45 is the New 50: Age to Start Screening for Colorectal Cancer

Due to an alarming rise in cases of colorectal cancer in men and women younger than 50, an independent panel of health specialists has recommended that people of average risk for the malignant disease begin screening at 45 years old instead of the traditional 50.

The USPSTF and ACS Unite Against One Common Concern

The United States Preventive Services Task Force (USPSTF) made significant changes to its 2016 recommendations and aligned them with the guidelines of the American Cancer Society (ACS), which lowered the age for initial colorectal cancer screening to 45 years old in 2018.

A Preventable Disease

Colorectal cancer is one of the most preventable cancers, as obesity, lack of physical activity, smoking, heavy consumption of alcoholic beverages, and a diet high in red meat are some of its strongest risk factors.

Furthermore, colorectal cancer’s history of progressing slowly, as well as the availability of screening exams that can intercept and detect cancer early, play a leading role in prevention. In fact, despite the recent surge in cases (even among millennials, many of whom are entering their 40s as of 2021), the overall incidence of colorectal cancer in individuals 50 years old and older has reduced steadily since the mid-1980s due to improved screening procedures and changing patterns of controllable risk factors.

A Closer Looking at the Increasing Rates

However, “a concerning increase in colorectal cancer incidence among younger individuals has been documented since the mid-1990s, with 11 percent of colon cancers and 15 percent of rectal cancers in 2020 occurring among patients younger than 50 years, compared with 5 percent and 9 percent, respectively, in 2010,” revealed Kimmie Ng, MD, MPH, the director of the Young-Onset Colorectal Cancer Center at Dana-Farber Cancer Institute in Boston, MA.

The direct cause of young-onset colorectal cancer remains unknown.

Importance of Screening Earlier

Lowering the recommended age to begin screening will make testing for colorectal cancer, which is so crucial, available to millions of people in the United States. And, hopefully, medical professionals can save many more lives by catching colorectal cancers earlier or by preventing the disease altogether.

The Research

The United States Department of Health and Human Services funds the USPSTF, which is an independent panel of health experts. They are responsible for the systematic analysis of any evidence supporting the effectiveness of preventive services and develop recommendations. 

American health insurance groups are mandated to cover all services that the USPSTF suggests with a grade A or B level of evidence, regardless of how much it may cost at no charge to the patient. The task force recommendation means that health insurers must cover preventive procedures, including stool tests and colonoscopies, which help detect colon cancer in its early stages.

The task force decided on age 45 based on research showing that beginning screening at that particular age prevented more premature deaths than starting at age 50, with a small increase in the overall number of colonoscopy complications. There is no modification to the USPSTF 2016 recommendation to only screen men and women aged 76 to 85, as research showed only small increases in life-years gained.

Should CRC Screening Initiate at a Younger Age?

American actor Chadwick Boseman, famous for portraying iconic African American characters, died due to colon cancer at the age of 43, which not only strengthened the urgency of screening for the said disease at an earlier age, especially among Blacks, but also begs the question, “should people start screening for colorectal cancer at a much younger age?”

Though the majority of young-onset colorectal cancer diagnoses and deaths occur in people 45 to 49, the rate of increase is steepest among the very youngest patients. Colon cancer incidence is rising by 2 percent per year in 20 to 29-year-olds, in comparison with 1.3 percent among 40 to 49-year-olds. On the other hand, rectal cancer incidence is increasing by 3.2 percent each year in 20 to 29-year-olds and 30 to 39-year-olds, compared with 2.3 percent in 40 to 49-year-olds.

Even individuals younger than 45 — in their 20s and 30s — are developing this cancer and often at advanced stages, said Ng. As such, the USPSTF recommendation to start screening at age 45 is insufficient to detect cancer in younger people.

A Call for Further Research and Analysis

Optimal prevention and early detection of colon and rectal cancers in those younger than 45 will require further and more extensive research to determine the underlying causes and risk factors, which have remained elusive.

Addressing the Barriers

According to the authors of a 2021 article highlighting the USPSTF’s updated recommendations, bold steps are necessary to turn the lowered age to initiate screening into meaningful decreases in colorectal cancer incidence and mortality rates, noting that despite the preventive advantages of colorectal cancer screening, only 68.8 percent of eligible people in the United States undergo testing.

Moreover, the rate is much lower among uninsured and underinsured individuals, those with low incomes, and among racial and ethnic minorities. Additional factors that prevent certain people from undergoing screening include concerns about the invasive nature of colonoscopies, lack of understanding regarding the importance of screening, and limited access to recommendations for screening.

Steps Toward Reduced Incidence and Mortality Rates

The same 2021 editorial listed public awareness campaigns, including those targeted at gaps in colorectal cancer or CRC incidence and mortality between White Americans and minorities, and specific actions. For example, companies could provide employees aged 45 or older with a paid “wellness day” to encourage the need to undergo CRC screening. They could also hand day care or transportation vouchers to overcome the logistical hurdles of colonoscopies. Health systems could also schedule after-shift or weekend appointments for colonoscopies.

The new and improved recommendation “represents an important policy change,” stressed the authors, “to drive progress toward reducing colorectal cancer incidence and mortality.”

Alternative Treatments for Colorectal Cancer

Patients diagnosed with colorectal cancer can combat their disease with complementary and alternative treatments for colon cancer, which involves non-traditional approaches to medicine, including immunotherapy. This treatment causes fewer side effects than conventional methods and involves the use of medication that boosts a patient’s immune system to effectively detect and destroy cancer cells. Learn more about immunotherapy for colorectal cancer or contact us at 480-757-6573 to schedule a consultation.

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