USPSTF Lowers Recommended Age for CRC Screenings, Requiring Insurance Coverage for Young Patients

Cathy Eng, MD, FACP, FASCO

The United States Preventive Services Task Force (USPSTF) is recommending that individuals at average risk of colorectal cancer begin screening exams at age 45 rather than 50 years of age due to the risk of early onset colorectal cancer (CRC), according to a press release by the USPSTF.¹

Since the mid-1990s, there has been a documented rise in young-onset CRC, which is defined as colorectal cancer that occurs in patients younger than 50. In 2020, 11% of colon cancers and 15% of rectal cancer occurred in patients younger than. This is a sharp increase from 5% and 9% respectively in 2010.²

The recommendation that screening start at age 45 is a B recommendation, while the recommendation that those who are 50 to 75 receive colorectal cancer screening remains an A recommendation. For those between the ages of 76 and 85, screening remains a C recommendation.1 The recommendation means that insurers will be required to cover screenings for those 45 years old and older. Further research is still needed as to why there is a rise in young-onset colon cancer.

“The USPSTF has provided level B recommendation suggesting there is a moderate net benefit which is in contrast to a level A recommendation of substantial net benefit. Methods of screening may include stool-based tests with high sensitivity, colonoscopy, virtual colonoscopy and flexible sigmoidoscopy. I think that's very important to demonstrate that these are the recommended screening tools and do not include serum or urine tests, etc., Cathy Eng, MD, FACP, FASCO, the David H. Johnson chair in Surgical and Medical Oncology, co-leader, Gastrointestinal Cancer Research Program, professor of Medicine (Hematology and Oncology), co-director, GI Oncology, vice-chair, SWOG GI Committee, director, VICC Young Adult Cancers Initiative, told Targeted Oncology, in an interview.

USPSTF recommends that individuals who are asymptomatic and who do not have a person history of colorectal polyps or a personal or family health history of genetic disorder that increase the risk of colorectal cancer receive screening. Additionally, the task force recommends that clinicians reach out to Black patients to help ensure they receive regular screenings, as Black patients are not only more likely to get colorectal cancer than other races and ethnicities but are also more likely to die of the disease.¹

“I think it's important to also recognize that they realize that the evidence demonstrates minimal harm to any individuals that opt to undergo a screening colonoscopy between the ages of 45 to 49, said Eng. “Although the evidence is not perfect, I think the data is substantial and fairly strong suggesting that the overall benefit to being screened is worthwhile for young patients between the ages of 45 and 49. As clinicians, we've seen first-hand the impact of an earlier vs. later stage of diagnosis.”

“In addition, because of health disparities we've often seen that black and Hispanic patients often present with more advanced disease. It had been previously suggested in the past that the screening age be reduced to the age of 45 years old for black patients. In short, I think a reduction in the screening age by five years may have significant impact in diagnosing individuals at an earlier stage, with overall little harm to the patient,” Eng explained.

According to an article published in JAMA Network, starting screening at 45 was associated with an estimated additional 22 to 27 life-years gained compared to starting at age 50. The increase in the number of complications is relatively small. However, extending screening beyond 75 was only associated with a small increase in life-years gained.³

However, questions remain if starting screening at 45 is early enough. The rate of colorectal cancer in those 20 to 29 years old is increase by 2% per year and 1.3% among those 40 to 49 years old. The rate of rectal cancer is also rising in these age groups. The rate of rectal cancer among those 20 to 29 and 30 to 39 is increased by 3.2% per year, and 2.3% for those 40 to 49. Further research is still needed about possible environmental risk factors.

Regarding how the updated recommendations from USPSTF will impact oncologists, Eng concluded, “I believe the impact will be substantial. This brings increased recognition to early-onset colorectal cancer and the importance of recognizing the signs and symptoms of colorectal carcinoma. If we are able to diagnosis patients at an earlier stage, we will be able to cure more patients potentially with surgical resection alone (stage two or stage three disease).”

_REFERENCE:

_{1. U.S. Preventive Services Task Force issues final recommendation on screening for colorectal cancer. News release. USPSTF. May 18, 2021. Accessed May 18, 2021. https://bit.ly/3ylAmuX/}

_{2.“45 is the new 50” as age for colorectal cancer screening is lowered. News release. Dana-Farber Cancer Institute. May 18, 2021. Accessed May 18, 2021. https://bit.ly/3bAHlX6.}

_{3. Ng K, May FP, Schrag D. US Preventive Services Task Force recommendations for colorectal cancer screening: forty-five Is the new fifty. JAMA. 2021;325(19):1943–1945. doi:10.1001/jama.2021.4133}