Colorectal cancer screening rates rose significantly after USPSTF lowered recommended age

Key takeaways:

• In 2021, the U.S. Preventive Services Task Force lowered the recommended age to start colorectal cancer screening from 50 to 45 years.
• Screening rates more than doubled in adults aged 45 to 49 years from the second quarter of 2021 to the fourth quarter of 2022.

Colorectal cancer screenings more than doubled for adults aged 45 to 49 years after the U.S. Preventive Services Task Force lowered the recommended age to start screening, a study by Epic Research found.

Although this increase was expected, Jackie Gerhart, MD, FAAFP, a clinical informaticist at Epic Research, based in Wisconsin, told Healio that “it was surprising just to see it graphically — how much it had changed compared to the other age groups, and especially to see it in contrast with some of the other higher age groups decreasing in terms of their number of colon cancers.”

In May 2021, the USPSTF recommended that colorectal cancer screening be conducted in all asymptomatic adults aged 45 to 75 years. Previously, screening was recommended to begin at age 50 years.

To determine how the guidelines influenced screening and diagnosis trends, Brad Fox, MD, FAAFP, a clinical informaticist at Epic Research, and colleagues reviewed the records of 66,545,809 patients, spanning from 2018 through 2022.

Between the first quarter of 2021 and fourth quarter of 2022, the researchers found that colorectal cancer screenings per 100,000 patients increased among those aged 45 to 49 years from:

• 3,386 to 8,086 in women; and
• 3,743 to 9,885 in men.

During that same period, pre-cancerous polyp diagnosis rates in this age group increased from 368 to 954 diagnoses per 100,000 patients in women, and from 471 to 1,468 diagnoses per 100,000 patients in men.

Fox and colleagues reported that the rate of colorectal cancer diagnoses decreased overall from 2018 to 2022, a finding they said was mostly driven by a decrease in diagnoses among patients aged 65 years and older.

For men aged 45 to 49 years, however, the diagnosis rate increased following the revised guidance, from 34 diagnoses per 100,000 patients in the second quarter of 2021 to 51 diagnoses per 100,000 patients in the fourth quarter of 2022. There was no significant increase among women in that age group.

Gerhart encouraged primary care physicians to continue screening all recommended age groups and to review patients’ histories, potential comorbidities and other risk factors while having individual conversations with patients “rather than just having an age cut-off as the only source of decision.”

She also noted that receiving a positive stool sample from a patient does not conclude testing.

“You shouldn’t just assume that if it’s positive for blood, that it’s coming from a hemorrhoid or something more benign,” she said. “You really need to get that checked out further. That's part of the screening process — to continue until you have a definitive diagnosis.”

Gerhart pointed out that the study offers real-world evidence for clinicians.

“It’d be helpful to see this kind of evidence that’s timely, that is actionable and published publicly so that people can actually take action on it,” she said. “We should use this kind of data in deciding what we should do for future guidelines. For example, it was great to see that 45- to 50-year-olds had an increased rate of screening. I’d love to see what the benefit/risk is for the 40- to 45-year-old population, and continue to push that a little bit. Because as we have more noninvasive testing, the risk ratio goes down a little bit, so maybe it’s more beneficial to include them in the guidelines going forward.”