Disparities in OB/GYN-Ordered CRC Screenings Based on Age, Race, and Income

Key Takeaways:

• Obstetricians/gynecologists (OB/GYNs) could improve rates of colorectal cancer (CRC) screening among women. Among patients whose OB/GYNs ordered CRC screenings, 71.4% completed the test, and 71.3% with a positive result received a follow-up colonoscopy.
• Test adherence varied by age, race, and income. Older women and women with higher household incomes were more likely to complete CRC screenings. White patients had the highest rate of test adherence, with adherence being slightly lower among minority groups.
• Women with higher household incomes were more likely to receive a follow-up colonoscopy after a positive test result. Colonoscopy adherence also varied based on type of insurance coverage.

Screenings for CRC remain underutilized for women in the US. Considering how many women routinely visit an OB/GYN, with some viewing these physicians as their primary care provider, researchers sought to assess the impact of OB/GYNs on adherence to CRC screenings.

Using real-world data from Exact Sciences Laboratories LLC (ESL) and a national multipayer administrative claims database, the study identified 160 068 women aged between 45 and 75 years who were ordered multitarget stool DNA (mt-sDNA) tests by their OB/GYN between July 2016 and December 2022.

Adherence to CRC Screening Influenced by Age, Race, and Income

Out of the 160 068 patients, 114 360 (71.4%) completed the mt-sDNA screening within a year. Adherence to testing increased among older patients: 67.1% among women 45 to 49 years; 71.8% among women 50 to 64 years; and 76.7% among women 65 to 75 years. This is likely due to barriers to screening for younger patients as well as misconceptions about CRC and its screening methods.

Adherence to screenings varied by race/ethnicity: adherence was highest among White patients (73.1%). Adherence among Black or African American patients was 66.3%; Hispanic or Latina, 66.8%; Asian or Pacific Islander, 68.8%. These gaps likely result from disparities in screening participation, care access, and insurance coverage.

Adherence also increased by median household income: 69.0% among patients with <$50 000 which steadily increased to 73.1% among patients with >$200 000. Additionally, test adherence was higher in non-urban areas as well as among patients with Medicare and Medicare Advantage.

Adherence to Follow-up Colonoscopies Dependent on Insurance and Income

Among the 114 360 women who completed an mt-sDNA test, 9773 (8.6%) received a positive result and were recommended a follow-up colonoscopy. Out of this group, 6971 (71.3%) completed a colonoscopy within a year of their test results.

As with the CRC screenings, adherence to colonoscopies increased with median household income: 67.4% among patients with <$50 000; 67.6% among patients with $50 000 to $75 000; 72.2% among patients with $75 000 to $100 000; 76.4% among patients with $100 000 to $200 000; and 83.2% among patients with >$200 000.

Additionally, women with Medicare (78.6%) and commercial health insurance (71.7%) were more likely to have follow-up colonoscopies than women insured by Medicare Advantage (68.7%) and Medicaid (64.7%).

Increasing Rates of CRC Screening Among Women

The study’s findings illuminate various gaps in care across age, race, socioeconomic status, and insurance coverage. They also demonstrate the role of OB/GYNs in raising awareness of CRC and providing access to preventative screenings. Utilizing these physicians could help improve CRC screenings and reduce care barriers.

The authors note, “This context underscores that OB/GYN-delivered CRC screening represents a complementary, rather than replacement, pathway for preventive care.”

Reference

Greene M, Gameng L, Nowd P, Ellis T, Molmenti C, Bingham J. Adherence to obstetrician-/gynecologist-ordered multi-target stool DNA test screening and follow-up colonoscopy: a national multi-payer study of US women. Adv Ther. 2026;43:2722-2735. doi:10.1007/s12325-026-03590-8