USPSTF Lowers CRC Screening Age, Forcing Insurance Coverage

The United States Preventive Services Task Force (USPSTF) now recommends colorectal cancer (CRC) screening to begin at 45 years of age, rather than the previous recommended age of 50. These new recommendations, which were published in JAMA, now align with those of the American Cancer Society.

These recommendations finalize draft guidelines that were issued in October 2020, and, in doing so, will mandate insurance coverage for CRC screening (colonoscopies and stool tests) in adults starting at age 45.

Nurses should encourage all eligible patients to get screened, especially those who are at increased risk.

“We know that black adults get colorectal cancer more often and are more likely to die from colorectal cancer than people of other races and ethnicities,” said John B. Wong, MD, interim chief scientific officer at Tufts Medical Center, primary care physician, and member of the USPSTF said.

“Clinicians, nurses, physicians, and others should reach out to their black patients to help make sure they get screened… What’s really important [to take home] is that colorectal cancer screening helps people ages 45 to 75 liver longer and healthier lives.”

The guidelines come after a concerning increase in CRC incidence in people under the age of 50. While this has been a trend since the mid 1990s, researchers are still unsure why younger adults are seeing higher CRC rates, especially since CRC diagnoses have been going down in the over-50 population due to modifying risk behaviors.

“Our recommendation calls out for additional research to try to understand better what the causes are, and to see if we can find [out] because once you find and determine the cause, then maybe we can do something to prevent that from happening going forward,” Wong said.

Most young-onset CRC diagnoses and deaths occur in people between the age of 45 and 49–so there is hope that the new recommendations will catch cancers earlier and decrease the number of CRC fatalities.

However, the rate of young-onset CRC is actually growing most in individuals who are even younger. Colon cancer incidence is increasing by about 2% every year in the 20- to 29-year-old cohort, compared to 1.3% in the 40- to 49-year-old cohort. Similarly, rectal cancer is also increasing at a steeper rate in the 20- to 29-year-old group than the 40- to 49-year-old group, at 3.2% yearly and 2.3% yearly, respectively.

“We are now seeing patients even younger than 45–in their 20s and 30s–who are being diagnosed with this cancer and often at very late stages,” said Kimmie Ng, MD, MPH, guideline author, in a statement. “Clearly the USPSTF recommendation to start screening at age 45 will not be enough to catch those young people who are being diagnosed.”

The USPSTF will continue to analyze data and update recommendations, if needed.

“As part of our normal process at the USPSTF, we want our recommendations to be as up-to-date as possible. So roughly every 5 years, we re-examine the evidence, look for new research, look to see if there are any changes in the evidence that might alter the recommendations we make,” Wong said.

Reference

US Preventive Services Task Force. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. May 18, 2021.