A new large-scale study shows young adults are more likely to get colorectal cancer (CRC) screening since the release of the 2021 U.S. Preventive Services Task Force (USPSTF) CRC screening guidelines, which lowered the age of starting CRC screening from 50 to 45. In a study of over 10,000,000 Americans, they found screening uptake increased significantly in the 20 months after the USPSTF recommendation.
The study appears in JAMA Open Network, the lead author is Sunny Siddique of the Yale School of Public Health.
CRC is one of the most prevalent cancers. It is the third most common cancer accounting for approximately 10% of all cancer cases and is the second leading cause of cancer-related deaths worldwide.
It is most common among older people, but its incidence in that group has been decreasing globally over the last decades, probably because of better screening. Paradoxically, CRC’s incidence in patients below 50 years old has been increasing, for reasons not yet fully understood.
In May 2021, the USPSTF issued a grade B recommendation encouraging colorectal cancer (CRC) screening among average-risk individuals aged 45 to 49 years.
This study of 10,221,114 privately insured individuals aged 45 to 49 years, showed mean rates of CRC screening uptake increased significantly in the 20 months after the USPSTF recommendation vs the 20 months before. People from areas with high socioeconomic status and metropolitan areas experienced a higher increase.
In this cohort study of 10,221,114 people aged 45–49 years, they found that among privately insured beneficiaries aged 45 to 49 years, CRC screening uptake increased after the USPSTF recommendation, with potential disparities based on SES and locality.
Measurable decreases in CRC incidence and mortality have been attributed to increased screening. In June 2016, the USPSTF concluded with high certainty that screening for CRC of average-risk, asymptomatic adults aged 50–75 years is of substantial net benefit. Since then, due to the rising incidence of CRC among younger individuals, more guidelines have encouraged individuals aged 45–49 years to receive screening too.
In May 2018, the American Cancer Society (ACS) issued a qualified recommendation that adults with average risk who are aged 45 years or older undergo regular CRC screening. Following this recommendation, CRC screening among individuals aged 45–49 years more than doubled according to an ACS study of approximately 5,800 individuals included in the 2018 National Health Interview Survey.
Subsequently, in May 2021, the USPSTF issued a grade B recommendation for CRC screening in adults aged 45–49 years, mandating insurance coverage for this preventive service. Despite these efforts, screening remains below the national target of 80% among adults aged 45 years or older, with particularly low screening observed among individuals aged 45 to 49 years; those identifying as American Indian or Alaska Native, Asian, or Hispanic; individuals born outside the U.S.; and individuals with income below 100% of the federal poverty level.
