On October 27, 2020 The United States Preventive Services Task Force (USPSTF) released draft guidelines recommending that colorectal cancer (CRC) screenings begin at 45 years old for average-risk individuals, a shift from the current USPSTF guidelines that recommend beginning at age 50. This was in direct response to the increase in incidence of early age onset colorectal cancer (EAO CRC) and aligns with the American Cancer Society’s 2018 recommendation that screening begin at age 45.

Please note, the CRC screening recommendations are still in draft form. Insurance will not cover the change in guidelines and clinicians may not recommend screening for those under age 50, until the guidelines are finalized.

Fight CRC provided feedback on the draft guidelines during the public comment period with input from members of the Medical Advisory Board and Early-Age Onset Workgroup.

Today, Fight Colorectal Cancer (Fight CRC) submitted an official comment on behalf of thousands of advocates urging The United States Preventive Services Task Force (USPSTF) to finalize their recommendation to adapt the colorectal cancer (CRC) screening guidelines and lower the age to begin screening to 45.

Fight CRC praised the USPSTF for updating its stance on colorectal cancer screening for average-risk individuals to include those 45 to 49 years, in response to the alarming growth of early age-onset colorectal cancer (EAO CRC). Suggestions to further strengthen the guidelines were also provided, based on input from members of the Medical Advisory Board and Early Age Onset Workgroup, such as upgrading the recommendation from a B to A grade and designating follow-up colonoscopies for evaluation of abnormal stool tests as part of the screening process, rather than a separate diagnostic procedure. In response to the proposed USPSTF guidelines, we recommend that essential factors for adaptability and application be considered, such as cost, resources needed, and potential barriers to implementation, access, and feasibility.

Through a collaboration with the Colorectal Cancer Alliance and the Colon Cancer Coalition, nearly 1,600 advocates participated in an action alert to voice their support for the draft language.

“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.” – Tayde Castro, colorectal cancer survivor

The bottom line is clear: lowering the screening age for average-risk individuals will save lives.

However, it’s important to note these guidelines alone are not a silver bullet for solving the rise in EAO CRC and there is still room for improvement. If and when the updated USPSTF guidelines are adopted, the colorectal cancer advocacy community will need to keep the following considerations in mind:

• The USPSTF guidelines were developed for average-risk patients. Other professional organizations have developed separate guidelines for those at a higher risk of colorectal cancer due to a family history, genetic mutation, or personal history of colorectal cancer. It is important to know your risk of colorectal cancer, as you might need to be screened even before 45 years old if at increased risk.
• Education about what the guidelines mean and who they apply to will be essential for successfully reaching average-risk patients aged 45 and older who have not yet been screened.
• Knowing the signs and symptoms of colorectal cancer are critical. No matter your age, it is extremely important to talk to your healthcare provider about any signs and symptoms you are experiencing. If you feel like your provider is not taking you seriously about signs or symptoms, advocate for yourself and if needed, find another provider.
• The scientific community does not yet know why rates of colorectal cancer among young adults (under age 50) without a familial or genetic risk are rising. Researchers are working quickly to answer this question. Fight CRC is supporting a collaborative approach to this effort through the Early-Onset Colorectal Cancer Workgroup.

• The USPSTF will review the public comments, including ours, and consider any final changes to the guidelines based on the feedback.
• In order to finalize the recommendations, the task force will conduct a vote to approve the guidelines.
• After approval, the final recommendation and evidence summary will be published in the Journal of the American Medical Association (JAMA) and copies of the final recommendations and evidence reports will be posted on the task force website.
• Insurers and healthcare providers will go through their own processes to adopt and begin implementing the updated guidelines. Private insurance plans subject to the Affordable Care Act (ACA) and Medicare plans are required to provide coverage all preventive screenings with an A or B recommendation without any co-pay or out-of-pocket costs to the patient.
• As always, Fight CRC will continue to push for the policies and research that benefit our community the most.

Update: The final recommendations in the May 2021 USPSTF update lowered the screening age to 45.