Preventive medicine

USPSTF updates colorectal cancer screening guidelines

Screening should start at age 45, task force recommends, noting that colorectal cancer is the third leading cause of cancer deaths in the U.S.

The U.S. Preventive Services Task Force (USPSTF) recently updated its colorectal cancer screening guidelines and now recommends that screening start at age 45. USPSTF shared additional details about its updated guidelines with the AOA, which is a partner of the USPSTF. Below is an edited summary of those details:

The USPSTF now recommends that colorectal cancer screening start at age 45; the task force continues to strongly recommend screening people who are 50 to 75 years old. Overall, people 45 to 75 should be screened to reduce their risk of dying from this disease. For adults 76 to 85, the task force recommends that the decision to screen be made on an individual basis.

These recommendations apply to adults without symptoms and who do not have a personal history of colorectal polyps or a personal or family health history of genetic disorders that increase the risk of colorectal cancer.

Many patients haven’t been screened

Colorectal cancer is the third leading cause of cancer deaths in the United States. Despite strong evidence that screening for colorectal cancer is effective, about a quarter of people ages 50 to 75 have never been screened.

“Far too many people in the U.S. are not receiving this lifesaving preventive service,” says USPSTF vice chair Michael Barry, MD, director of the Informed Medical Decisions Program in the Health Decision Sciences Center at Massachusetts General Hospital. “We hope that this new recommendation to screen people ages 45 to 49, coupled with our long-standing recommendation to screen people 50 to 75, will prevent more people from dying from colorectal cancer.”

Black adults get colorectal cancer more often than people of other races and ethnicities and are more likely to die from this disease. The task force recognizes this disproportionate risk and encourages clinicians to reach out to their Black patients to help make sure they are receiving regular screening.

Testing options

The final recommendation includes two types of tests that are recommended to screen for colorectal cancer: direct visualization tests and stool-based tests.

“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,” says USPSTF member Martha Kubik, PhD, RN, a professor and director of the School of Nursing, College of Health and Human Services at George Mason University. “To encourage screening and help patients select the best test for them, we urge primary care clinicians to talk about the pros and cons of the various recommended options with their patients.”

The task force’s final recommendation statement and corresponding evidence summary and modeling analyses are available here.

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