New manuscript publication on early-age onset CRC announced: Recommendations include lowering screening initiation to 45 years.

Fight Colorectal Cancer (CRC) is excited to announce the publication of the manuscript “Colorectal Cancer Screening Initiation before the age of 50 years: A Microsimulation Analysis” into Cancer. This manuscript is the collaborative effort of the American Cancer Society, Fight CRC, Memorial Sloan Kettering in the United States, and Erasmus University in the Netherlands. The release of this manuscript informed the newly announced American Cancer Society (ACS) guidelines and provides direction for scientists and patients looking to understand the increase in the incidence of early-age onset (EAO) colorectal cancer in the US.

What did investigators research?

In 2016, the results from modeling studies used to guide the US Preventive Services Task Force (USPSTF) colorectal cancer screening guidelines suggested screening begin at age 50 for average risk adults. However, these models didn’t account for the data which showed an increase in CRC incidence in the under 50 population. Investigators recognized the need to update a modeling study with new data about early age onset to reassess the age at which CRC screening should begin and end for the average risk population. Dennis Ahnen, one of Fight CRC’s medical advisory board members, and Andrea (Andi) Dwyer, Fight CRC’s Director of Health Promotion recognized the need to explore early-age onset CRC further in response to the urgency voiced from the advocacy community.  To do so, they strategized efforts to help maintain momentum with a working group to address the increasing early-age onset incidence rates. Consistent with previous methods to help determine population based screening approaches, the goal of this group was to rerun the modeling studies to provide relevant and updated data into the MISCAN model taking into account the increased incidence and mortality rates of CRC in adults under age 50. The MISCAN model is a mathematical model that analyzes trends in colorectal cancer, taking into account for example: demographics, risk exposure, natural history, treatment, screening dissemination, and the impact of screening. With this information, the model simulates colorectal cancer data. The group discovered that a more appropriate age to begin screening is 45 years of age. According to the lead author Elisabeth Peterse, "as a result of the increasing incidence of early age of onset colorectal cancers, screening initiation at age 45 years now has a favorable balance between screening benefits and burden." Dwyer noted, ‘this was a great opportunity to collaborate with worldwide experts to inform the analyses, which were the first to take race, gender and this increased risk into account and the results, to change the 45 rather than 50 for both men and women and for all races and ethnicities.’ Additionally, it was determined that screening should be completed every 10 years via colonoscopy until the age of 75 years. After 75, the model recommends annual fecal immunochemical tests, and flexible sigmoidoscopy and computed tomographic (CT) colonography tests every 5 years.

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While these findings won’t immediately translate into tangible changes to all population based guidelines, such as USPSTF screening guidelines, they build upon the current knowledge of population based screening and guideline development. The results are also sparking necessary conversations about why the incidence of under 50 cases are increasing, and how research and advocacy efforts can be utilized in conjunction to fight this phenomena.

"Being a survivor of early age colorectal cancer I see first hand how this is affecting younger and younger people. It's vital we invest in research to understand why this is happening in hopes to learn what steps we can take to prevent it or if people need to look at screening options earlier than the current recommend age" -Amanda Houston, Stage II survivor

The data tells us that early onset colorectal cancer is alive and well. What the data does not tell us is why. Fight CRC is working hard to understand the necessary steps to mitigate the increased incidence in young adults by convening experts, engaging and educating patients, and harnessing the data. 

According to Trish Lannon, President of the Colon Club, “early-age onset is such an important issue that needs to be dealt with. When you have doctors and patients who are not educated about CRC at an early age, you end up with people having a late stage colorectal cancer diagnosis. That puts them at a low survival rate, but if we can do more to educate people we can help ensure that cases are caught early or even prevented.”

Fight CRC’s patient education and research team see the updated screening age as an exciting step in addressing EAO CRC, one that was made possible through persistence in advocacy and research. It remains extremely important to continue educating health care professionals about EAO, to get screened on time and follow-up with screening as needed, and discuss family history to learn about any increased risk. In addition, the team stresses the importance of research -- that research in this area must continue so that we have a better understanding of why more young people are being diagnosed. Fight Colorectal Cancer will continue to stay at the forefront of the early-age onset issue and cover what the new ACS guideline changes mean for patients and the CRC community.