A draft proposal released to the public by the U.S. Preventive Services Task Force on Oct. 27, 2020 lowered the recommended age at which to begin colorectal cancer screening to 45. This is a significant update by the task force, which previously recommended in its most recent 2016 guidelines that colorectal cancer screening begin at the age of 50 for patients who are considered normal risk.
The newly released proposal factors in the increasing evidence that the rates of colorectal cancer have been rising in younger patients. Over 10% of all colon cancers are diagnosed in patients under the age of 50, a fact that led the American Cancer Society to recommend in 2018 that screening begin at age 45. The plight of younger Americans being diagnosed with colorectal cancer gained particular attention recently with the tragic death of actor Chadwick Boseman at the age of 43.
The United States Preventive Services Task Force is a panel of health experts that includes physicians and epidemiologists who gather the most updated evidence in order to provide recommendations for healthcare providers across the country. Cancer screening recommendations are of particular public interest as they offer a guide to both primary care physicians about which tests to order and to insurance companies about which tests are covered. This draft proposal will be available for public comments for the next four weeks, and then a final recommendation will be made.
What does this mean for me?
Once this recommendation is finalized, people who are considered to be at normal risk should discuss colorectal cancer screening with their primary care providers as soon as age 45. That means if you are 45 to 49 years old, you should also have this conversation with your physician, as these new guidelines will apply to you as well.
What does it mean to be normal vs high-risk?
High risk patients include those with a first-degree family member (i.e. parent or sibling) with a history of colorectal cancer, patients who have been diagnosed with inflammatory bowel disease, and those who have been diagnosed with a genetic condition that predisposes them to colorectal cancer. Most patients who do not have these risk factors are considered to be average or normal risk. Other potential colorectal cancer risk factors that are important to consider but do not necessarily change the age at which to begin screening include cigarette smoking, heavy alcohol use, obesity and type 2 diabetes.
What are my options for colorectal cancer screening?
Most people think of a colonoscopy when they hear about screening for colon cancer. While this is the preferred method of screening for many healthcare providers because it can both make a cancer diagnosis and allow for removal of early pre-cancerous growths (polyps), there are a number of other approved screening tests. If you have a normal colonoscopy, then a repeat colonoscopy is recommended 10 years later for screening.
Flexible sigmoidoscopy is another screening technique that is similar to a colonoscopy, but it does not evaluate the entirety of the colon. Thus, it is recommended that this be performed at more frequent intervals and potentially in combination with stool-based tests. There are multiple approved stool-based tests that evaluate for blood or abnormal DNA, which may indicate the presence of colorectal cancer, and need to be performed every one-two years. An additional screening test utilizes a CT scan to visualize the inside of the colon and rectum. If CT or stool-based screening tests are utilized, any abnormal result is usually further investigated with a colonoscopy.
I am optimistic that the updated recommendations will lead to saved lives in this group of younger adults who may be diagnosed at an earlier, curable stage. Other people will benefit by having pre-cancerous polyps found and removed prior to the growths having the chance to develop into cancerous tumors. I encourage you to discuss these new recommendations with your primary care provider and help to reverse the troubling trends in the incidence of younger adults with colorectal cancer.
Learn more about Jonathan Mizrahi, MD