Task Force lowers age for colorectal cancer screening to begin

The U.S. Preventive Services Task Force (USPSTF) expanded its recommended ages for colorectal cancer (CRC) screening to ages 45 to 75 years, lowering the threshold from age 50. Selective screening is still recommended for those ages 76 to 85 years.

The USPSTF recommendation to screen adults ages 50 to 75 years for colorectal cancer is Grade A, while that for those ages 45 to 49 years is Grade B. The recommendation to selectively screen adults aged 76 to 85 years for colorectal cancer, considering the patient's overall health, prior screening history, and patient's preferences is Grade C.

The new recommendation applies to adults 45 years or older who do not have signs or symptoms of colorectal cancer and who are at average risk, such as no prior diagnosis of colorectal cancer, adenomatous polyps, or inflammatory bowel disease, as well as no personal diagnosis or family history of genetic disorders that predispose them to a high lifetime risk such as Lynch syndrome or familial adenomatous polyposis. The recommendations were published by JAMA on May 18, and were accompanied by a systematic review and modeling study.

Several types of screening tests are recommended, according to the statement. Patients may have preferences for different frequencies of screening, location (home or physician's office), methods (stool-based or direct visualization), preprocedure bowel preparation, anesthesia or sedation during the test, and follow-up procedures for abnormal findings, it noted . Recommended screening strategies include:

• high-sensitivity guaiac fecal occult blood test or fecal immunochemical test (FIT) every year,
• stool DNA-FIT every one to three years,
• CT colonography every five years,
• flexible sigmoidoscopy every five years,
• flexible sigmoidoscopy every 10 years with annual FIT, and
• colonoscopy screening every 10 years.

Physicians should discuss with patients the decision to screen, taking into consideration the patient's overall health status (life expectancy, comorbid conditions), prior screening history, and preferences.

An editorial in JAMA Surgery noted that the new recommendation is based on evidence of moderate certainty that the net benefit is moderate to substantial.

“Support for a younger age at onset for screening was initially based on a recognition that the incidence of CRC [colorectal cancer] among patients younger than 50 years has increased and that it is often being diagnosed in advanced stages owing, in part, to diagnostic delays,” stated one of three editorials accompanying the recommendation. “While the incidence of CRC among patients aged 40 to 49 years is lower than among those 50 years or older, these data are influenced by lead-time bias given differential screening and diagnostic colonoscopy rates, such that the CRC risk of younger cohorts is actually greater than many patients and clinicians may realize.”