On May 30, 2018 The American Cancer Society (ACS) updated their guidelines for recommended screening for colorectal cancer from age 50 to age 45. This was in direct response to the increase in incidence of early age onset (EAO) colorectal cancer. Here’s what you need to know and how Fight CRC has been involved.

What is the background?

In 2017, The American Cancer Society (ACS) investigators published in the Journal of the National Cancer Institute that colorectal cancer (CRC) incidence rates are continuing to rise in young and middle-aged adults, including people in their early 50s. In addition, rectal cancer rates are increasing particularly fast, as 3 in 10 rectal cancer diagnoses are in patients younger than age 55. This information was no shock to the colorectal cancer community who has been and continues to see a number of younger adults diagnosed with this disease--adults diagnosed prior to age 50, which has been the recommended screening age for many years. Richard C. Wender, MD, Chief Cancer Control Officer of the American Cancer Society provides some helpful background on the new screening update: https://www.youtube.com/watch?v=4f_6k8_Jkq8

How will the new guidelines affect me?

The new ACS guidelines recommend that average-risk individuals get screened for colorectal cancer at age 45. That means having a discussion with your doctor before that time. If you are over age 50 and have already been screened for colorectal cancer, it is important to stay up to date on your testing schedule. Currently, the United States Preventive Services Task Force (USPSTF) suggests screening at 50 for the average-risk population. There are other institutions, however, with guidelines that already recommend screening before age 50 for certain groups of people at increased risk. This includes those who have a personal or familial history of colorectal cancer or adenomatous polyps, African Americans, and others who are at increased risk of developing colorectal cancer. The update to ACS is significant because it applies to all average-risk adults, not just those at an increased risk.

Will my screening be covered if I’m between ages 45-50?

Some insurance plans may follow ACS guidelines, but many follow USPSTF guidelines. Made up of a group of experts in prevention and evidence-based medicine, the work done by the United States Preventive Services Task Force (USPSTF) is typically what leads to insurance coverage (including Medicaid and Medicare) for preventive screenings, like colorectal cancer. The USPSTF will not update their guidelines simply because the ACS updated theirs. This is because the organizations have two distinct guidelines that are developed using different methods, processes, and timelines for review. At this point, coverage of average-risk individuals under age 50 is up to the discretion of the insurance company. It’s important to have a conversation with your healthcare provider to understand when screening is recommended for you, and to call your provider and ask what your plan covers and which screening guidelines the insurance carrier follows.

I’m under age 45… what about me?

Young adults with an elevated risk (like personal or family history of CRC or polyps, Lynch syndrome, etc) should start screening earlier. Visit Fight CRC’s page “Screening Options for High Risk” to learn more about screening for high-risk individuals. People who are under age 45 without an elevated risk should talk to their healthcare provider about signs and symptoms, such as (but not limited to) blood in the stool, abdominal pain, or unintentional weight loss. It is extremely important to have these conversations with your physician to determine a plan. If you feel like your provider is not taking you seriously about signs or symptoms, advocate for yourself and if needed, seek a second opinion.

What type of screening is recommended and at what age does screening end?

According to guidelines, for individuals who do not have a personal or familial history of colorectal cancer, adenomatous polyps, or a hereditary syndrome that puts them at increased risk, screening until age 75 can be done with colonoscopy every 10 years, fecal immunochemical testing annually, flexible sigmoidoscopy every 5 years, and computed tomographic colonography every 5 years. To learn more about screening options, visit FightCRC.org.

WHY is EAO occurring?

It is still not clear why early age onset CRC is on the rise. It’s important that research continues in this area and that dedicated energy and resources are put forth to understanding the cause, the WHY, of early age onset. We are on the forefront of these efforts and will keep the community informed as more information becomes available. To learn more, visit: https://fightcolorectalcancer.org/research/driving-research/under-50/

How was Fight CRC involved in this research?

Fight Colorectal Cancer collaborated with the American Cancer Society, Memorial Sloan Kettering in the United States and Erasmus University in the Netherlands on “Colorectal Cancer Screening Initiation before the age of 50 years: A Microsimulation Analysis.” We initiated and informed the modeling studies that went into this research. The release of this manuscript provides direction for scientists and patients striving to understand why there is an increase in the incidence of EAO CRC in the United States. What can patients do? Immediately, if you were diagnosed under the age of 50, please consider taking our survey. Your participation and stories will help as we continue to engage with the research community to understand why this phenomenon is occurring. Other ways to get involved:

• Educate people to see a doctor when experiencing signs and symptoms - at any age.
• Encourage people to learn their family histories to identify their personal risk of CRC.
• Follow up with a doctor’s recommendations when screening is recommended.
• Support research in this area - dedicate energy and resources toward the research that will work to understand the etiology or the WHY early age onset CRC is on the rise.
• Donate to support research efforts

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