pharmacologic interventions chosen to target a most bothersome symptom.

When more restrictive dietary measures are needed, a regimen low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) is often prescribed or one that has high fiber content, low total carbohydrates, and high proportions of protein and fat.

 Study authors, led by Sanna Nybacka, PhD, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, described a dearth of research either comparing dietary approaches to IBS symptom management or comparing dietary approaches to medical treatment of the predominant gastrointestinal (GI) symptoms. Their study was designed to compare 3 options: a FODMAP diet plus traditional IBS dietary advice (FODMAP+); a low-carbohydrate diet, and pharmacologic treatment.

For the single-center, single-blind randomized controlled trial Nybacka and fellow researchers enrolled individuals at a specialized outpatient clinic at the Sahlgrenska University Hospital, screening those aged 18 years and older with moderate-to-severe IBS (Rome IV criteria, IBS Severity Scoring System (IBS-SSS) score of 175 or greater, and no reported serious diseases or food allergies.

A total of 1104 individuals were assessed for eligibility between January 2017 and September 2021. The modified intention-to-treat cohort numbered 294 participants (18% men, mean age 38 years) who were randomly assigned in a 1:1:1 ratio to receive dietary or medical intervention as follows: FODMAP+ diet (n = 96); low carbohydrate diet (n = 97); and optimized medical therapy (n = 101). Participants followed the assigned regimens for 4 weeks. All were masked to the dietary intervention, but medication was open label.

The primary end point of interest was the proportion of participants in each group with a response to the 4-week intervention, defined as a reduction of 50 or more in IBS-SSS relative to baseline score.

Researchers reported that after 4 weeks, 73 (76%) of 96 participants in the FODMAP+ diet group, 69 (71%) of 97 participants in the low-carbohydrate diet group, and 59 (58%) of 101 participants in the optimized medical treatment group experienced the reduction of 50 or more in IBS-SSS vs baseline with a statistically significant difference between groups (

Participants in the 2 dietary intervention groups returned to their habitual dietary habits over the next 6 months. When investigators followed up with them, 68% in the FODMAP+ group and 60% in the low-carbohydrate group still had clinically significant symptom relief.

Nybacka et al had hypothesized that the diet combining FODMAP, and traditional IBS dietary advice would be superior to the low-carbohydrate diet and to medical intervention, which was borne out by the findings. But as they point out, while the 2 dietary interventions proved more effective than medical therapy, all 3 reduced IBS symptom severity. Further, all 3 approaches also improved quality of life symptoms of depression and anxiety, and non-GI somatic symptoms.

“With this study, we can show that diet plays a central role in the treatment of IBS, but that there are several alternative treatments that are effective,” Nybacka said in a University of Gothenberg press release.

 “We need more knowledge about how to best personalize the treatment of IBS in the future and we will further investigate whether there are certain factors that can predict whether individuals will respond better to different treatment options,” concluded the author.

1. Nybacka S, Törnblom H, Josefsson A, et al. A low FODMAP diet plus traditional dietary advice versus a low-carbohydrate diet versus pharmacological treatment in irritable bowel syndrome (CARBIS): a single-centre, single-blind, randomised controlled trial. Lancet Gastroenterol Hepatol. Published online April 18, 2024. Doi:10.1016/S2468-1253(24)00045-1
2. Dietary treatment more effective than medicines in IBS. News release. University of Gothenberg. April 19, 2024. Accessed April 24, 2024. https://www.gu.se/en/news/dietary-treatment-more-effective-than-medicines-in-ibs

More participants consuming either of 2 common IBS dietary regimens experienced significant and sustained symptom relief vs those given pharmacotherapy.  

Food vs Medicine for IBS: Dietary Measures First, New Study Suggests

New research presented at the 2024 Crohn’s & Colitis Congress, January 25-27, 2024, in Las Vegas, NV, shed light on the financial burden of 

Findings from a real-world cohort study show that unplanned emergency service and medication utilization make up the majority of costs of IBD care and, according to study authors, should be the focus of value-based interventions among patients with IBD.

“Effective management of IBD should focus on improving patient symptoms and outcomes while containing healthcare costs,” wrote researchers in the study abstract. “To develop high-value treatment strategies and influence policy on high-value care, we must first have a better understanding of the primary drivers of cost in this population.”

Presenting author Jeffrey Berinstein, MD, MSc, clinical instructor, internal medicine, University of Michigan, Detroit, and colleagues conducted the study using data from IBM Watson, “a nationwide insurance claims database covering millions of commercially insured individuals across the US,” they wrote.

Investigators identified adults aged 18-65 years with a diagnosis of IBD in the primary or secondary position from January 2019 to January 2020 based on ICD-10 codes for Crohn disease and ulcerative colitis. They measured cost and utilization as a per member per year (PMPY), according to the abstract.

A total 105 496 individuals with IBD (51.9% women; 42.5% aged 30-49 years) were identified for the study.

Researchers observed that the mean PMPY total costs were $40 842, of which $31 051 (76%) were directly correlated to gastrointestinal (GI)-related costs. Mean PMPY total costs in this population ranged from $1178 to $144 945, with 15% of participants experiencing costs over $76 346 PMPY, added investigators. 

The main drives of GI-related costs were divided into the following 3 categories:

Outpatient medical service costs: $11 306 (36%)

In addition, results showed per member utilization included:

2.87 non-gastroenterologist GI visit (may include visit to a primary medical clinician, rheumatologist, dietician, etc.)

“While appropriate high-cost pharmaceutical utilization should not be reduced, innovative strategies leveraging more cost-effective medication delivery may provide an important opportunity to curb costs,” concluded Berinstein et al. “Furthermore, the high rate of non-gastroenterologist GI visits suggests that there is a potential for optimizing care pathways, by incorporating multidisciplinary care including, PCPs, mid-level providers, and other ancillary services into the IBD care model.”

 Berinstein J, Melmed G, Allen J, Berry S. Cost-drivers of healthcare expenditures in inflammatory bowel disease. Abstract presented at: 2024 Crohn’s & Colitis Congress; January 25-27, 2024; Las Vegas, NV. Accessed January 26, 2024.

Unplanned emergency service and medication utilization make up the majority of costs of IBD care, reported researchers. 

New Study Highlights Primary Drivers of Cost of Inflammatory Bowel Disease Care

Digital Edition for Patient Care Online for January, 2025

Patient Care Online January 2025 | Patient Care Digital Edition

US Colorectal Cancer Screening Increased Three-Fold among Adults Aged 45-49 Years, but Disparities Persist

Food vs Medicine for IBS: Dietary Measures First, New Study Suggests

New Study Highlights Primary Drivers of Cost of Inflammatory Bowel Disease Care