U.S. Task Force Recommends Starting Colorectal Cancer Screening At Age 45

Adults should start screening for colon cancer at age 45, a five-year difference from the originally recommended age of 50, according to a new proposal by the U.S. Preventive Services Task Force (USPSTF) issued on October 27.

While the proposal is still in draft form and, therefore, not yet finalized, the USPSTF says the recommendation comes on the heels of an increased number of cases of colorectal cancers in young adults. While adults younger than 50 are still at a lower risk for developing colon and rectal cancers, the group says the uptick in cases amongst people under 50 cannot be ignored.

“Colorectal cancer is the third leading cause of cancer death for both men and women, with an estimated 53,200 persons dying from colorectal cancer in the United States in 2020,” the USPSTF states. “Colorectal cancer is most frequently diagnosed among persons ages 65 to 74 years.”

However, the USPSTF also points to a study published in the Journal of the National Cancer Institute that shows colon and rectal cancer incidence in 45-year-old adults is now nearly equivalent to that of a person who is 50.

“The screening recommendation in the past was 50 years of age for an average-risk patient, that is, a patient with no family history,” Harish Gagneja, MD, a board-certified gastroenterologist in Texas, tells Verywell. “USPSTF is considering the change because there has been a significant increase in colorectal cancer risk in patients younger than 50 years of age.”

Hisham Hussan, MD, a gastroenterologist at The Ohio State University Comprehensive Cancer Center, agrees. “Early-onset colorectal cancer (i.e., diagnosed before 50 years of age) is predicted to rise to 10.9% of all colon and 22.9% of all rectal cancers by 2030,” he tells Verywell, pointing to a 2015 study published in the Journal of American Medical Association Surgery. “Our data published at the American College of Gastroenterology (ACG) is consistent with others showing a similar rate of high-risk polyps or colorectal cancer in adults aged 45 to 49 and 50 to 54.”

What’s Next? 

Now that the USPSTF posted the draft for review, they will seek public comment until November 23. From there, they will issue a final recommendation. 

If you noticed the grade “B” on the proposal, you might be wondering what that means. The USPSTF uses a grading system to determine its recommendation for a particular treatment or service. A grade B means the task force recommends the service. “There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial,” the site notes.

“In clinical practice, grade A and grade B recommendations are essentially the same," Gagneja adds. "They are based on the level of the studies that have been conducted as well as recognizing that the benefits of a colonoscopy outweigh the risks.”

What Does the American Cancer Society Recommend?

This recommendation isn’t brand new in terms of colorectal cancer screening recommendations. The American Cancer Society (ACS) lowered its recommendation to begin screening at age 45 (down from its previously recommended age 50) in 2018. 

The organization also notes that certain risk factors are factored into the ultimate recommendation for screenings. The ACS defines those risk levels into two categories: average risk and increased or high risk.

You're considered average risk if you do not have:

• Personal history of colorectal cancer or certain types of polyps
• Family history of colorectal cancer
• Personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
• Confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP)
• Personal history of getting radiation to the abdomen (belly) or pelvic area to treat a prior cancer

If you have any of the above you're considered increased or high risk. People with these risks need to start colorectal cancer screenings before age 45, be screened more often, and get specific tests.

According to the Centers for Disease Control and Prevention (CDC), about one-third of American adults have not been screened for colorectal cancers as recommended. In 2018, the CDC said that meant only 67.2% of adults reported being up-to-date with colorectal cancer screening.

Reasons for not getting screened, according to the CDC, include:

• Lack of access to health insurance
• Irregular visits to a doctor
• Lack of educational resources about the importance of colorectal cancer screenings

Talk to your doctor about getting screened for colorectal cancer if you're within the recommended age group or have an increased or high risk of developing the condition.