In a move that has the potential to save thousands of lives, the U.S. Preventive Services Task Force (USPSTF) this week lowered the recommended screening age for colorectal cancer from 50 to 45 for asymptomatic patients with no family history of colorectal cancer. Considered the leading source of medical guidance in the U.S., the USPSTF is an independent, volunteer organization made up of national experts in internal medicine, family medicine, pediatrics, OB/GYN, nursing, behavioral health, and more.
“Since the 1970s, we have observed a steady increase in the incidence and mortality associated with colon cancer in patients under the age of 50,” says CU Cancer Center member Swati Patel, MD. “We don’t fully understand why this is happening, but if current trends continue — in part because we’re doing a great job of screening older individuals — by 2030 or so, up to 20% of all colon cancers and almost 30% of all rectal cancers will be diagnosed in patients under the age of 50.”
By lowering the recommended screening age, Patel says, the USPSTF is putting screening at top of mind for younger individuals, as well as ensuring that insurance companies will pay for the screening procedures for those 45 and older.
“When you look at the increasing rates of colorectal cancer and how frequently it’s being diagnosed in the U.S., there’s this artificial jump in cases between 49 and 50,” she says. “That’s not because there is something biologically different between 49- and 50-year-olds; it’s because when patients are eligible for screening, there is a spike in diagnoses in people who had probably had colorectal cancer for several years and didn’t have symptoms. That really suggests to us that if we had the option to offer screening at age 45, that those patients could be diagnosed at earlier stages or the cancer could potentially even be prevented altogether.”
Multiple screening options
While the colonoscopy is perhaps the best known screening option for colorectal cancer, Patel emphasizes that there are other tests available to screen for the disease.
“There’s a whole menu of options that have been shown to be effective,” she says. “There are noninvasive tests such as stool-based tests, then also structural tests such as colonoscopy that can directly visualize the colon.”
The advantage of the colonoscopy, Patel says, is that during the procedure doctors can find and remove precancerous polyps before they have the chance to grow into cancer.
The best test, she says, is “the test that gets done!”
Game-changer for medically underserved populations
The change in recommended screening age is especially big news at the Colorado Cancer Screening Program (CCSP) at the CU Cancer Center, which exists to help patients in rural and medically underserved communities get screened for colorectal, lung, genetic and hereditary cancers and also coordinate with the partnering breast and cervical cancer screening program. That’s not only because the change will result in more people getting screened at a younger age, but because Medicaid and other insurance providers will now cover the procedures at no cost to patients, says CCSP director Andrea (Andi) Dwyer.
“Within our medically underserved community, particularly communities of color, this will be fantastic for us to have Medicaid and other types of private insurance being able to honor that USPSTF guideline,” she says. “Most of the people we see through the CCSP program and our partners are Medicaid patients, so this is really going to be a game-changer.”
Symptoms and family history still important
While Patel is encouraged by the potential for lives saved by the lowered screening age, she stresses that the recommendation is for asymptomatic individuals with no family history of cancer. Those with a family cancer history or symptoms such as rectal bleeding, a change in bowel habits, or unexplained weight loss should not wait until age 45 to talk to their physicians, she says.
“The most important time to talk to your doctor about colorectal cancer risk is when you first meet them, no matter how young or old you are,” she says.
But for those individuals at average risk, Patel says the USPSTF made the right move by lowering the recommended screening age to 45.
“It’s not just that it prevents people from dying from colorectal cancer, but for somebody in their 40s or 50s, it has implications for the financial toxicity associated with a cancer diagnosis in an otherwise young, healthy, productive member of society,” she says. “These are individuals who are often caregivers; they’re often taking care of not only younger generations, but also caregivers for older generations, and they have decades of contribution remaining. Early detection of cancer at a curable stage is extremely important in this young population.”