The U.S. Preventive Services Task Force (USPSTF) on Tuesday finalized guidance recommending that most Americans start getting screened for colon cancer starting at age 45 rather than age 50.

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Details on the guidance

According to USPSTF, the new guidance, published in JAMA, reflects data showing that colon cancer is becoming increasingly common among adults younger than 50. Colon cancer is the third-leading cause of death for men and women in the United States.

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Colon cancer is most commonly found in adults 65 to 74 years old, but according to USPSTF, the number of new colon cancer cases in adults ages 40 to 49 increased by nearly 15% between 2000-2002 and 2014-2016.

"New science about colorectal cancer in people younger than 50 has allowed us to expand our recommendation to include peoples ages 45 to 49," John Wong, chief scientific officer at Tufts Medical Center and a member of USPSTF, said.

A variety of screening tests can be used to provide the recommended screenings, according to USPSTF, including "stool-based tests with high sensitivity, colonoscopy, [CT] colonography, and flexible sigmoidoscopy."

"Based on the evidence, there are many tests available that can effectively screen for colorectal cancer, and the right test is the one that gets done," Martha Kubik, a USPSTF member, said.

USPSTF estimated that, for every 1,000 individuals screened under the new guidelines, there will be two to three fewer colon cancer cases, approximately one fewer colon cancer death, and up to an additional 27 life-years saved, relative to the prior recommendations.

The recommendations apply to adults without symptoms of colon cancer and who are at considered at average risk for the disease.

USPSTF gave the recommendation for adults age 45 to 49 a "B" grade. As a result, commercial insurers will be required to cover the screenings for these individuals with no out-of-pocket costs.

The new recommendation aligns with guidance from the American Cancer Society, which lowered its recommended colon cancer screening age from 50 to 45 in 2018.

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Beyond saying that colon cancer screenings should start at age 45, the updated recommendations continue to urge regular screening for adults aged 50 to 75. For adults aged 76 to 85, USPSTF recommends "selectively offer[ing] screening" depending upon the patient's health, screening history, and other factors.

A 'huge step'

Alex Krist, chair of USPSTF, in a statement said, "Unfortunately, not enough people in the U.S. receive this effective preventive service that has been proven to save lives. We hope that this recommendation to screen people ages 45 to 75 for colorectal cancer will encourage more screening and reduce people's risk of dying from this disease."

Marcie Klein, VP of prevention for Colorectal Cancer Alliance, said the new recommendation is a "huge step" in the effort to increase access to colon cancer screenings. She estimated the recommendation could affect up to 15 million adults.

"This is huge progress, and we are so thrilled that the task force has acknowledged the need to bring the age down to 45," she said. "Right now, we want to maximize this opportunity to get the word out about this new age limit."

Now, Klein said, it's up to providers and insurers to spread the word about the new recommendation.

"This is just the beginning because now that the task force has released its guidance, it's really going to be up to companies and insurers and health care providers to … put this over the finish line and promote the adherence to this," she said. "It's going to take a lot of work to get the full impact on outcomes" (Knutson, Axios, 5/18; Associated Press, 5/18; Johnson, Modern Healthcare, 5/18; Sullivan, The Hill, 10/27/20; Stein, "Shots," NPR, 5/18).