The U.S. Preventive Services Task Force has lowered the age for when adults should start screening for colon and rectal cancer from 50 to 45. Experts expect the move to save thousands of lives as more cases are flagged and treated at earlier stages of the disease.
Finalized recommendations published Tuesday in the Journal of the American Medical Association are an update to the task force's 2016 colorectal cancer screening recommendations to begin screenings at age 50 for asymptomatic adults at average risk.
The new recommendations state adults aged 45 to 75 have routine colorectal cancer screenings. Screenings for adults aged 76 and older should be done based on the individual patient's screening history and overall health status.
"New science about colorectal cancer in people younger than 50 has allowed us to expand our recommendation to include people ages 45 to 49," said USPSTF member Dr. John Wong, chief scientific officer at Tufts Medical Center in Boston.
The USPSTF estimated earlier screenings would be associated with up to an additional 27 life-years, two to three fewer colorectal cancer cases, and between 0.9 and 1 fewer deaths from the disease compared to adults who begin screenings at age 50.
The updated USPSTF recommendations follow a similar change made by the American Cancer Society, which in 2018 lowered its recommended age for beginning routine colorectal cancer screening to 45.
The "B" grade given to the recommendation change means patients starting at age 45 with commercial insurance can get colorectal cancer screenings with no out-of-pocket costs.
Marcie Klein, vice president of prevention for patient advocacy organization, Colorectal Cancer Alliance, said the change marked a "huge step" in efforts to increase access to preventive screenings. She estimated allowing first-dollar health insurance coverage for adults starting at age 45 could impact up to 15 million adults.
"This is huge progress, and we are so thrilled that the task force has acknowledged the need to bring the age down to 45," Klein said. "Right now we want to maximize this opportunity to get the word out about this new age limit."
Colorectal cancer is the third leading cause of cancer death among adults, with more than 52,000 people in the U.S projected to die from the disease in 2021. While most colorectal cancer cases are diagnosed in people aged 65 to 74, incidents among adults aged 40 to 49 have increased by nearly 15% between 2000 and 2016. Meanwhile, 10.5% of new colorectal cancer cases occur in those younger than age 50.
According to the USPSTF, in 2018, 31% of U.S. adults were not up to date with their colorectal cancer screening.
Wong hoped the new USPSTF recommendations could help address outcome disparities. Black adults have the highest rates of incidence and mortality from colorectal cancer compared to other ethnic and racial groups, with 18 deaths for every 100,000 adults compared to 13.6 deaths per 100,000 among white adults.
But a 2018 study by the Centers for Disease Control and Prevention found screening rates among Black adults aged 50 to 75 were 70%—the second highest among racial and ethnic populations.
Klein said clinicians should urge Black patients to get colorectal cancer screening, follow-up, and treatment to reduce the gap in care that has led to outcome disparities.
"This is just the beginning because now that the task force has released its guidance, it's really going to be up to companies and insurers and healthcare providers to really kind of put this over the finish line and promote the adherence to this," Klein said. "It's going to take a lot of work to get the full impact on outcomes."
