Colorectal cancer screening test preferences by sociodemographic factors and health beliefs in diverse underserved populations

Background Despite the availability of multiple screening options, rates of colorectal cancer (CRC) screening remain suboptimal. With recent approval of a blood test for CRC screening, there is an urgent need to understand screening preferences of populations with low screening rates. Methods Between October 2023 and June 2024, we conducted a survey among adults aged 45–75 at ambulatory primary care clinics across multiple community health centers and federally qualified healthcare centers across the city as well as in community settings regardless of prior screening Results A total of 1,014 individuals completed the survey. Respondents were 12.8% Black/African American, 51.6% White, 23.4% Hispanic, 15.8% South Asian, and 4.2% Asian. Overall, the highest test preference was for screening colonoscopy (45.5%) followed by blood test (29.9%). Colonoscopy was preferred by individuals under age 70 (47.5%), while stool-based (20.2%) and blood-based (31.9%) tests were the most preferred among above 70 years (p = 0.0429. Whites (54.6%), Blacks (44.6%), and Hispanics (35.9%, p < 0.001) preferred colonoscopy, while Asians (37.2%) and South Asians (24.4%) favored blood tests. Factors associated with preference for a colonoscopy over other screening tests were younger age: respondents aged below 70 years were more likely to prefer colonoscopy, compared to respondents aged above 70 years (OR = 1.72, 95% CI [1.20–2.47], p = 0.003); Nonsmoker compared to former/current smokers (OR = 2.04, 95% CI: [1.10–3.94], p = 0.028); Having undergone a prior colonoscopy (OR = 6.83, 95% CI: [4.52–10.6], p = < 0.001) or not having a prior stool test (OR = 1.56, 95% CI: [1.52–2.11], p = < 0.001). Factors associated with preference for a blood test over other screening tests were education level: respondents without any college experience were more likely to prefer blood test compared to respondents with college experience (OR = 1.46, 95% CI: 1.02– 2.07, p = 0.038); Nonsmoker compared to former/current smokers (OR = 1.73, 95% CI: [1.00–2.99], p = 0.048); Never undergone a prior colonoscopy (OR = 1.76, 95% CI: [1.23–2.51], p = 0.002). Factors associated with preference for a stool test over other screening tests were: age over 80 years compared to respondents aged below 80 (OR = 3.34, 95% CI: 1.67– 6.55, p < 0.001); respondents with college experience were more likely to prefer blood test compared to respondents without college experience (OR = 1.62, 95% CI: 1.02– 2.66, p = 0.048); Conclusion The study underscores importance of patient preference in deciding which tests to offer. Tailored strategies addressing demographic, socioeconomic, and health belief barriers are needed to improve CRC screening adherence.