A panel of public health experts is set to recommend that people get screened for colorectal cancer starting at age 45—five years earlier than their current recommendation. The proposed change is due to mounting evidence that colon cancer is becoming more common among younger people.
The U.S. Preventive Services Task Force (USPTF) is a government-appointed but independent panel of experts whose recommendations guide nationwide screening and preventive care practices. They routinely review the current medical evidence for the risks and benefits of various population-level interventions, including cancer screening and vaccination. Their guidelines carry plenty of weight: Vaccines recommended by the USPSTF, for instance, are legally required to be covered with no out-of-pocket costs by private insurance under the Affordable Care Act.
Currently, the USPTF recommends that people at average risk start being screened for colorectal cancer starting at age 50 up until age 75. This recommendation is backed by enough evidence to warrant their strongest level of certainty, called Grade A. But in new draft guidelines released this week, the USPTF is now looking to add an additional Grade B recommendation that people between the ages of 45 and 49 also get screened. Those over the age of 75 are still recommended to get screened only if they and their doctor agree that it’s best, since the benefits of screening are small past that point.
The change, though not supported by as much clear evidence as the current guidelines, is the result of growing reported rates of colorectal cancer among people in their mid-to-late 40s and even earlier. In August 2020, for instance, Black Panther star Chadwick Boseman died at age 43 after a years-long struggle with colorectal cancer. The change also follows identical recommendations made in 2018 by the American Cancer Society.
“Recent studies showing a rising incidence in individuals aged 45 to 49 drew our attention to that age group,” John Wong, chief scientific officer at Tufts Medical Center and a member of the USPTF, told NBC News.
Colorectal cancer is the third leading cause of cancer deaths in the U.S. and is expected to kill around 52,000 Americans this year. Though the death rate from cancer continues to decrease over time, including from colorectal cancer, experts have been worried about these increases in cases among younger people.
Factors like obesity and a diet high in processed meats are likely important contributors to developing colorectal cancer. But low screening rates are also thought to help account for higher death rates among Black and Native American communities, as well as among those living in poverty. Even now, a quarter of Americans between the ages of 50 and 75 are estimated to have never been screened for colorectal cancer at all.
There are three major tests for screening, which call for different periods of time between screenings. The colonoscopy and the flexible sigmoidoscopy both use a camera inserted in the rectum to physically look for potentially cancerous growths called polyps, while doctors can also test a person’s stool for the minute presence of blood—a key sign of colorectal cancer—or suspicious DNA from cancer cells.
If used alone, the stool tests are supposed to be done every one to three years, while the colonoscopy is supposed to be done every 10 years (the less-invasive flexible sigmoidoscopy is recommended every 10 years if paired with an annual stool test and every five years if used alone). More recent research has indicated that stool tests by themselves may be able to detect colorectal cancer as well as colonoscopy for people with no added risk and no symptoms. In their revised guidelines, the USPTF calls for any method to be used, at the patient’s preference.
The USPTF’s recommendations aren’t final. Members of the public, particularly outside medical experts, will be allowed to submit comments to the USPTF on the proposed change until November 23, 2020.