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The U.S. Preventive Services Task Force is recommending that people of average risk start colorectal cancer screenings at 45 instead of 50. The move aligns with guidelines issued by the American Cancer Society in 2018 and highlights growing concerns around an increase in colorectal cancer cases among young people.

The task force says the change could save thousands of lives.

The new guidelines apply to asymptomatic people of average risk: no prior diagnosis of colorectal cancer, no family history or genetic disorders that increase your risk of the disease, no history of precancerous polyps, and no diagnosis of inflammatory bowel disease. Selective screening is recommended for people ages 76-85 based on overall health, screening history and preferences.

The guidelines published in JAMA recommend screenings including colonoscopy, computed tomography colonography, flexible sigmoidoscopy and stool-based tests with high sensitivity. With the task force’s official recommendation, colorectal cancer screening tests for people 45 to 49 will be covered by insurance companies, making it accessible and affordable to millions more Americans.

We need more research to better understand why we’re seeing more and more colon and rectal cancers in young adults.
Dr. Ibrahim Halil Sahin, Gastrointestinal Oncology Program

Moffitt Cancer Center experts fully endorse the change.

“Projections show that by 2040, for 20- to 49-year-olds, colorectal cancer will be the leading cause of cancer-related deaths in the U.S. Currently it’s breast cancer. That’s the future of colorectal cancer in this population,” said Dr. Ibrahim Halil Sahin of the Gastrointestinal Oncology Program at Moffitt. “Implementing these guidelines will help to change the course of this concerning trend in the U.S. We also need to increase awareness of colorectal cancer in our younger population. That’s critical.”

Younger Adults More at Risk
Colorectal cancer is the third leading cause of cancer death, and nearly 53,000 people will die of the disease this year. The data show that for Americans ages 45 to 49, there are about 7,000 new colorectal cancer cases per year and about 1,800 deaths. This group accounts for about half of colorectal cancer diagnoses occurring under the previous recommended age of 50.

“We need more research to better understand why we’re seeing more and more colon and rectal cancers in young adults,” said Sahin, who suggests looking at environmental factors, increasing metabolic syndrome, obesity, diabetes, red meat consumption and perhaps also gestational exposures.

Chadwick Boseman

Chadwick Boseman died of colon cancer at 43.

Actor Chadwick Boseman was just 43 when he died of colon cancer in 2020. His death underscores that this isn’t a disease affecting only older people. It also highlights health disparities for Black people. Black Americans are 20% more likely to be diagnosed with colon cancer than whites and are 40% more likely to die from it. “The biggest challenge for Black Americans is access to even routine health care. This disparity is not just limited to colon cancer,” said Sahin. “We also need to increase early onset colorectal cancer awareness in young Black adults.”

Moffitt sees colorectal cancer patients in their 20s. If you’re younger than 45 and at average risk, screening isn’t recommended. So when should you be concerned?

Sahin says it’s important to pay attention to these red flags, which are the most common symptoms of colorectal cancer in younger patients:

  • Bowel habits changes
  • Rectal bleeding
  • Unintentional weight loss
  • Abdominal pain and cramps

Pandemic Delays
It’s important to remember that colon cancer is one of the most treatable cancers when caught early. But the COVID-19 pandemic has caused many to delay screenings, and Sahin says he’s already seeing more patients with advanced cases, a trend likely to continue.

Now there are growing platforms to offer more screening options that can be done at home, such as stool-based DNA tests and fecal immunochemical tests. These are covered by insurance, and kits are shipped to your home. It’s important to note that positive results will still trigger a colonoscopy, which remains the definitive test for diagnosis and treatment.

“Stool-based screening models using stool DNA testing is promising and may have a growing role in the early detection of colon cancer and precancerous lesions particularly for the younger population. However, it’s important to note that this is not a definitive test, and colonoscopy remains the gold standard,” said Sahin.