US task force proposes starting colorectal cancer screening at age 45

The US Preventive Services Task Force — the nation’s leading panel for medical guidance — is considering a draft recommendation to lower the recommended screening age for colon and rectal cancers to 45.

Previously, it was recommended to start screening at age 50.

“This new draft recommendation — and we’re seeking feedback — is that all adults ages 45 to 75 should get screened for colorectal cancer and, perhaps selectively so, in some people older than that, ages 76 to 85, depending on their overall health and their pattern ofscreening in the past,” Dr. Michael Barry, a member of the task force, told CNN on Monday.

The task force posted this draft recommendation online Tuesday and plans to receive public comment on the draft before making the recommendation final in months ahead.

Draft recommendations do not affect insurance coverage — but if finalized, the final recommendation would mean that, under current law, colorectal screening services could be covered by most private insurance plans, with no copay for patients ages 45 to 75, as the screening would be recommended.

The draft recommendation proposes an “A” recommendation for colorectal cancer screening in all adults ages 50 to 75 but a “B” recommendation for screening adults ages 45 to 49.

“Both an A and B recommendation mean that we think clinicians and patients should do it,” Barry said. “For practical purposes, they’re really the same in terms of the action.”

Yet “the difference relates to how we view the evidence, and the evidence of benefit was greater for adults 50 to 75 than for 45 to 49. We’re more certain about it — so that’s why the two different grades,” Barry said.

The draft recommendation is based on emerging epidemiologic data suggesting that there has been a rising risk for colorectal cancer among younger adults, ages 45 to 49. This rising risk received worldwide attention recently when “Black Panther” star Chadwick Boseman died of colon cancer in August. He was 43.

Along with examining epidemiologic evidence, Barry said that the task force commissioned a set of simulation models to look at questions related to colorectal cancer screening.

“The simulation models really supported the epidemiologic data suggesting that while the benefit is largest for people age 50 to 75, we can prevent some additional colorectal deaths by starting screening at age 45,” Barry said.

The draft evidence review and draft modeling report were also posted online Tuesday alongside the draft recommendation statement. The public is invited to comment on the draft recommendation through November 23.

This isn’t the first time that screening for colon and rectal cancer at age 45 has been considered. The American Cancer Society already has updated its guidelines for colorectal cancer screening to start at age 45 instead of 50, as previously advised. That update was made in 2018.

Yet the USPSTF did not follow suit at the time.

“Apparently, the US Preventive Services Task Force now has revisited all of the available data out there — and they’ve done the modeling studies that go into how they craft and decide on these guidelines — and have now determined that indeed with new emerging data about how much this is increasing in young people, it now does make sense and will likely lead to great benefit to start screening at age 45,” said Dr. Kimmie Ng, a medical oncologist and director of the Young-Onset Colorectal Cancer Center at Dana-Farber/Brigham and Women’s Cancer Center in Boston.

The Young-Onset Colorectal Cancer Center launched last year in response to the increase in colon and rectal cancer cases among younger adults. Some of the research at the center is focused on answering the questions about why this increase has occurred.

Ng, who was not involved in the Task Force recommendations, emphasized that there are also racial disparities in the incidence and mortality of colorectal cancer — where Black adults are more likely to get the disease at a younger age and more likely to die from the disease — and screening early might help close that racial gap.

“So hopefully by starting screening earlier for all average risk Americans, we may be able to make some in roads into mitigating those disparities,” Ng said.

In general, “we definitely have seen an uptick in young people coming in with diagnoses of colorectal cancer often at very advanced stages of the disease and who have no obvious risk factors for the disease,” Ng said. “The fact that we do see so many young people diagnosed under the age of 45 really points to the continued need for research about what the underlying causes are.”