U.S. Task Force: Colorectal Cancer Screenings for ‘Average Risk’ Adults Should Start at Age 45

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November 5, 2020

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Adults at “average risk” who do not have symptoms should be screened for colorectal cancer starting at age 45, five years earlier than is now recommended, the nation’s top preventive medicine panel now says.

The U.S. Preventive Services Task Force currently recommends that people aged 50 to 75 be regularly screened for colorectal cancer. Until it’s newly announced guidance, the position of the task force stood in contrast with the American Cancer Society’s, which updated its recommendation in 2018 to say regular screenings should start at age 45.

Colorectal cancer, which includes bowel cancer, colon cancer, or rectal cancer, refers to any cancer that affects the colon and the rectum. The draft recommendation from the task force is now open for public comment.

“Colorectal cancer is the third leading cause of cancer deaths, so making an impact on that third leading cause, where we think there are quite a few preventable deaths, can make a big difference,” said Michael Barry, a member of the U.S. Preventive Services Task Force and a professor of medicine at Harvard Medical School.

Rates of colorectal cancer in people younger than 50 have been increasing by about 2 percent a year. Consult with your primary care physician to determine if you are at average risk for colorectal cancer and when you should be screened.

The updated guidance by the U.S. task force does not apply to adults with a family history of colorectal cancer, a history of inflammatory bowel disease, genetic syndromes such as familial cancerous polyps, a personal history of previous colorectal cancer or benign polyps, or other risk factors. These higher-risk adults should be screened by age 40 or earlier.

“Early screening is indicated if there is a first-degree relative with history of colorectal cancer and in patients with known high-risk genetic syndromes such as hereditary nonpolyposis colorectal cancer,” says Michael Chuong, M.D., a radiation oncologist and director of Proton and MR-Guided Radiation Therapy at Miami Cancer Institute, who specializes in the treatment of gastrointestinal cancers. “Early screening should begin at 40 years, or 10 years before the first-degree relative’s diagnosis, whichever is earlier.”

The colonoscopy is still the No. 1 recommended procedure. There is also a “virtual colonoscopy” option for those who don’t want to go through an invasive test. Moreover, there are basic at-home screening kits available for colorectal cancers — the fecal occult blood test (FOBT); the fecal immunochemical test (FIT), and the stool DNA test. If these tests come back positive, a colonoscopy is generally recommended.

But only during colonoscopies can precancerous or suspicious-looking polyps be removed.

“We should educate the public about the high prevalence of colorectal cancer, and that screening leads to detecting colorectal cancer at an earlier stage that is more likely curable,” says Dr. Chuong. “National colorectal cancer screening recommendations are in place because screening saves lives.”

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