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May 18, 2021

Colorectal cancer screenings should start for adults at age 45, medical task force says

Cases of the disease have increased among people ages 40-49 in recent years, researchers found

Prevention Colorectal Cancer
Colorectal cancer screenings RAWPIXEL.COM/PEXELS

It's estimated that more than 10% of new colorectal cancer cases occur in people younger than 50 years old, researchers found.

Colorectal cancer screenings should now begin for adults at age 45, the U.S. Preventive Services Task Force said Tuesday, as cases of the disease have grown among people in their 40's over the last several years.

The medical panel's latest recommendation states that colorectal cancer screenings can have a moderate net benefit for adults ages 45-49 and decrease the number of colorectal cancer cases and deaths.

Researchers said that adults ages 50-75 years old are strongly recommended to continue screenings for colorectal cancer, citing the substantial net benefit it serves for people in this age group.

Colorectal cancer checks should continue to be done on a case-by-case basis for adults ages 76-85 years old, the task force said. Doctors should selectively offer screenings for adults in this age group based upon the patient's overall health, prior screening history and screening preferences. Researchers found that colorectal cancer screenings have a small net benefit for people in this age demographic who have already been screened.

All colorectal cancer screenings should be stopped for adults ages 86 and older, the volunteer medical panel said.

The task force's updated guidance applies to all adults, including those who have no symptoms and no personal history of colorectal polyps or a personal or family health history of genetic disorders that increase the risk of colorectal cancer.

The independent panel's recommendation also included direct visualization and stool-based tests to screen for colorectal cancer.

"Based on the evidence, there are many tests available that can effectively screen for colorectal cancer, and the right test is the one that gets done," task force member Dr. Martha Kubik said. "To encourage screening and help patients select the best test for them, we urge primary care clinicians to talk about the pros and cons of the various recommended options with their patients."

The U.S. Preventive Services Task Force's updated guidance comes as colorectal cancer cases increased among adults ages 40-49 years old, despite the risk being much lower among adults younger than 50 years old. Nearly 94% of new colorectal cancer cases occur in adults ages 45 and older.

It's estimated that more than 10% of new colorectal cancer cases occur in people younger than 50 years old, according to the task force. Researchers also found an incidence rate of 20 new colorectal cancer cases per 100,000 persons ages 40-49 years old. The incidence rate of colorectal cancer in adults ages 40-49 has increased by almost 15% from 2000-2002 and 2014-2016. 

The recent trend of colorectal cancer cases appearing in adults younger than 50 years old has been found in white and Hispanic/Latino adults.

Colorectal cancer is the third-leading cause of cancer deaths among men and women in the U.S., according to the task force. Almost 53,000 Americans are expected to die from colorectal cancer in 2021.

The disease is most frequently diagnosed among adults ages 65-74 years old. Researchers found an incidence rate of 105.2 new colorectal cancer cases per 100,000 persons ages 60 years and older.

Black adults get colorectal cancer more than people of other races and ethnicities, and are more likely to die from the disease, the task force found. Researchers found an incidence rate of 43.6 colorectal cancer cases per 100,000 Black adults. The task force encouraged doctors to reach out to their Black patients to make sure they are regularly screened and have access to high-quality screenings.

The task force also found higher incidence rates among American Indian and Alaskan Native adults, men, people with a family history of colorectal cancer and people with risk factors such as obesity, diabetes, long-term smoking and unhealthy alcohol use.

In 2016, more than a quarter of eligible adults ages 50-75 were found to have never been screened for colorectal cancer. As of 2018, 31% of eligible adults were not up to date with their colorectal cancer screenings. Researchers said those numbers are too high.

"Far too many people in the U.S. are not receiving this lifesaving preventive service," task force vice chair Dr. Michael Barry said. "We hope that this new recommendation to screen people ages 45 to 49, coupled with our long-standing recommendation to screen people 50 to 75, will prevent more people from dying from colorectal cancer."

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