When Screening for Colon Cancer To Save Lives: 45 Is the New 50

A national body of evidence-based health experts — including SHP Director Douglas K. Owens — recommends screening for colon cancer in adults 45 to 75 in an effort to protect Americans from the third leading cause of cancer death in the country.
Blue Colon Cancer Ribbon

A national body of medical experts is calling on clinicians to screen their patients for colorectal cancer starting at 45 years old, instead of waiting until 50, as the rate of colon and rectal cancer in young adults has seen a substantial increase in the last two decades.

Colorectal cancer is the second leading cause of cancer deaths in the United States, with an estimated 52,980 people projected to die of the disease by the end of this year. The American Cancer Society says while the rate at which people are diagnosed with colorectal cancer in the United States has been dropping among people 65 and older — due to more people getting recommended screenings — the trend has reversed for younger Americans.

Adults 50 to 64 years old have experienced an increase of about 1% a year, while adults 40 to 54 years old have experienced a 2.2% a year increase in colorectal cancer for adults.

This somber trend has prompted a national body of evidence-based medical experts to recommend lowering the age of screening from 50 to 45 years of age. The US Preventive Services Task Force, which published its recommendation statement in JAMA on May 18, is calling on clinicians to implement routine colorectal cancer screenings for their younger patients,  including those who have no symptoms or a personal or family history of the disease.

“Colorectal cancer screening is one of the most effective preventive interventions — it clearly prevents deaths from colon cancer,” said Stanford Health Policy’s Douglas K. Owens, a member and past chair of the Task Force.

The Task Force is an independent volunteer panel of experts in prevention and evidence-based medicine whose final recommendations are followed by most primary care physicians and clinicians nationwide. Its members reviewed 33 existing studies on the effectiveness of screenings and commissioned three microsimulation models, which found that screening at 45 was associated with an additional 22 to 27 life-years gained compared with starting at age 50 per 1,000 persons screened.

The Task Force notes that Black and American Indian/Alaska Native adults have the highest incidence of and mortality from colorectal cancer. From 2013 to 2017, incidence rates were 43.6 cases per 100,000 African Americans, compared with 39 cases per 100,000 American Indian/Alaska Native and 37.8 cases among white adults. The death rates from 2014 to 2018 were 18 and 15.1 deaths per 100,000 Blacks and American Indian/Alaska Native adults, respectively, compared to 13.6 deaths per 100,000 non-Hispanic white adults, 10.9 deaths per Hispanic/Latino adults and 9.4 deaths per 100,000 Asian/Pacific Islander adults.

“The causes for these health disparities are complex; recent evidence points to inequities in the access to and utilization and quality of colorectal cancer screening and treatment as the primary driver for this health disparity rather than genetic differences,” the Task Force notes in its s

“We recommend earlier screening because the epidemiology of colorectal cancer has changed, with increasing numbers of younger people getting cancer,” Owens said, adding that today there are many tests to effectively screen for colorectal cancer.

While the 2010 Affordable Care Act eliminated co-pays for preventive visits and cancer screenings, 31% of eligible adults were still not up to date with colorectal screening as of 2018.

“The potential of the USPSTF guidelines change to decrease mortality related to colorectal cancer will only be realized if it is accompanied by strategic implementation,” three independent physicians — Kimmie Ng,MD, MPH; Folasade P. May, MD, PhD, MPhil; and Deborah Schrag,MD, MPH — wrote in an editorial accompanying the Task Force recommendation in JAMA. They noted concerns about the invasiveness of colonoscopy, as well as lack of screening services and clinician recommendation, were among the barriers to higher screening rates.

“Bold steps will therefore be necessary to translate these new USPSTF recommendations into meaningful decreases in colorectal cancer incidence and mortality,” they wrote, proposing a slew of steps that could be taken by employers and health systems to promote screenings.

“Special efforts are required to reach vulnerable populations, including those who are underinsured, self-employed, mentally ill, disabled, or incarcerated,” they said.

And given the sizeable gaps in colorectal cancer incidence and mortality between Black and white adults in the United States, they said, quality metrics must make inroads among Black populations so interventions can begin to close the gap.

“Communicating the morbidity and mortality attributed to colorectal cancer in the Black community, including the recent death of Chadwick Boseman at age 43, has potential for increasing awareness.”

doug owens

Douglas K. Owens

Professor of Medicine
Owens is an MD, decision-scientist and director of Stanford Health Policy

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