A Simpler Draw: Rethinking Colorectal Cancer Screening for Adults With Intellectual and Developmental Disabilities

Adults with intellectual and developmental disabilities (IDD) face substantial barriers to colorectal cancer screening, including communication difficulties, caregiver burden, and difficulty completing stool collection or bowel preparation. These barriers likely contribute to lower screening completion and higher cancer-related mortality in this population. Blood-based colorectal cancer screening, which can be completed during a routine blood draw without stool collection or bowel preparation, may reduce several of these logistical barriers. However, most adults with IDD are insured through Medicaid, and current coverage for the leading blood-based test excludes Medicaid beneficiaries in nearly all states, undermining the accessibility argument for this population specifically. We argue that blood-based screening deserves consideration as part of an individualized, equity-focused approach to colorectal cancer prevention in adults with IDD, provided it is offered alongside, not instead of, higher-sensitivity options, and we call for expanded Medicaid coverage and continued improvement in test performance to close the gap between accessibility and effectiveness.