Perspective from Daniel M. Labow, MD
Perspective from Deborah A. Fisher, MD, MHS
Source:

USPSTF. Draft recommendation statement. Colorectal cancer: Screening. Available at: www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/colorectal-cancer-screening3. Accessed Oct. 27, 2020.

October 27, 2020
5 min read
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USPSTF expands colorectal cancer screening recommendation to include adults aged 45 years

Perspective from Daniel M. Labow, MD
Perspective from Deborah A. Fisher, MD, MHS
Source:

USPSTF. Draft recommendation statement. Colorectal cancer: Screening. Available at: www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/colorectal-cancer-screening3. Accessed Oct. 27, 2020.

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All adults should begin to get screened for colorectal cancer at age 45 years, according to a draft recommendation by the U.S. Preventive Services Task Force.

This is the first time the USPSTF has recommended screening initiation at age 45 years. The “B” recommendation indicates high certainty that the net benefit is moderate or moderate certainty that the net benefit is moderate or substantial.

Draft recommendations by the U.S. Preventive Services Task Force.

The task force continues to strongly recommend screening for adults between the ages of 50 and 75 years. The “A” recommendation indicates high certainty that the net benefit of screening for this age group is substantial.

Decisions on screening for adults aged 76 to 85 years should be made on an individual basis. The “C” recommendation indicates moderate certainty that the net benefit of screening for this age group is small.

This draft recommendation is now open for public comment.

“New science about colorectal cancer in younger people has enabled us to expand our recommendation to screen all adults starting at age 45 [years], especially Black adults who are more likely to die [of] this disease,” Michael Barry, MD, task force member and director of the Informed Medical Decisions Program at Massachusetts General Hospital, said in a USPSTF press release. “Screening earlier will help prevent more people from dying [of] colorectal cancer.”

This new draft recommendation applies to adults without symptoms who do not have a personal history of colorectal polyps or a personal or family health history of genetic disorders that may increase risk for colorectal cancer.

Colorectal cancer is the third leading cause of cancer death in the United States, according to the USPSTF, with about 53,200 people projected to die of the disease in 2020.

About 10.5% of new colorectal cancer cases occur in people aged younger than 50 years; however, most diagnoses occur between the ages of 65 and 74 years.

Recent epidemiological data suggest incidence among adults aged 45 years is almost equivalent to incidence among those age 50 years.

In 2016, about 25% of eligible adults in the U.S. had never undergone colorectal cancer screening.

Alex Krist
Alex Krist

“Unfortunately, not enough people in the U.S. receive this effective preventive service that has been proven to save lives,” Alex Krist, MD, MPH, task force chair and professor of family medicine and population health at Virginia Commonwealth University, said in the press release. “We hope that this recommendation to screen people ages 45 to 75 [years] for colorectal cancer will encourage more screening and reduce people's risk of dying [of] this disease.”

Specifically, Black adults are more likely than other populations to be diagnosed with colorectal cancer and to die of the disease. The USPSTF particularly encourages clinicians to recommended colorectal cancer screening to their Black patients beginning at age 45 years.

Colorectal cancer incidence rates from 2013 to 2017 were 43.6 cases per 100,000 for Black adults, 37.8 per 100,000 for white adults, 31.8 per 100,000 for Asian/Pacific Islander adults, 39 per 100,000 for American Indian/Alaska Native adults and 33.7 per 100,000 for Hispanic/Latino adults, according to the draft recommendation.

Death rates were 18.5 per 100,000 for Black adults, 13.6 per 100,000 for white adults, 9.6 per 100,000 for Asian/Pacific Islander adults, 15.8 per 100,000 for American Indian/Alaska Native adults and 11.1 per 100,000 for Hispanic/Latino adults.

It remains unclear whether the disparity is driven primarily by biology, access to and utilization of screening and treatment, or disparities in screening and treatment quality, according to the task force.

Additionally, the task force recommends direct visualization tests and stool-based tests to screen for disease. The recommendation does not include serum tests, urine tests or capsule endoscopy.

“There are many tests available that can effectively screen for colorectal cancer,” Martha Kubik, PhD, RN, task force member and professor and director of the school of nursing in the College of Health and Human Services at George Mason University, said in the release. “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.”