In an effort to curb rising colorectal cancer rates among younger Americans, the United States Preventive Services Task Force (USPSTF) has changed its stance on colorectal cancer screening, lowering the recommended age to start screening to 45. The task force previously recommended beginning screening at age 50.
The USPSTF’s decision aligns with guidelines from organizations like the American Cancer Society (ACS), which also recommends that preventive colorectal cancer screening begin at age 45 among adults with no symptoms of colorectal cancer who have an average risk of developing the disease at some point in life.
Both the USPSTF and ACS state that colorectal cancer screening should continue through age 75 for all Americans and that screening should be performed only on a case-by-case basis among Americans ages 76 to 85.
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Who Gets Colorectal Cancer? New Patterns Emerge, While Others Remain
Approximately 10.5 percent of new colorectal cancer cases crop up in people under age 50, according to the USPSTF, which predicts that nearly 53,000 people in the United States will die from the disease in 2021. It is the third most common cause of cancer death among Americans, the task force notes.
While colorectal cancer has historically been considered a disease that affects people in their 60s and 70s, data spanning several decades shows that that is no longer the case, says Fola May, MD, PhD, director of quality for gastroenterology at UCLA Health in Los Angeles.
In fact, data published in January 2020 in JAMA Network Open shows that, between 2000 and 2015, incidence rates of colorectal cancer between ages 49 and 50 increased by 46.1 percent. And of all cases diagnosed at age 50, a staggering 92.9 percent were deemed invasive (meaning the cancer had already spread to other parts of the body).
“The reality is that, since the 1990s, we’ve seen an increase in colorectal cancers that occur in people who are under age 50,” explains Dr. May. “When you look at people who are aged less than 50, the rates of colorectal cancer have increased by 1 to 2 percent per year, and that’s very different than if you look at individuals who are over 65, where the rates are down every year.”
Will New Guidelines Address Disparities?
Colorectal cancer has also long been known to affect African Americans disproportionately compared with people of other races and ethnicities. Statistics published in March 2020 by the Centers for Disease Control and Prevention (CDC) show that, out of every 100,000 people living in the United States in 2016, more than 49 African Americans were diagnosed with colorectal cancer (compared with more than 41 white Americans, more than 38 Hispanic Americans, more than 34 Asian Americans or Pacific Islanders, and more than 32 American Indian or Alaska Native people).
African Americans experience the highest rate of death from colorectal cancer as well, the CDC states, with one of the most well-known cases being that of African American actor Chadwick Boseman. The beloved star of the Marvel film Black Panther was diagnosed with stage 3 colorectal cancer in 2016 and died in August 2020 at 43.
Whether the USPSTF’s new screening recommendation helps alleviate these disparities in diagnosis and survival of colorectal cancer remains to be seen, says May.
“I think hopefully now that everyone’s going to be getting screened earlier, African Americans are also more likely to get screened earlier,” May explains, noting that prior to the USPSTF’s new recommendation, other medical societies like the American College of Gastroenterology were already recommending that African Americans begin receiving colorectal cancer screening at age 45.
But more steps are likely needed to ensure that screening is accessible to people who need it, especially in medically underserved populations.
“What we’re hoping is that with the introduction of the new guideline, there will also be more support for public health intervention and research to make sure that these recommendations are also taken up in low-income populations and in Black and Latino populations, where we traditionally see lower-than-usual screening rates,” May adds.
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What Is Colorectal Cancer Screening?
Colorectal cancer screening is a preventive measure that helps doctors look for polyps (potentially precancerous growths that can form in the colon and rectum) or other signs of the disease, such as blood in stool. Doctors can use five different methods to check patients for signs of colorectal cancer, according to the National Cancer Institute:
- Colonoscopy This testing option lets doctors see your colon by inserting a thin, flexible, lit tube with a lens through the rectum.
- DNA Stool Test This method entails examining a sample of your stool for DNA changes indicative of possible colorectal cancer. According to May, stool tests can be administered at home.
- Fecal Occult Blood Test This test checks a stool sample for microscopic amounts of blood, which could signal colorectal cancer.
- Sigmoidoscopy This method of screening allows doctors to use a thin, flexible, lit tube with a lens to take a look at the rectum and sigmoid, or lower colon.
- Virtual Colonoscopy This test involves using computed tomography (a type of X-ray) to produce multiple images of the colon.
If you’re between the ages of 45 and 49, May recommends talking with your primary care provider about colorectal cancer screening as soon as possible now that you’re eligible for it. “There are many ways to accomplish this goal of getting screened, but the most important thing for that age group is that you take action on it as soon as you can,” May says.
And if you have one or more risk factors for the disease, you may need to start screening even earlier than age 45. Risk factors for colorectal cancer include:
- Having a personal or family history of colorectal cancer
- Having a personal or family history of inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis
- Being overweight or obese
- Frequently consuming red or processed meat
- Drinking alcohol heavily
- Not exercising regularly
- Being older than age 50
- Having type 2 diabetes
- Being of African American or Eastern European Jewish descent
- Having a rare inherited genetic syndrome, like Lynch syndrome
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