Following new guideline changes from the U.S. Preventive Services Task Force (USPSTF), individuals with an average risk of colorectal cancer should now receive screening for the disease starting at age 45 instead of 50. While the American Cancer Society had previously made this change in its recommendations in 2018, a new JAMA study from an independent expert panel was the driving factor behind the USPSTF’s updates.
Although colorectal cancer incidence in individuals over 50 has decreased in the last three to four decades, a different trend has been observed in individuals under 50. "A concerning increase in colorectal cancer incidence among younger individuals (ie, younger than 50 years; defined as young-onset colorectal cancer) has been documented since the mid-1990s, with 11% of colon cancers and 15% of rectal cancers in 2020 occurring among patients younger than 50 years, compared with 5% and 9%, respectively, in 2010," commented Kimmie Ng, MD, MPH, who is the director of the Young-Onset Colorectal Cancer Center at Dana-Farber Cancer Institute and first author of an accompanying article to the JAMA study also published in the journal.
Although it’s still unclear what causes young-onset CRC, the change in guidelines will make screening more accessible to younger people, with the hope that earlier detection will save lives. However, Ng thinks that the guidelines don’t go far enough, noting that colon cancer incidence is increasing by 2% per year in 20 to 29-year-olds (versus 1.3% in 40 to 49-year-olds) while rectal cancer incidence is increasing by 3.2% per year in 20 to 29-year-olds and 30 to 39-year-olds *compared to 2.3% in 40 to 49-year-olds).
"We are now seeing patients even younger than 45 -- in their 20s and 30s -- who are being diagnosed with this cancer and often at very late stages," said Ng. "Clearly the USPSTF recommendation to start screening at age 45 will not be enough to catch those young people who are being diagnosed."
Yet, not only do the guidelines mean younger people will now have access to screening, they also mean that health insurance companies will be required to cover preventive procedures and screening costs. As the authors explain, the guidelines thus "represent an important policy change to drive progress toward reducing colorectal cancer incidence and mortality."