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.