Additional Efforts Necessary to Implement New Recommended Age Range for Colorectal Cancer Screenings

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In an accompanying editorial to the recently updated U.S. Preventive Services Task Force recommendation for colorectal cancer screenings, doctors suggested additional measures that would help increase the screening rate among eligible adults and potentially lower the mortality rate.

The U.S. Preventive Services Task Force (USPSTF) recently announced an updated recommendation for the screening of colorectal cancer, lowering the age to begin screenings from 50 to 45 and mandating insurance coverage.

But according to an accompanying editorial opinion piece published in JAMA Oncology, further research is still necessary to determine the causes of early-onset colorectal cancer in patients even younger than 45, and additional efforts to reach at-risk groups are necessary to implement these new guidelines.

Most early-onset colorectal cancer deaths occur between ages 45 to 49, said the authors, but data suggests the rate of increase in incidence is steepest in the youngest patients. Colorectal cancer incidence was found to be increasing by 2% per year among 20- to 29-year-olds versus 1.3% among 40- to 49-year-olds.

The authors also noted that implementation of the updated recommendation will be key to achieving prevention of the disease. Data shows that in 2018, the colorectal cancer screening rate in the United States was 68.8%. It was lower among the uninsured, low-income individuals and racial and ethnic minorities, proving that it’s crucial to reach nearly one third of the eligible-for-screening population.

In a change from the 2016 recommendations, the USPSTF conducted modeling studies in groups based on gender and race, finding that screening is equally effective in every population. However, disparities in colorectal cancer incidence and mortality persist and require further attention, according to Dr. Kimmie Ng, the editorial’s first author and director of the Young-Onset Colorectal Cancer Center at Dana-Farber Cancer Institute.

Black adults are 20% more likely to be diagnosed with colorectal cancer and 40% more likely to die than other groups, according to the American Cancer Society.

“So, we do hope that by lowering the screening recommendation to age 45 for everybody, that more Black Americans will also be getting screened,” said Ng, in an interview with CURE®.

“And hopefully, we're going to be making a dent in eliminating some of these disparities. We do think that the biggest reason for the disparities is unfortunately racial inequities in access to care and access to quality care. And so, we know that Black and Hispanic adults, for example, have a lower uptake of screening. So we really need to focus a lot of our public health efforts and public awareness campaigns in these communities where screening really will have a big impact.”

The editorial authors suggested several potential efforts beyond guidelines, quality metrics and public awareness campaigns that would encourage higher screening rates, such as an employer-provided “wellness day” for employees aged 45 to 75 to undergo screening or to be assisted with fecal immunochemical test (FIT) kits, appointment scheduling and daycare/transportation.

Other suggestions included occupational health services providing on-the-spot FIT screenings bundled with flu shots, health systems offering weekend or after-hours appointments for colonoscopies, safe ride services or the extension of post-procedure recovery periods for patients who lack social support, special efforts to reach vulnerable populations (underinsured, self-employed, mentally ill, disabled or incarcerated patients), physician accountability for prevention and outreach to patient families as well as improved communication from physicians who have diagnosed patients to their patients’ at-risk relatives.

As research continues to examine the causes of the recent rises in colorectal cancer incidence among younger age groups, scientists are considering environmental factors, the rise of obesity and sedentary behavior, according to Ng.

“We don't think that it's any change in the genetic makeup of human beings, because the change happened a little bit too abruptly and quickly, starting in the mid 1990s,” said Ng. “And most of the young people who are being diagnosed actually do not have a genetic syndrome or a family history of colon cancer.”

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