Colorectal Cancer: US Task Force Reduces Recommended Age to Start Cancer Screening to 45 Years

According to official recommendations, colorectal cancer screening services between the ages of 45 and 75 are covered by most private insurance plans at no cost.

“For many, it means less barriers to screening between the ages of 45 and 49,” Barry said, adding that there may be a time lag before insurance coverage begins. Stated.

Colorectal cancer is the third leading cause of cancer death, with approximately 52,980 deaths estimated in 2021 in the United States. Most cases are diagnosed in people aged 65-74 years, but this recommendation reflects recent case trends. Young people.

Guidance change according to the trend you care about

The final recommendation states that 10.5% of cases of new colorectal cancer are people under the age of 50, and cases of adults aged 40-49 increased by almost 15% between 2000-2002 and 2014-2016. ..

Dr. Benjamin Lebwohl, a gastroenterologist at the NewYork-Presbyterian and Columbia University Medical Center, told CNN: “To some extent, it may be caused by obesity, but there are many non-obese people under the age of 50 who develop colorectal cancer without recognizable risk factors.”

Doctors still don’t know why more cases are occurring in the younger age group, but they say that screening people early can save lives. If colorectal polyps are detected early enough, they can be removed before they develop into cancer.

To inform the decision, the Task Force commissioned a review of colorectal cancer screening in the United States. This included 33 studies on screening effectiveness, test accuracy, and harm.

We also considered a modeling study that estimated the lifespan obtained from screening for colorectal cancer to be 171-381 per 1,000 people aged 40 years. The model showed that the number of additional lifespans obtained from screening after age 75 was relatively small. Researchers reduced the age at which screening begins from 50 to 45 years, with an additional lifespan of 22-27 years per 1,000 people, 161-784 additional colonoscopy, and 0.1 associated with screening. Estimated to cause ~ 2 additional complications.

Starting screening at the age of 45 “provides an efficient balance between the burden of colonoscopy and the lifespan gained,” said a study published at JAMA on Tuesday.

Disproportionate impact on black adults

The USPSTF currently recommends joining groups such as the American Cancer Society to lower the age threshold for screening adults at average risk for colorectal cancer. The American Cancer Society changed from 50 to 45 in 2018. In 2017, the US Multisocial Task Force on Colorectal Cancer recommended that screening begin at age 45 for African Americans and at age 50 for other groups.

This is because African Americans are more likely to die of colorectal cancer. In the new recommendation, the Task Force cites the incidence of colorectal cancer from 2013 to 2017, 37.8 per 100,000 white adults, compared to 43.6 per 100,000 black adults. Shown.

The USPSTF said the limited evidence prevented it from making specific individual recommendations for colorectal cancer screening in black adults.

“No one knows the definitive answer to why African Americans seem to have disproportionate amounts of colorectal cancer,” Dr. Carl Crawford, a gastroenterologist at NewYork-Presbyterian and Weill Cornell Medicine, told CNN. Said. “It is not clear whether this is due to reduced screening rates, post-screening follow-up, or the type of treatment these patients receive.”

Crawford said additional investigation into these disparities is needed.

“It may not be just genetic factors,” he said. “There may be problems with access to more environmental or medical systems that we couldn’t really put our finger on.”

“A time bomb with a 10-year fuse”

Barry said he hopes the new guidance will facilitate screening for all groups and ages included in the recommendations. In 2018, the Task Force noted that 31% of eligible adults were not up to date on screening for colorectal cancer. It was during the coronavirus pandemic, before many people skipped cancer screening along with other preventative care measures.

Dr. Michael Ginner, Chief Executive Officer and Chief Executive Officer of the Miami Cancer Institute at Baptist Health, said:

“During the pandemic, we learned that colonoscopy screening was down 85% from the previous year’s baseline,” he said. “When it is modeled over time, modeling may predict an additional 4,000 deaths from colon cancer within 10 years,” he says.

Doctors are urging patients to catch up with missed screenings, especially now that more Americans are vaccinated against the coronavirus daily.

“We contacted the patient and asked them to schedule a colonoscopy two weeks after the second dose of the vaccine,” Lebwohl said. “They are very intentional about this.”

There are several screening options for colorectal cancer, including colonoscopy and stool-based testing.

“There are many tests available that can effectively screen for colorectal cancer based on evidence, and appropriate tests are done,” said Martha, a professor and director of the School of Nursing at the USPSTF.・ Kubic said. Human Services at George Mason University said in a statement.