The United States Preventive Services Task Force has lowered their guidelines, now what?

Today, the United States Preventive Task Force (USPSTF) accepted draft language, and lowered the colorectal cancer screening age from 50 to 45 for average risk individuals. Read below for the most common questions and answers surrounding this update.

There were no research trials conducted to inform this decision to move to 45 vs 50. Is the science strong enough to move the guideline to 45 years old?

It is true that randomized control trials have not been conducted to explicitly test the benefit of screening at age 45 vs. 50. However, modeling studies that take into account previous study data and factors have been utilized as the standard methodology to determine the best age to begin screening. 

Three modeling studies were utilized to inform this guideline recommendation, including the Microsimulation Screening Analysis-Colon (MISCAN-Colon) model, Colorectal Cancer Simulated Population model for Incidence and Natural history (CRC-SPIN), and Simulation Model of Colorectal Cancer (SimCRC). More recent data indicating a rise in colorectal cases in younger people was factored in the modeling studies and determined that the optimal age to begin screening is 45 vs. 50 years old. 

The recent article published in the Journal of the American Medical Association (JAMA)  predicts that colorectal cancer is estimated to become the leading cause of cancer-related deaths by 2030 in those 20-49 years old. Why did the USPSTF not take into account this prediction?

The data and information from the JAMA article was not included in these analyses because it was released after the guideline review. The latest article predicting elevated trends in colorectal cancer cases and deaths was released in April 2021. The USPSTF has been using data up to 2020 to complete their review. However, it creates a sense of urgency in the community to ensure we’re doing all we can to avoid reaching this statistic by 2030.

Learn more about what Fight CRC is doing in EAO CRC here.

I’m under the age of 45, what about me?

This change in the recommendation addresses the screening benefit vs. the screening burden. Recommending the screening age for the average-risk population too early could result in more harm from screening than lives ultimately saved. This recommendation is for average-risk populations only, meaning an individual has no personal history or family history of colorectal cancer and is not at risk for a genetic or familial syndrome.

Young adults at a higher risk of developing CRC (such as personal or family history of CRC or polyps, Lynch syndrome, etc) should talk to their doctor and may be eligible to start screening earlier.

People who are under age 45 at average risk should talk to their healthcare provider about any signs and symptoms they experience, 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.

Will my insurance begin covering screening at age 45?

Most private health insurance plans, as well as Medicare and Medicaid (in most states) follow USPSTF recommendations and will begin to cover screening  at 45 years old. The change might not be immediate, as insurance carriers typically update their coverage in the next plan year or after exactly one year from the issue date of the recommendations. But some insurance plans are already covering colorectal cancer screening at age 45 (such as those who follow American Cancer Society guidelines vs USPSTF). If you are unsure, it is best to check with your insurance provider. 

Rates of CRC are still higher in older individuals than in younger individuals. Don’t they need screening more than younger people? How will this benefit people over 50?

It’s correct that rates of colorectal cancer are still higher in the 50 and over population. Data shows there have been rapid declines in colorectal cancer in individuals 65 and older for the last several decades. However, in people under 50 and those 50 to 64, rates have increased by 2% and 1% annually, respectively. 

Lowering the screening age to 45 is likely to increase screening for those 50-54, who notoriously do not receive screening on time. By beginning screening at age 45, the colorectal cancer community can begin messaging much earlier (45-49) in hopes that additional time would result in higher rates of individuals receiving their screening earlier, no later than the age of 50. Experts call this lead-time messaging.  

Cost analysis completed indicated starting CRC screening at age 45 years is likely to be cost effective. But it was also concluded lowering costs could be achieved by increasing participation rates for unscreened older and higher-risk persons.


Other Updates in EAO CRC

Earlier this month, a study published in the Journal of the American Medical Association titled “Estimated Projection of US Cancer Incidence and Death to 2040” discussed predictions of cancer cases and cancer deaths for the most common cancers up to the year 2040.

One statistic in particular stuck out for our community.

“In the group aged 20 to 49 years, colorectal cancer was estimated to become the leading cause of cancer-related deaths by 2030.”

While this statistic is shocking, colorectal cancer incidence and mortality rates in individuals younger than 50 have been steadily increasing since the mid-1990s. According to Becky Siegel, Epidemiologist for the American Cancer Society (ACS), “it’s important to realize that colorectal cancer is already the leading cause of cancer death in males <50 and has been for many years.”

Even though this isn’t the news that we want to hear, the colorectal cancer community is coming together to ensure that we do as much as we can so we don’t reach this statistic by the year 2030. 

"As a health-oriented author who wrote about the science of aging in my 20s, I was shocked to have received a Stage III CRC diagnosis that my docs said clearly had developed in my 30s. This is one reason why I am especially motivated to help researchers and patient advocacy related to those who (also) get shock diagnoses long before the "average." 

-Curt Pesmen, Fight CRC Research Advocate; author of How a Man Ages and The Colon Cancer Survivors' Guide

Lowering the Screening Age from 50 to 45

This month, the United States Preventive Services Task Force (USPSTF) accepted draft language, reviewed our public comments, and lowered the colorectal cancer screening age from 50 to 45 for average risk individuals.  

According to the late Dr. Dennis Ahnen, “In my mind this is the one thing we can do right now to make the biggest impact on early age onset colorectal cancer. There are other things that are important, finding the cause is important, taking a better family history is still important, but I think the thing we can do right now that would make the biggest impact would be to advocate hard for the starting age of 45.”

Previously, the National Comprehensive Cancer Network (NCCN) released updated colorectal cancer screening guidelines recommending colorectal cancer screening begin at the age of 45 and in March 2021, the American College of Gastroenterology (ACG) lowered their recommended screening age to 45 as well. 

"Extending the colorectal cancer screening age to age 45 is the first step in what will need to be a massive public health and clinical medicine effort to ensure that all individuals have access to colorectal cancer screening. We have a lot of work to do to meet this task, but it will certainly save lives."

-Fola May, MD, Fight CRC Medical Advisory Board member

While early-age onset colorectal cancer (EAO CRC) is defined as colon and rectal cancer occurring in those under the age of 50, lowering the screening age to 45 is a start. It is estimated that this change could help avoid 11,000 deaths over the course of 5 years. Additionally, 21 million Americans would be eligible for screening.

Lowering the screening age will also benefit communities disproportionately affected by EAO CRC. A recent study published at the American Association for Cancer Research (AACR) found that Black patients with early-onset CRC had significantly higher tumor mutational burden (TMB) than White patients. Previously, the same researchers highlighted that Black patients, but not Hispanic patients, with early-onset CRC had a greater risk of death compared with White patients.

We congratulate the USPSTF for updating its stance in response to the alarming growth of young-onset CRC. Lowering the recommended age for screening is supported by both the science and a moral obligation to save lives. Therefore, we applaud the USPSTF for its recommendation to reduce the age of screening for those at average risk of colorectal cancer to 45.

Patti Hollenback
Caregiver and RN/Nurse Navigator

“My late husband Harry was diagnosed with Stage IV CRC at the age of 47. He died three years later at age 50. Had he been screened at 45, his cancer would have been diagnosed at a much earlier stage and he’d probably still be here to see his first grandson come into the world. The evidence is clear now that CRC is being diagnosed at younger ages and screening will make a difference.”

Kim Woods
Stage I survivor diagnosed at age 49

“I am 49, just a few months shy of 50. My doctor went ahead and put in orders because I was close to that ‘magic’ age, so I decided to go ahead and get my colonoscopy out of the way. I had TOTALLY considered putting it off until sometime in my 50th year. To my utter shock and surprise, my doctor called to tell me three polyps were precancerous and one was cancerous. I have no family history, no symptoms, nothing. My case is a PERFECT EXAMPLE of why the screening age should be lowered. I am one of many who could have avoided a diagnosis of cancer with earlier screening.”

Tayde Castro
Stage IV survivor diagnosed at age 48

I was diagnosed with stage IIIb cancer at 48 years old. I had no symptoms that would have indicated colon cancer prior to discovering a bulge in my lower abdomen myself. If I had been screened at 45, the disease would have been detected at an earlier stage and I would not be dealing with stage IV cancer now, as my disease has progressed. Prevention is the key.”

Advocate for Increased Funding for Colorectal Cancer

Greater federal funding for colorectal cancer research is also a critical factor to help determine why more and more young people are being diagnosed with colorectal cancer and to give us the tools to help change these statistics. 

The National Institutes of Health (NIH) and National Cancer Institute (NCI) are key funders of colorectal cancer research and have worked with Fight CRC through our Early-Age Onset Work Group. Another federal agency conducting important medical research is the Department of Defense (DoD) Congressionally Directed Medical Research Program (CDMRP). 

The CDMRP supports high risk, high reward, high impact research and is focused on diseases that impact active duty military personnel. Given that the majority of active duty military are in their 20s and 30s, early-onset CRC must be a top priority. 

Fight CRC is working with our advocacy partners and congressional champions to create a Colorectal Cancer Research Program within the DoD CDMRP. This would not only provide a dedicated funding stream, but also allow for a targeted approach to identify the best and highest use for those dollars for colorectal cancer research. 

A greater commitment from the federal government is crucial if we are going to stop, and ultimately reverse the trends we are seeing in early-onset CRC. To add your voice to this effort, complete our action alert to reach out to your member of Congress today. 

Rally on Research: Join the Conversation

Beginning in 2019, Fight CRC, in partnership with the medical community from the Jiménez Díaz Foundation Hospital in Madrid, Spain, formed an EAO CRC Workgroup of researchers, clinicians, and patient advocates across the globe to bring attention to the rise in cases in patients under 50 and understand the causes of these striking increases. We all want to know why this is happening, fully aware that for some, time is running out.

The workgroup continues to meet both virtually and at live events to understand the most important approaches to addressing colorectal cancer in young adults, both in the United States and internationally.

Join us on June 24th and 25th for an interactive Rally on Research focused on EAO CRC. Come engage with other researchers, clinicians, and patient advocates to build a path toward a cure for EAO CRC. We’ll be helping answer burning questions, such as: What research is underway now? What’s the path moving forward? How can clinicians provide great care? How can patients share their experiences to influence future plans? How can you join the international research efforts and be part of the community tackling this issue? 

Registration is free because we need your voice at the table!

Fight CRC is continuously dedicated to working alongside our patient community, clinicians and researchers to address early age onset disease. Dr. Dennis Ahnen was pivotal to guiding this work and dedicated his life to tackling EAO CRC and we will continue to fight alongside our community to make progress in EAO CRC research.

One thought on “Making Progress in Early-Age Onset Colorectal Cancer

  1. My brother has just been diagnosed with stage IV CRC at age 48. His doctor said it has probably been growing for 5 years. There is no family history so screening at age 45 would likely have caught this at a much more manageable — if not curable — stage. Thank you for your efforts to improve the odds for everyone.

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