USPSTF Recommendations and Colorectal Cancer in Young Adults – Current Challenges and Future Opportunities | Oncology | JAMA Network Open

In recent years, the increasing incidence of colorectal cancer (CRC) in adults under the age of 50 has become a concern among experts. Colorectal cancer is currently the leading cause of cancer-related death in men and the second leading cause of cancer-related death in women in this population.1 In response to this increasing trend, in 2021 the U.S. Preventive Services Task Force (USPSTF) recommended starting colorectal cancer screening at age 45. Of note, this recommendation received a grade B rating, indicating that the supporting evidence is substantial but not as strong as the evidence for starting screening at age 50. Masu.

This study by Siddique et al.2 analyzed claims data from Blue Cross Blue Shield (BCBS) to assess changes in CRC screening uptake among individuals aged 45 to 49 years after the latest USPSTF recommendations. According to the U.S. Census Bureau, between 3.1 million and 3.4 million people were eligible for BCBS over the study period, a representative sample of nearly 20 million people in this segment of the U.S. population.³

Comparing two time periods, May 2018 to December 2019 and May 2021 to December 2022 (20 months before and after the USPTF recommendation), Siddique et al.2 found an absolute increase in bimonthly screening rates of 1.01 (95% CI, 0.62 to 1.40) percentage points for individuals aged 45 to 49 years (P< .001). Furthermore, Siddique et al.² Overall, 13.9% of adults ages 40 to 49 reported having a screening test between May 2021 and December 2022.² Although we do not provide annual rates (or rate increases) for screening, using the data provided and assuming that attrition rates for two-month intervals in the lives of BCBS subjects are negligible, in 2022 and 2019. Screening rates were estimated by adding those rates to screen each of the six bimonthly intervals, resulting in 11.7% versus 3.5%, an 8.2 percentage point increase in annual screening rates.

Based on survey and interview data, colorectal cancer screening uptake in 2021 is estimated to be 59% for individuals aged 45 years and older and 20% for individuals aged 45 to 49 years.4 These estimates are higher than those reported in this study by Siddique et al.²However, it must be recognized that screening rates are difficult to estimate and that an 8.2 percentage point increase in annual screening rates from 2019 to 2022 is substantial.⁵

It is also important to note that different screening methods, such as colonoscopy and noninvasive tests (including stool-based tests), have different sensitivities for detecting adenomatous lesions and colorectal cancer. Detecting and removing adenomatous lesions can reduce the incidence of cancer, which is the difference between stool-based tests and colonoscopies. Siddique et al.2 reported on the use of various screening methods, with colonoscopy showing the greatest increase. Additionally, the use of stool DNA testing has increased following recommendations from the USPSTF, with approximately 25% of screenings being conducted through stool DNA testing.² All non-invasive tests require a follow-up diagnostic colonoscopy if the result is positive. Challenges in completing this tracking process are well documented, raising concerns about the suboptimal nature of this approach at the population level.⁶ In this study by Siddique et al.² Colonoscopy utilization was higher in metropolitan areas, and prevalence of stool DNA testing was not significantly different between low-resource areas and metropolitan areas. This difference may lead to differences in cancer incidence and mortality between resource-rich and resource-poor regions in the future and should be the focus of further research.

A study by Siddique et al.2 They also found significant differences in testing rates based on race, ethnicity, sociodemographic status, and place of residence. Additionally, men were more likely to undergo colonoscopies than women. Although the disparity is not unique to this population, it is more pernicious at both the individual and population level due to the younger age of affected individuals. Research to understand and efforts to address these disparities is central to providing equitable care.

Increased colorectal cancer screening rate among people aged 45 to 49 reported by Siddique et al.2 It's encouraging. However, it is unclear whether this increase is entirely due to USPSTF recommendations; other factors, such as deferrals and deferrals of testing conducted after increased COVID-19 restrictions, may have contributed to this significant increase. may have contributed to the increase. Ultimately, there is great potential for effective and lifesaving interventions, such as CRC screening, to reach this young and productive population, and further research is needed to improve the delivery of screening services. is.

Open access: This is an open access article distributed under the terms of. CC-BY license. © 2024 Sadeghi S et al. JAMA network open.

Corresponding author: Sarmad Sadeghi, MD, PhD, School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave, Ste 3440, Los Angeles, CA 90033 ([email protected]).

Conflict of interest disclosure: There were no reports.