The U.S Preventive Services Task Force (USPSTF) will soon recommend adults at average risk of colon cancer (colorectal cancer) with no symptoms start screening at age 45 instead of age 50 as previously recommended.
October 2020 draft recommendations from this group update previous recommendations from 2016. The guidelines propose lowering the starting age for colon cancer screening from age 50 to 45 for adults at average risk defined as:
- No personal history of colon cancer or growths (polyps) on the colon
- No inflammatory bowel disease, such as Crohn disease or ulcerative colitis
- No family history of colon cancer or known inherited cancer predisposition (e.g., Lynch syndrome)
While the risk for colon cancer is much lower in adults under age 50 than in older adults, the USPSTF notes recent studies point to an increasing number of cases in younger people.
This new USPSTF recommendation aligns with the American Cancer Society's guidelines from 2018 that also suggested that colon cancer screening should begin at age 45 in average-risk adults. (Read American Cancer Society Lowers Starting Age for Colon Cancer Screening to 45.)
Colon cancer is the third leading cause of cancer death for both men and women. An estimated 53,200 people are expected to die of the disease in the United States in 2020. Although most frequently diagnosed between ages 65 and 74 years, an estimated 10.5% of new colon cancer cases occur in people younger than age 50, the draft recommendations note. Recent data suggest that colon cancer incidence in 45 to 50-year-old adults is similar to what it was for adults age 50 and older before routine screening was introduced. The rate of colon cancer was considerably higher in older adults before regular screening was recommended. Now it has fallen significantly in this age group—largely due to regular colonoscopies.
Meanwhile, despite strong evidence that screening for colon cancer is effective, about a quarter of people ages 50 to 75 have never been screened. The USPSTF continues to recommend screening for adults ages 50 to 75 and advises that healthcare providers and patients ages 76 to 85 make decisions about screening on an individual basis by considering prior screening results and overall health.
The draft recommendations emphasize the importance of screening for Black adults who get colon cancer more often than other populations and who are more likely to die from this disease. For example, from 2013-2017, the frequency of new cases among Black adults was 15.3% higher than new cases among White adults. The death rate among Black adults was about 26% higher than the death rate in White adults during this time. The higher risk of colon cancer in younger Black adults was highlighted recently when actor Chadwick Boseman, the star of the movie "Black Panther," died of the disease in August at age 43.
"The USPSTF recognizes the higher colon cancer incidence and mortality in Black adults and strongly encourages clinicians to ensure their Black patients receive recommended colon cancer screening, follow-up, and treatment," the draft guidelines say.
The Task Force notes that there are multiple screening strategies individuals can consider. The options include stool-based assays (e.g., fecal immunochemical test (FIT), guaiac-based fecal occult blood test, stool DNA test) and imaging tests that allow healthcare practitioners to view the inside of the colon and rectum (e.g., colonoscopy, virtual colonoscopy, and flexible sigmoidoscopy). For more details on these tests and their recommended intervals, read the article on Colon Cancer.
"We urge primary care clinicians to discuss the pros and cons of the various recommended options with their patients to help decide which test is best for each person," said Task Force member Martha Kubik, Ph.D., RN.