Additional effort required to implement a new recommended age range for colorectal cancer screening

United States Preventive Services Task Force (USPSTF) Recently announced updated recommendations For colorectal cancer screening, we will reduce the age at which screening begins from 50 to 45 and require insurance coverage.

However, according to the accompanying editorial article published in JAMA Oncology, Further studies are still needed to identify the cause of early-onset colorectal cancer in patients younger than 45 years, and additional efforts to reach risky groups are needed to implement these new guidelines. Is required.

The authors said that most deaths from early-onset colorectal cancer occur between the ages of 45 and 49, but the data suggest that the rate of increase in incidence is the fastest in the youngest patients. There is. We found that the incidence of colorectal cancer increased by 2% annually between the ages of 20 and 29, compared by 1.3% between the ages of 40 and 49.

The authors also stated that the implementation of updated recommendations would be the key to achieving disease prevention. According to the data, the colorectal cancer screening rate in the United States in 2018 was 68.8%. It is low among uninsured low-income earners and racial and ethnic minorities, demonstrating that it is important to reach nearly one-third of the population to be screened.

As a change from the 2016 Recommendations, the USPSTF conducted modeling studies in groups based on gender and race and found that screening was equally effective in all populations. However, according to Dr. Kimmie Ng, the editor’s lead author and director of the Dana-Farber Cancer Institute’s Center for Young-onset Colorectal Cancer, the disparity in incidence and mortality of colorectal cancer continues and continues. You should be careful.

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

“So we want more black Americans to be screened by lowering the screening recommendations to 45 for everyone,” Ng said in an interview with CURE®. ..

“And hopefully we will make a dent in eliminating some of these disparities. Unfortunately, the biggest reason for the disparity is race in access to care and access to quality care. We consider it to be inequality. So, for example, blacks and Hispanic adults have been found to have less screening uptake, so in these communities where screening actually has a significant impact. , We need to focus on many of our public health efforts and awareness campaigns. “

Editors have guidelines and quality indicators that promote higher screening rates, such as “Wellness Day” provided by employers to help employees between the ages of 45 and 75 screen and support fecal immunochemical tests. , And suggested some potential initiatives that go beyond public awareness campaigns. (FIT) Kits, booking schedules, day care / transportation.

Other suggestions include occupational health services that provide on-the-spot FIT screening bundled with influenza shots, medical systems that provide weekend or overtime appointments for colonoscopy, safe boarding services, or social support. Included an extension of postoperative recovery period for patients who are deficient in. Physicians for special efforts, prevention and outreach to the patient’s family to reach a vulnerable population (uninsured, self-employed, mentally ill, disabled or imprisoned) Explanation, and improved communication from the doctor who diagnosed the patient to the patient’s at-risk relatives.

Scientists are considering environmental factors, increased obesity and sedentary behavior, as studies continue to investigate the causes of the recent increase in colorectal cancer incidence in the younger age group, according to Ng.

“Since the mid-1990s, the changes have happened a bit more rapidly and quickly, so I don’t think it’s a change in human genetic makeup,” Ng said. “And most of the young people diagnosed do not actually have a family history of hereditary syndrome or colon cancer.”

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