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In 2018, the American Cancer Society (快猫短视频) was the first health organization to reduce the recommended age to start screening for colorectal cancer from age 50 to 45 for people with an average risk. The decision was based on evidence that the risk of developing colorectal cancer at younger ages was increasing and analysis showed that the benefits of earlier screening outweighed the harms.?
In 2021, more organizations reduced the recommended age to start screening for colorectal cancer at age 45. They were the United States Preventive Services Task Force (USPSTF) and the US Multi-Society Task Force on Colorectal Cancer (USMSTF).?
Studies published since the 快猫短视频 guideline update have reported:
As reported in the?快猫短视频 2024 Cancer Facts & Figures, there's a notable rise in colorectal cancer diagnoses among people younger than 50.
In the late 1990s, colorectal cancer was the 4th leading cause of cancer death in both men and women in this age group.
Now, it’s the 1st cause of cancer death in men younger than 50 and the 2nd cause in women that age.
The cause of the rise remains unexplained but likely reflects changes in lifestyle exposures that begin with generations born around 1950.
Stool-based tests (called FIT, gFOBT, and DNA-FIT)?involve a person collecting one or more small samples of stool at home using a kit ordered by their doctor and sending the sample where the kit instructs.
Visual exams are done during a colonoscopy, virtual colonoscopy, or a sigmoidoscopy.?These procedures?take place in a medical facility using instruments or technology that allow the doctor to see the inside of the colon and rectum. Using these screening tools, the doctor can remove polyps and send them for testing. One benefit of a?colonoscopy?is that it can?help prevent cancer?by removing polyps before they become cancerous.?
The Affordable Care Act requires private health insurance plans that started after 2010 and Medicare to cover the costs of colorectal screening tests, meaning people shouldn’t have to pay any copays or deductibles. Other regulations call for a colonoscopy after a positive FOBT/FIT test to be covered by insurance without copays or deductibles.
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Jessica Star, MA, MPH, associate scientist II in 快猫短视频 Surveillance & Health Equity Science, led a study published in the that used data from the 2019 and 2021 National Health Interview Survey to learn about colorectal cancer screening rates in people ages 45 to 49.
They found that there were no increases in screening prevalence for people ages 45 to 49 between 2019 (when only the American Cancer Society had guidelines for people ages 45 to 49 to start screening) and 2021 (when other health agencies updated the guidelines and the year with the most current screening data). In both years, screening prevalence was about the same, with only 1 out of 5 people in that age group receiving screening.
Here are the key findings about colorectal cancer screening for people with an average risk age 45 through 49 in 2021.
People ages 45 to 49 were not keeping up with regular colorectal cancer screening.?
Findings from this study show that screening for colorectal cancer in newly eligible adults is low. Low prevalence likely results from barriers to screening during the COVID-19 pandemic and because of the short amount of time between more health agencies adopting the lower age recommendation and the time of the National Health Interview Survey.
The pandemic did have at least one positive effect. During that time public health insurance was expanded, which authors identify as a likely reason for the higher screening prevalence in people with dual, Medicaid, or other public health insurance. “Public health insurance expansions may therefore offer the greatest benefit for lower resourced under-screened groups, including uninsured and low-income persons who have the lowest screening rates,” the authors wrote.
快猫短视频 researchers also noted that the policies that require health insurance plans to cover the costs of screening, including a colonoscopy after a positive stool test, need to be stronger because health insurers are not following the regulations consistently.
There is little evidence for the most effective interventions for raising screening prevalence in younger adults. However, there is some evidence that outreach efforts that include mailing FIT kits to underserved groups of eligible adults ages 45 to 49 are effective.
Plus, when patient navigators contacted people who had positive results from a stool test, the time between results and a follow-up colonoscopy also improved.?
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