An independent group of experts that advises the nation on preventive medical services has lowered the recommended age for adults to begin regular screenings for colorectal cancer from 50 to 45.
The U.S. Preventive Services Task Force has given this recommendation for people without symptoms who are at average risk of getting colorectal cancer. Those with a personal or family history of colorectal cancer, inflammatory bowel disease or a genetic disorder that makes them more likely to get colorectal cancer, such as Lynch syndrome, are encouraged to get screened sooner than age 45.
Image credit: Michigan Medicine
The USPSTF updated its guideline primarily because more people are developing colorectal cancer at a younger age.
“Over the past 30 years, the general U.S. population has moved from about 5% of all colorectal cancers under the age of 50 years to now 10.5% of colorectal cancers under this age,” says John Carethers, M.D., the John G. Searle Professor of Internal Medicine at the University of Michigan Medical School, the chair of the Department of Internal Medicine at Michigan Medicine and a professor of human genetics who studies the genetics and disparities of colorectal cancer.
“We see many patients under age 50 with colorectal cancer here at the University of Michigan Rogel Cancer Center,” says Samantha Hendren, M.D., M.P.H., the surgical director of the Multidisciplinary Colorectal Cancer Clinic at the Rogel Cancer Center. “Some of these patients come to us with more advanced cancer, which is less likely to be cured. I know that starting screening at age 45 will prevent deaths from colorectal cancer.”
Why you should get screened
Colorectal cancer is the second deadliest cancer in the United States — but it’s also one of the most preventable with regular screenings.
Usually, colorectal cancer develops from abnormal growths, known as polyps, in the colon or rectum. These can be detected and removed during a colonoscopy, during which a physician examines your bowel with a camera attached to the end of a long, flexible tube. (The majority of polyps found during a colonoscopy are not cancerous, but it’s best to get rid of them before they develop into cancer.)
“The fact that you can do a one-day test every 10 years and improve your odds of never getting colon cancer,” says John Krauss, M.D., the medical director of the Multidisciplinary Colorectal Cancer Clinic at the Rogel Cancer Center, “that’s something you should do.”
In addition to colonoscopies, several other colorectal cancer screenings are available, including at-home screenings that analyze stool samples for DNA changes and blood, which can indicate a polyp.
Each screening has different pros and cons.
A colonoscopy only needs to be done once every 10 years, but it requires some preparation and has a small risk of complications, while stool-based tests like Cologuard are convenient and less invasive, but need to be performed far more frequently and require a follow-up colonoscopy if they come back positive.
“I still like the colonoscopy as the best test because it’s diagnostic — it can see polyps — and it’s therapeutic — it removes them,” Krauss says. “Whereas the other things sometimes just trigger a colonoscopy being done.”
Michigan Medicine has a specialized team that performs more than 100,000 colonoscopies over the past decade — the kind of experience that makes complications less likely.
The USPSTF did not recommend one screening over another because no studies so far have compared the tests.
Racial inequities
Nor is there a specific recommendation for Black adults, who have the highest rate of colorectal cancer and are more likely to die from it.
Important to note is that Black people are not at a genetically higher risk of colorectal cancer. Many factors contribute to the racial inequity, including decades of limited access to screenings and lack of awareness about the need for these tests as well as lower-quality care when Black people receive treatment for colorectal cancer.
White and Hispanic people have had the largest increases in colorectal cancer cases among those younger than 50, but they still develop colorectal cancer less frequently than those who are Black and under 50.
“Ironically, while there have been calls by several organizations over the past 10 years to move the initial screening age for Black patients to 45 years, this was controversial due to lack of real investigative data,” Carethers says. “All races and ethnicities should benefit from the USPSTF recommendation to begin colorectal cancer screening for all groups at age 45, which will lower the consistent burden among Black patients and the emerging elevated burden among non-Black patients, saving lives.”
Insurance coverage
Thanks to the new guideline, private health insurance companies will be required to cover colorectal cancer screenings without any copays from age 45 to 75, as mandated by the Affordable Care Act. (The USPSTF does not recommend screening for everyone after age 75 but encourages more selective testing based on the person’s health, screening history and preferences.)
A few caveats remain; if you go to an out-of-network provider for your screening when an in-network provider could have given you the test, you could be charged, for instance.
And if you decide to undergo a screening that’s not a colonoscopy, and it comes back positive, you may have to pay for a subsequent colonoscopy since some health insurance companies no longer consider the procedure preventive at that point.
Always call your insurance company before undergoing any test or procedure to determine how much it will cost and ask any other questions you might have.