Under a draft recommendation proposed by the US Preventive Services Task Force (USPSTF), all adults would be screened for colorectal (CRC) cancer at 45 years rather than the current clinical standard of 50 years.1
“New science about [CRC] in younger people has enabled us to expand our recommendation to screen all adults starting at age 45,” said USPSTF member, Michael Barry, MD.1
The rationale for recommending earlier CRC cancer screening is based on emerging epidemiological data demonstrating an increasing incidence of CRC in younger patients.2 Existing evidence indicates that there has been an approximate 51% increase in CRC diagnoses in patients less than 50 years of age since 1994.
This younger subgroup is expected to account for 12% of new CRC cases and 7% of CRC-related deaths in 2020, according to data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results program and the Centers for Disease Control and Prevention National Program of Cancer Registries.3
Recent epidemiological data also suggest that CRC incidence in adults at 45 years “now approaches that of persons age 50 years in the era prior to the introduction of routine screening.” Despite the availability of preventive screening modalities, these resources are underutilized, with approximately just one-quarter of eligible adults (50-75 years) in the United States pursuing CRC screening in 2016.2
The proposed draft guidance is currently open to public comment until November 23, 2020. When final, it will replace the USPSTF’s 2016 A grade recommendation that screening for CRC should be initiated at 50 years and continue until 75 years.
Notably, the current draft recommendation continues to uphold the USPSTF’s 2016 recommendation that CRC screening should be pursued in adults aged 76 to 85 years on an individual basis (C grade recommendation). The draft guidance also maintains the 2016 suggestion that screening be discontinued after 85 years. Each of these 3 recommendations applies to adults without symptoms of CRC who do not have a personal history of CRC polyps or a personal or family health history of genetic disorders that increase the risk of CRC.2
The recommendation that CRC screening begin at 45 years is classified as a B-grade recommendation,2 indicating that there is “high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial,” justifying the implementation of the intervention.4 The draft guidance is expected to be especially impactful for Black individuals, who are known to be disproportionately affected by CRC and have higher mortality rates than the general population.1
The draft guidance supports the use of 2 specific screening modalities, direct visualization tests, and stool-based tests, however, these are not the sole methods available that should be considered. “There are many tests available that can effectively screen for [CRC],” said USPSTF member, Martha Kubik, PhD, RN. “We urge primary care clinicians to discuss the pros and cons of the various recommended options with their patients to help decide which test is best for each person.”1
1. US Preventive Services Task Force issues draft recommendation on screening for colorectal cancer. News release. US Preventive Services Task Force. October 27, 2020. Accessed October 28, 2020.
2. Draft recommendation statement; colorectal cancer: screening. US Preventive Services Task Force. October 27, 2020. Accessed October 28, 2020.
3. Siegel RL, Miller KD, Sauer AG, et al. Colorectal cancer statistics, 2020. CA Cancer J Clin. 2020;70(3):145-164.
4. Grade definitions. US Preventive Services Task Force. Updated June 2018. Accessed October 28, 2020.