Screening Rates Rose Among People Aged 45–49 After Release of Updated Colorectal Cancer Guidelines

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Colorectal cancer screening rates more than doubled among people aged 45 to 49 in the months after the release of updated American Cancer Society guidelines in 2018 recommending screening in that age group, according to a new study. According to the findings from Fedewa et al—published in Cancer—the increase was unique to the 45 to 49 year-old age group.


In May 2018, the American Cancer Society (ACS) updated its colorectal cancer screening guidelines, lowering the age to begin average-risk screening from 50 to 45 years based on increasing incidence of early-onset colorectal cancer and a favorable benefit-to-harm ratio. Whether this change has influenced screening among people in their mid-to-late 40s was unknown.

To find out, investigators examined recent colorectal cancer screening patterns among adults aged 45 to 49 compared to those aged 50 to 59 in the United States. They reviewed responses from about 5,800 people aged 45 to 59 participating in the 2018 National Health Interview Survey, an in-person household survey.


Among people aged 45 to 49, past-year colorectal cancer screening rates rose from 4.8% in the first quarter (Q1) of 2018 to 6.6% in Q2, 8.8% in Q3, and 11.7% in Q4. Compared to Q1, screening rates were 4.1% and 7.0% percentage points higher in Q3 and Q4, respectively. The estimated number of people aged 45 to 49 screened for cancer rose from 226,656 in Q1 of 2018 to 592,351 in Q4—an increase of 365,695 people.

Past-year colorectal cancer screening did not increase among people in their 50s.

The authors say the 2018 ACS guidelines and accompanying scientific and lay media attention may have raised provider and patient awareness of asymptomatic and symptomatic testing for colorectal cancer, noting that similar abrupt changes in screening following release of updated guidelines have been reported for prostate and breast cancer.

“It is unknown whether the recent accelerating colorectal cancer screening rates among people [aged] 45 to 49 years will be sustained,” said first author Stacey A. Fedewa, PhD. “Commercial health insurers are only required to cover average-risk screening beginning at age 50, following recommendations from the U.S. Preventive Services Task Force. Also, it’s possible those who quickly adopted updated guidelines may have been those at increased risk.”

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The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.