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In addition to promoting on-time screening for average-risk adults starting at age 45, CRC signs and symptoms may need timely assessment by a health care provider to rule out other conditions and identify a diagnosis. The objective of this study was to examine primary care providers\u2019 (PCPs\u2019) awareness of CRC-related symptoms and their diagnostic approaches for patients under age 50 using the 2023 DocStyles panel survey. This survey included 1490 PCPs practicing in the United States. A descriptive analysis was conducted to examine symptom awareness and referral practices. Log binomial regression was used to examine predictors of greater symptom awareness. Symptom awareness of early-onset CRC was highest for changes in bowel habits (79%) and lowest for abdominal pain (43%). Fewer obstetricians\/gynecologists and physician assistants were aware of CRC signs and symptoms. Most PCPs would complete a workup and assess patients for family history of cancer for patients presenting with rectal bleeding\/bloody stools, iron deficiency anemia, or changes in bowel habits. Around 45% of PCPs would refer patients with rectal bleeding\/bloody stools to diagnostic colonoscopy or offer a stool-based screening test. Some PCPs may benefit from additional training on signs and symptoms of early-onset CRC and evidence-based guidelines for symptom assessment. These findings indicate that many PCPs prefer to complete a medical workup and assess for family history of cancer as first steps, and most would not immediately refer patients to diagnostic colonoscopy.<\/jats:p>","DOI":"10.1177\/19427891251411924","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T14:24:42Z","timestamp":1768314282000},"page":"94-102","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Knowledge, Symptom Awareness, and Referral Practices of Primary Care Providers in Early-Onset Colorectal Cancer"],"prefix":"10.1177","volume":"29","author":[{"given":"Julie S.","family":"Townsend","sequence":"first","affiliation":[{"name":"Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Chamblee, Georgia, USA."},{"name":"Centers for Disease Control and Prevention, Chamblee, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary C.","family":"Puckett","sequence":"additional","affiliation":[{"name":"Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Chamblee, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sallyann M.","family":"Coleman King","sequence":"additional","affiliation":[{"name":"Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Chamblee, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Djenaba A.","family":"Joseph","sequence":"additional","affiliation":[{"name":"Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Chamblee, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,1,13]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"National Cancer Institute and Centers for Disease Control and Prevention. 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