Supreme Court Case Could Threaten Free Colorectal Cancer Screenings

The American College of Gastroenterology (ACG) is urging the US Supreme Court to uphold the authority of the US Preventive Services Task Force (USPSTF), warning that millions of Americans could lose access to essential colorectal cancer (CRC) screenings.¹ In an amicus brief filed Monday in Kennedy v Braidwood, the ACG highlighted the potential consequences of limiting the USPSTF’s role in guiding preventive care coverage under the Affordable Care Act (ACA).

“Simply put, the implications of the Court’s upcoming decision on patient care and public health should not be understated,” said Amy S. Oxentenko, MD, FACG, president of the ACG, in a statement. “We informed the Supreme Court of how much progress we’ve made in recent decades in preventing colorectal cancer deaths through colonoscopy with polypectomy, but also warned the justices how much is at stake in this moment—especially as incidence rates continue to rise among younger Americans.”

The ACG represents the interests of gastrointestinal clinicians and their patients. In the brief, the group outlined the success and importance of CRC screening for public health, while also emphasizing the need to reduce barriers to access.

Since the USPSTF updated its recommendations that patients aged 45 to 49 years be screened for CRC, research found disparities based on socioeconomic status and area of residence, emphasizing a need for interventions in these areas to increase screening in all patients.² Furthermore, CRC is the second leading cause of cancer-related deaths in the US.³ CRC has also been found to increasingly affecting younger adults, with diagnoses among those under age 55 years nearly doubling over the past decade.

The Supreme Court case comes at a critical moment in the fight against CRC. Although overall incidence rates have dropped nearly 50%—largely due to increased screening—early-onset CRC is on track to become the leading cause of cancer death in people aged 20 to 49 by 2030, according to the ACG.

The ACA’s preventive services mandate has eliminated cost-sharing for screenings, removing a key barrier to care. Research shows that out-of-pocket costs deter patients from getting screened, particularly those from lower-income backgrounds. If the Court upholds the lower court’s ruling in Braidwood, the ACG warns that screening rates could decline—leading to more late-stage diagnoses and higher mortality rates.

Although the ACG steered clear of constitutional arguments, it underscored the public health stakes. Beyond ACA-regulated insurance plans, the USPSTF’s recommendations influence screening mandates in 16 states. A Court ruling against the task force’s authority could trigger further legal battles over state mandates, leaving millions of Americans in limbo.

“Colorectal cancer screening includes colonoscopies and other, noninvasive tests that can detect warning signs before colorectal cancer develops,” the brief outlined. “The data are clear: colorectal cancer screening saves lives by stopping colorectal cancer—the second most common cause of cancer mortality in the US—in many cases even before it happens.”

This spring, the court will decide the validity of the USPTSF and its recommendations under the Patient Protection and ACA.

References

1. ACG champions the importance of preventive care and colorectal cancer screening in Supreme Court amicus brief. American College of Gastroenterology. News release. March 5, 2025. Accessed March 7, 2025. https://www.newswise.com/articles/acg-champions-the-importance-of-preventive-care-and-colorectal-cancer-screening-in-supreme-court-amicus-brief

2. Bonavitacola J. CRC screening increases in patients aged 45 to 49 after USPSTF recommendation. AJMC®. October 7, 2024. Accessed March 7, 2025. https://www.ajmc.com/view/crc-screening-increases-in-patients-aged-45-to-49-after-uspstf-recommendation

3. Steinzor P. 5 things to know about colorectal cancer. AJMC. March 7, 2025. Accessed March 7, 2025. https://www.ajmc.com/view/5-things-to-know-about-colorectal-cancer