Screening for colorectal cancer should start at 45, panel says

The nation’s leading advisory panel on preventive medicine practices is recommending adults at average risk for colorectal cancer begin getting screened at age 45 in light of mounting evidence that there is a steady rise in cases among younger adults and that it has a disproportionate impact on black Americans.

Draft recommendations issued by the U.S. Preventive Services Task Force on Tuesday mark a departure from conclusions the expert panel made in its last update to its recommendations in 2016.

At that time, USPSTF found there was a “modest increase in life-years gained” associated with starting screening earlier than age 50, yet there lacked enough empirical evidence on the clinical benefit of testing younger populations.

But the increased incidence of colorectal cancer cases among younger adults over the past two decades prompted the USPSTF to give its recommendation a “B” grade. Under the Affordable Care Act, USPSTF screening recommendations graded “A” or “B” requires health insurers to provide first-dollar coverage for such tests.

Rates of colorectal cancer cases among adults ages 20 to 39 increased by as much as 2% a year from 2011 to 2016, while cases among people 65 and older decreased by 3% annually during the same period, according to research from the American Cancer Society.

Rates of mortality for colorectal cancer have seen similar age trends. Death rates among people 65 and older have declined by 3% a year from 2008 to 2017 but have increased by 1.3% among those younger than 50 throughout that same period, according to the ACS study.

“A 45-year-old person now has about the same chance of getting colon cancer as a 50-year-old did in the past,” said USPTSF Chair Dr. Alex Krist, professor of family medicine and population health at Virginia Commonwealth University.

Among the recommended types of screening were a colonoscopy done once every 10 years as well as stool-based tests that patients perform more frequently at home.

Krist said lowering the recommended colorectal cancer screening age could also help to increase screening rates among those racial and ethnic minority groups that are disproportionately impacted by colorectal cancer.

The colorectal cancer death rate is nearly 40% higher among black adults compared to white adults, while deaths among Native Americans and Alaskan Natives are about double the rate of black adults.

“There is a health inequity that we have to address,” Krist said. “Black people are more likely to gee colon cancer at a younger age, so lowering the recommendation for screening all people aged 45 to 75 is particularly important for black people.”

The recommendation change was lauded by advocacy organizations and healthcare providers who saw the move was a significant first step toward narrowing those racial disparities.

“A lot of us were hoping this was what the USPSTF would do,” said Dr. Noelle LoConte, an oncologist and associate professor of medicine at the University of Wisconsin School of Medicine and Public Health and Carbone Cancer Center. “We were expecting an October surprise but maybe this was not the one we were expecting.”

LoConte said a vital next step will be for healthcare providers to increase their outreach efforts to ensure greater access to colorectal cancer screening for vulnerable populations and to educate primary care providers and insurers about its benefits.

“If you look at colorectal cancer screening, the benefits in terms of mortality and incidence is the greatest there for screening than for almost any other types of cancer,” LoConte said. “I just think it’s a total win any way you look at it.”

The more immediate challenge for many providers is how to address the steep decline in patients coming to healthcare facilities for routine tests and screening due to fears of contracting COVID-19. LoConte said her center saw an 80% to 90% reduction in cancer screenings in the months of March and April.

“There’s a lot that we are going to have to do,” LoConte said. “Right now our focus in cancer control is on messaging that people really need to get back to screening and that it’s something that can’t wait until after COVID is gone.”


Tags: covid-19, pandemic

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