Value of Timely Screening

Early detection of colorectal cancer (CRC) has been shown to decrease mortality.1 As such, the current CRC screening guidelines recommend screening in all average-risk patients ≥45 years of age.2-6,a Data supporting these recommendations suggest an increase in CRC incidence in individuals aged 40-49 years that is double that of individuals aged 50 to 54 years (1.3% vs 0.5% increase per year from 2008 to 2017) and an increase in CRC mortality in adults younger than 50 years since 2005.4 Despite clear CRC screening recommendations, screening rates are well below the nationwide target;7,8 thus, important opportunities for screening and early detection are being missed.

All Cancers in America

Early detection of CRC improves survival rates1

The evolution of colorectal adenoma to early CRC typically takes more than 10 years, providing an important opportunity for screening and early detection9,10

Recent updates to guidelines that expand screening to individuals aged 45-49 years means ~19 million more are eligible for screening11,b

EARLY DETECTION OF CRC IMPROVES SURVIVAL

Pie chart and statistics on survival rate

  • The evolution of colorectal adenoma to early CRC typically takes more than 10 years, providing an important opportunity for screening and early detection9,10
  • Approximately 70% of CRC develops from adenomas,9 and timely detection and removal of advanced adenomas (pre-cancer) can prevent CRC development10

HIGHER RATES OF SCREENING ARE ASSOCIATED WITH A REDUCTION IN CRC INCIDENCE AND MORTALITY13

Higher rates of screening are associated with a reduction in colorectal cancer incidence and mortality

The study was performed using a dynamic cohort of Kaiser Permanente Northern California (KPNC) health plan members, aged 51-75 years of age, for the years 2000-2015. KPNC is an integrated healthcare delivery organization that serves approximately 4.0 million members in urban, suburban, and semi-rural regions throughout California. The primary outcome was the influence of organized screening on screening up-to-date status, CRC incidence, and CRC-specific mortality. Limitations include that the observational design precludes confirming a direct causal link between the increases in screening and the decreases in colorectal cancer outcomes.

EARLIER SCREENING’S IMPACT ON THE 50-54 AGE GROUP

  • Lowering CRC screening age to 45 years is likely to have an impact on CRC incidence and mortality in the group ages 50 to 54 years.
  • Incidence in this age group is currently increasing, in contrast to the declining incidence in all age groups after age 54 years.4

                                                        Only 48%

                                                              of the 50 to 54 years old population are up-to-date on screening.1

References

Siegel RL, Miller KD, Goding Sauer A, et al. Colorectal cancer statistics, 2020. CA Cancer J Clin. 2020;70(3):145-164.

Davidson KW, Barry MJ, Mangione CM, et al. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(19):1965-1977.

Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Colorectal Cancer Screening. Version 2.2021. © National Comprehensive Cancer Network, Inc. 2022. All rights reserved. Accessed February 23, 2022. To review the most recent and complete version of the guideline, go online to NCCN.org.

Wolf AMD, Fontham ETG, Church TR, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018;68(4):250-281.

Shaukat AK, Kahi CJ, Burke CA, et al. ACG clinical guidelines: colorectal cancer screening 2021. Am J Gastroenterol. 2021;116(3):458-479.

Patel SG, May FP, Anderson JC, et al. Updates on age to start and stop colorectal cancer screening: recommendations from the US Multi-Society Task Force on Colorectal Cancer. Gastroenterol. 2022;162(1):285-299.

American Cancer Society. Colorectal cancer facts & figures 2020-2022. Atlanta: American Cancer Society; 2020.

National Colorectal Cancer Roundtable. 80% in every community. Accessed December 9, 2021. http://nccrt.org/

Rex DK, Boland CR, Dominitz JA, et al. Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2017;112(7):1016-1030.

10 Winawer SJ, Fletcher RH, Miller L, et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterol. 1997;112(2):594-642.

11 Piscitello A, Edwards DK. Estimating the screening-eligible population size, ages 45-74, at average risk to develop colorectal cancer in the United States. Cancer Prev Res. 2020;13(5):443-448.

12 National Cancer Institute. Cancer stat facts: colorectal cancer. Accessed December 9, 2021. https://seer.cancer.gov/statfacts/html/colorect.html

13 Levin TR, Corley DA, Jensen CD, et al. Effects of organized colorectal cancer screening on cancer incidence and mortality in a large community-based population. Gastroenterol. 2018;155(5):1383-1391.


Footnotes

All recommendations are category 2A unless otherwise indicated. The National Comprehensive Cancer Network (NCCN®) makes no representations or warranties of any kind regarding their content, use or application and disclaims any responsibility for their application or use in any way.

Estimate based on the US population aged 45-49 as of 2018, adjusted for the reported rates of high-risk conditions and prior screening history for CRC.

Based on people with CRC in stage I, stage IIa, or stage IIb between 2011 and 2017. 

Per American Joint Committee on Cancer’s (AJCC) staging system: Localized = stage I, IIa, IIb. Regional = stage IIc and III. Distant = stage IV.7

Last updated: 3/1/2022