Provider Knowledge, Risk Perceptions, and Communication Readiness Drive Discussions about Early-Onset Colorectal Cancer: A National Survey of US Healthcare Providers

BACKGROUND: The incidence of early-onset colorectal cancer continues to increase among adults younger than 50 years, yet delays in diagnosis remain common. OBJECTIVE: As an initial step of the Early-Onset Colorectal Cancer Awareness campaign, we evaluated U.S. healthcare providers' knowledge, attitudes, diagnostic practices, and perceived barriers related to the timely recognition and evaluation of early-onset colorectal cancer. DESIGN: This survey established baseline measures for a national early-onset colorectal cancer awareness campaign. SETTING: We conducted a national cross-sectional survey of physicians, nurse practitioners, and physician assistants practicing family medicine, internal medicine, emergency medicine/urgent care, and obstetrics and gynecology. MAIN OUTCOME MEASURES: The survey assessed early-onset colorectal cancer awareness, screening recommendations, evaluation of symptomatic younger adults, perceived barriers to diagnosis, and educational needs. Descriptive statistics summarized responses, and multivariable regression identified factors associated with guideline-concordant screening and diagnostic evaluation. RESULTS: A total of 277 providers completed the survey. Although 87% were concerned or very concerned about early-onset colorectal cancer and 82% reported increased concern over the preceding five years, providers identified substantial barriers to timely diagnosis. Approximately one-half reported that younger adults commonly experienced symptoms for four months or longer before seeking care. The most frequently cited barriers included patients expecting symptoms to resolve (84%), insurance and financial barriers (79%), reluctance to undergo colonoscopy (77%), and failure to recognize symptoms as serious (65%). Most providers (79%) identified additional guidance on early-onset colorectal cancer symptoms, risk factors, and diagnostic evaluation as the educational resource most likely to improve care. CONCLUSIONS: Despite widespread awareness of the increasing incidence of early-onset colorectal cancer, patient- and system-level barriers continue to delay diagnosis in younger adults. These findings identify opportunities for targeted education, clinical decision support, and health system interventions to promote timely evaluation of symptomatic patients and improve early detection of early-onset colorectal cancer. See Video Abstract.