Federal panel says colon cancer screening should start at 45, not 50

In response to an alarming, long-term increase in colorectal cancer among younger people, an influential federal panel on Tuesday lowered the recommended age to start screening from 50 to 45.

The American Cancer Society made the same recommendation three years ago, but with the U.S. Preventive Services Task Force now following suit, health insurers will have to get on board. They have a year to extend coverage of the menu of screening options — including colonoscopy, the gold standard exam — based on the updated guidance.

The latest studies and mathematical models suggest that finding and treating cancers at age 45 instead of 50 could add 22 to 27 years of life for those who get an earlier diagnosis, with only a small increase in complications, the task force reported in JAMA. For the first time, the models showed equal benefit across gender and races.

Oncologists and patient advocates cheered the change as a step forward, but said the real work lies ahead.

Jeffrey Farma, a surgical oncologist specializing in colon cancer at Fox Chase Cancer Center, noted that a third of adults age 50 and up are not up to date with screening, and a quarter have never been checked for colorectal cancer — the second leading cause of cancer death in the U.S. The rate is even worse among racial and ethnic minority groups and the poor.

“These numbers are staggering, and we are already seeing that these numbers are going to be much worse because of the COVID-19 pandemic and decreased or delayed screening for all types of cancers,” Farma said.

Meanwhile, physicians generally still assume colorectal cancer is a slowgrowing malignancy of advancing age, even though “early onset” disease — meaning before age 50 — is increasingly being diagnosed, often at incurable stages, in people in their 30s, 20s and younger. Researchers are far from understanding the biological reasons for this trend, although evidence suggests environmental toxins play a role, and may also be tied to the explosion in inflammatory bowel diseases such as Crohn’s disease.

“We should not lose sight of why this guideline is changing,” said Richard Wender, chair of family medicine and community health at Penn Medicine. “For decades now, we’ve been seeing this increase of colorectal cancer in younger age groups. We are now seeing a 16% increase in mortality under age 50.

“We’re still studying why this is happening,” added Wender, the former chief cancer control officer at the American Cancer Society. “It’s likely something in our diet. Overweight and obesity may be contributing to some extent. We need to move the screening age even younger.”