Colon and Rectal Cancer Screening Age Should Be Lowered to 45 Under New ACS Guidelines

The American Cancer Society’s (ACS) new guidelines recommend starting colon and rectal (colorectal) cancer screening at the currently recommended age of 50 instead at 45.

Under the new recommendation, for people at average risk, screening such as colonoscopy, fecal occult blood testing and other colorectal cancer screening should begin at age 50 no longer, but at 45. This change is based on new data showing that colorectal cancer incidence has increased somewhat in younger people.

- Related topic: Why is colorectal (colon and rectal) cancer targeting young people?

The recommendation to begin colorectal cancer screening at 45 is a striking development. It is the most important change in cancer screening guidelines for years. Although breast cancer screening with mammography has also prompted intense debate in the past, those discussions were mostly about how often mammography should be performed .

For colorectal cancer early detection, the recommended age for starting screening has changed, but the choice among available screening tests has not (such as colonoscopy every 10 years or annual stool tests).

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Existing colorectal cancer screening guidelines worldwide recommend routine screening from age 50 in people without symptoms or a family history of colorectal cancer, for colorectal cancer and polyps . However, recommendations differ regarding screening frequency, stopping age and preferred method. They also differ for high-risk people in terms of starting age, frequency and method. Beyond this, anyone with signs or symptoms of colon and rectal cancer should of course consult a physician without delay, even if younger.

Earlier starting ages for colorectal cancer screening had also been proposed in the past, but by the mid-1990s most organizations had agreed on age 50, and the starting-age recommendation had not changed for 20 years. This change should not be viewed as a conflict between organizations: the American Cancer Society (ACS) has only just published its recommendation, while another authoritative body, the US Preventive Services Task Force (USPSTF), last updated its guidance 2 years ago.

Increasing rates in young people

The American Cancer Society emphasized that, although colorectal cancer incidence continues to fall among people aged 55 or older, since 1994 there has been an increase among those under 50 of 51%. Cancer mortality rates in younger people have also recently begun to rise, providing another reason to start colorectal cancer screening earlier.

In its update, the ACS incorporated recent studies on rising colorectal cancer incidence in young adults through a new simulation/modeling study. The results showed that screening strategies including colonoscopy at 10-year intervals, starting at age 45, produced more life-years and a more favorable benefit-to-burden ratio than starting screening at 50. However, we will need to wait several more years to see the real-world effects of lowering the screening age to 45.

- Related topic: What you need to know about colon and rectal cancer

In conclusion, colorectal cancers are the 3rd most common cancer type in both women and men in our country. Despite their frequency, early detection appears largely achievable with properly planned medical follow-up. Although debate over whether screening should start at 45 or 50 seems likely to continue for some time, another problem is that most people do not undergo the recommended screening. Every part of society therefore has important responsibilities in expanding colorectal cancer screening so more people can benefit. 

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