Guideline from CRC task force recommends starting screening at ages 45 to 49 years in all average-risk patients

Increasing disease incidence and a favorable harm-benefit ratio are two reasons to expand the age range for colorectal cancer (CRC) screening to younger patients, a task force determined.

Data support beginning colorectal cancer (CRC) screening for average-risk patients at age 45 years, the U.S. Multi-Society Task Force on Colorectal Cancer recently concluded.

This recommendation is based on the increasing disease burden among individuals under age 50 years, emerging data that the prevalence of advanced colorectal neoplasia at ages 45 to 49 years approaches rates at ages 50 to 59 years, and modeling studies demonstrating that the benefits of screening outweigh the potential harms and costs, according to the task force.

The task force represents the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy. The new guideline is a focused update to its 2017 recommendations and was published by the American Journal of Gastroenterology, Gastroenterology, and Gastrointestinal Endoscopy on Nov. 15.

There was a 1.1% increase in CRC per year (95% CI, 0.3% to 2.0%) from 2006 to 2015 for those under age 50 years, the task force noted. This includes an increase of 0.7% per year (95% CI, 0.5% to 0.9%) for colon tumors and 1.7% per year (95% CI, 1.4% to 2.0%) for rectal tumors.

Current CRC incidence rates in individuals ages 45 to 49 years are similar to the incidence rates seen in 50-year-olds in 1992, before widespread CRC screening was performed. Based on 2001 to 2010 data in the SEER Registry, the CRC incidence among 45- to 49-year-olds was 30.8 per 100,000 men and 25.9 per 100,000 women. In 1992, CRC incidence in those ages 50 years was 25.6 per 100,000. Using historical population-based SEER data from 1975 to 2010, researchers forecasted that for patients ages 35 to 49 years, colon cancer and rectal cancer incidence rates will increase by 27.7% and 46.0%, respectively, by 2030.

Patients ages 76 to 85 years should make individual decisions about whether to continue screening based on prior screening history, life expectancy, CRC risk, and personal preference, the guideline said. Screening is not recommended after age 85 years.