S587 Colorectal Cancer Screening Trends and Disparities Across Demographics After USPSTF Guideline Updates and COVID-19 Disruptions

Introduction: This study was designed to assess real-world colorectal cancer (CRC) screening trends during a period of evolving national focus on preventive care. In 2021, the United States Preventive Services Task Force (USPSTF) lowered the recommended CRC screening age from 50 to 45 years. While this guideline update directly expanded eligibility for younger adults, it also contributed to increased public attention and healthcare system emphasis on CRC screening overall. Since this period overlapped with the coronavirus disease 2019 (COVID-19) pandemic and persistent demographic disparities, we evaluated screening patterns from 2015 to 2023 across 3 distinct timeframes (pre-pandemic, pandemic onset, post-pandemic recovery), focusing on variation by race, ethnicity, sex, and age in adults aged 50–75. Methods: We conducted a retrospective cohort study using the TriNetX database, including patients aged 50–75 without a prior CRC diagnosis. Screening was identified using CPT codes for colonoscopy, sigmoidoscopy, and fecal occult blood testing. Patients were grouped into 3 time periods: pre-pandemic (2015–2017), pandemic-impacted (2018–2020), and post-pandemic (2021–2023). Screening rates were assessed annually and stratified by demographic variables. Results: Screening incidence peaked at 1.08% in 2019 but dropped by 22% to 0.84% in 2020. Although rates rebounded to 0.99% by 2023, they remained below pre-pandemic levels, despite increased national focus on CRC screening during this period. Demographic disparities persisted: Black patients showed slower recovery (1.25% in 2023 vs 1.65% in 2019), while Hispanic patients exceeded pre-pandemic levels by 33%. Asian and American Indian/Alaskan Native populations experienced the steepest declines, with rates remaining below pre-pandemic levels through 2023. Conclusion: CRC screening trends from 2015 to 2023 reflect complex recovery patterns shaped by both the COVID-19 pandemic and increased national emphasis on screening following the USPSTF guideline update. Demographic disparities persisted, with incomplete recovery among Black patients and older adults, while Hispanic populations exceeded pre-pandemic screening levels. These findings highlight the need for adaptive, equity-focused screening strategies as healthcare systems continue to rebuild preventive care delivery.