The proposal to lower colorectal cancer screening to age 45 may lead to an increase in cases

Colorectal cancer (CRC) is responsible for over 50,000 deaths annually and is the third deadliest type of cancer in the United States. On October 27, the US Preventive Services Task Force (USPSTF) proposed new guidelines for CRC screening. If the proposed guidelines are accepted, the new eligibility criteria are likely to lead to an increase in new cases of CRC.

The guidelines, last updated in 2016, would now reduce the adult screening age from 50 to 45, down to the age of 75. The draft proposal follows a growing body of evidence suggesting an increased risk for adults aged 45 to 49 years of developing CRC. A 2017 study published by the Journal of the National Cancer Institute found that between the mid-1990s and 2016, colon cancer rates increased by 1.3% each year, while rectal cancer rates increased by 2.3% annually among underage adults 50.

In the United States, GlobalData epidemiologists predict that the number of incident cases diagnosed with CRC will be around 140,000 cases in 2020 and they expect this to grow to around 162,000 cases in 2028 (as shown in Figure 1). However, if these new guidelines go into effect, the number of incident cases diagnosed is likely to exceed current forecast estimates until 2028 as a result of increased case identification. The expanded screening criteria will help capture a larger portion of the potentially at-risk population and initiate screening in symptom-free individuals. Additionally, while the benefits of CRC screening are even greater for people aged 50 to 75, further deaths from CRC can be prevented by starting screening at the age of 45. Ultimately, the new recommendations will lead to an earlier diagnosis of the disease and better outcomes for patients.

The public comment period on the draft recommendation will be open until November 23, with final recommendations expected to be published in the coming months. GlobalData epidemiologists suggest that further analysis of surveillance data should take place over the next five years to more clearly assess, characterize and quantify the impact these new guidelines will have.