Should colorectal cancer screening start at age 45?

By Angela Betsaida B. Laguipo, BSNMay 21 2021

Colorectal cancer rates among young adults are steadily increasing over the years. The United States Task Force has long recommended that people aged 50 to 75 get screened.

Now, the U.S. Preventive Services Task Force updated its 2016 recommendation of colorectal screening for people aged 50, down to 45 years old. The five-year earlier screening can save many lives by allowing earlier diagnosis and treatment of the condition.

The task force, which is the U.S.’s leading panel for medical guidance, recently released a draft of their recommendation. The final recommendation has been published in the Journal of the American Medical Association (JAMA), after commissioning a systemic review to evaluate the benefits and harms of screening colorectal cancer in adults 40 years or older.

Study: US Preventive Services Task Force. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. Image Credit: Anatomy Image / Shutterstock

Colorectal cancer by the numbers

In 2021, an estimated 149,000 adults in the United States will be diagnosed with colorectal cancer. These include 104,270 new cases of colon cancer and 45,230 new cases of rectal cancer.

The incidence of colorectal cancer rates dropped by about 1 percent each year between 2013 and 2017. However, the decrease is mainly occurring in older adults, who are most affected by the condition. The incidence has been increasing in younger people since the 1990s. Between 2012 and 2016, the incidence increased by 2 percent each year in people under 50 years old and 1 percent between 50 and 64 years old.

In the U.S., colorectal cancer is the fourth most common cancer in men and women between 30 and 39 years old. It is also the third leading cause of cancer death for both men and women, with an estimated 52,980 persons in the U.S. projected to die from colorectal cancer in 2021.

For people ages 65 to 74, colorectal cancer is the most frequently diagnosed, and about 10.5 percent of new colorectal cancer cases occur in people younger than 50. For people aged 40 to 49, the cases of colorectal cancer increased by almost 15 percent from 2000-2000 to 2014-2016.

Colorectal cancer screening

In the 2016 recommendation of the USPSTF, colorectal screening was put forward for people between the ages of 50 and 75. Since increasing cases were reported by people younger than 50, health experts weighed in on reducing the age recommendation to see if this strategy can prevent colorectal cancer diagnoses and early treatment for those with the condition.

In the review, the team examined whether the findings varied by age, sex, race, or ethnicity. The team also commissioned a report from the Cancer Intervention and Surveillance Modeling Network Colorectal Cancer Working Group to provide information from comparative modeling. This will show how many cancer diagnoses and deaths will be prevented by different starting and stopping ages for screening strategies.

The USPSTF recommends screening for colorectal cancer in all adults aged 50 to 75 years in the new recommendation. For adults aged 45 to 49 years.

The task force recommends screening for colorectal cancer, and for those who are 76 to 85 years old, clinicians can selectively offer screening. This should be individualized, considering the patient’s overall health and prior screening history. However, screening should be discontinued after age 85 years.

The USPSTF notes that the recommendation applies to asymptomatic adults 45 years or older who are at average risk of colorectal cancer, such as those with no prior colorectal cancer diagnosis, those who have adenomatous polyps, inflammatory bowel disease, and those with no family history of known genetic disorders predisposing them to a heightened risk of colorectal cancer like familial adenomatous polyposis or Lynch syndrome.

Maintaining comparable benefits and harms of screening with the various strategies requires that patients, clinicians, and health care organizations adhere to currently recommended protocols for screening intervals, follow-up colonoscopy, and treatment,” the researchers noted in the study.