As colorectal cancer is becoming more prevalent in younger patients, the U.S. Preventive Services Task Force (USPSTF) introduced a draft recommendation that, if accepted, will lower the screening age from 50 years to 45 years in those with average risk.
The U.S. Preventive Services Task Force (USPSTF) issued a draft recommendation statement, which recommends lowering the age of initiating colorectal cancer screening from 50 to 45 in patients with average risk. These patients include those without symptoms, without a personal history of colorectal polyps or without a family or personal health history of genetic disorders that may increase colorectal cancer risk.
The USPSTF in 2016 recommended screening all adults between the ages of 50 to 75 years, although recent data suggest that the incidence of colorectal cancer in patients aged 45 years is slowly becoming similar to those aged 50 years.
“Unfortunately, not enough people in the U.S. receive this effective preventive service that has been proven to save lives,” said Task Force chair Dr. Alex Krist in a press release. “We hope that this recommendation to screen people ages 45 to 75 for colorectal cancer will encourage more screening and reduce people’s risk of dying from this disease.”
This draft recommendation statement emphasizes a net benefit with specific tests including colonoscopy, stool-based tests with high sensitivity, flexible sigmoidoscopy and computer tomography colonography. It is important to note that the draft recommendation does not include urine tests, serum tests or capsule endoscopy, as limited evidence is available on these methods.
Colorectal cancer is the third leading cause of death related to cancer in women and men, and an estimated 10.5% of new colorectal cancer cases are in patients younger than 50 years, according to the draft recommendation statement. In addition to age, other risk factors play a role in increasing rates of colorectal cancer including patients with a family history of colorectal cancer, men and Black adults.
This statement brings the USPSTF up to speed with the American Cancer Society, which issued an updated guideline recommendation in 2018 for screening to begin at age 45 for individuals at average risk for colorectal cancer.
“This harmonizes the stance of the USPSTF with the American Cancer Society,” said Dr. Mark Lewis, director of gastrointestinal oncology at Intermountain Healthcare in Murray, Utah, in an interview with CURE®. “The [American Cancer Society] recommended this shift downward in age of initiating colorectal cancer screening over 2 years ago, but the USPSTF carries significantly more weight in regard to what insurance carriers will cover.”
Attention has shifted toward the importance of screening younger adults for colorectal cancer especially since actor Chadwick Boseman died from the disease at the age of 43. He was diagnosed with stage 3 colon cancer in 2016, which progressed to stage 4while he was receiving treatment.
“This is a seismic shift in preventive health for Americans aged 45 [to] 49 that dramatically increases (by estimates of up to 20 million) the number of people eligible for screening,” said Lewis. “The putative biologic rationale is that we can detect and intervene upon polyps in the adenoma-to-carcinoma sequence either before they become malignant or at least when they remain curable with surgery.”
Lewis added that it is important for patients to understand the difference between screening and diagnosis. He said, “Patients younger than 45 should still call symptoms of concern (especially rectal bleeding) to the attention of their primary care providers to initiate an appropriate work-up. Hemorrhoids are a diagnosis of exclusion!”
“We congratulate the USPSTF for updating its stance in response to the alarming growth of young-onset CRC,” according to a joint statement from the Colorectal Cancer Alliance, Fight Colorectal Cancer and Colon Cancer Coalition. “This change will fulfill the USPSTF organizational mission to ‘improve the health of all Americans by making evidence-based recommendations about clinical preventive services.’ There is ample evidence to lower the screening age now. Lowering the recommended age for screening is supported by both the science and a moral obligation to save lives. Therefore, we applaud the USPSTF for its recommendation to reduce the age of screening for those at average risk of colorectal cancer to 45.”
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