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.2-5 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 2005.3 Despite clear CRC screening recommendations, screening rates are well below the nationwide target;6,7 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 detection8,9
Recent updates to guidelines that expand screening to individuals aged 45-49 years means ~19 million more are eligible for screening10,a
EARLY DETECTION OF CRC IMPROVES SURVIVAL
Percent of Cases by Stage1 and 5-Year Relative Survival Rate1
- The evolution of colorectal adenoma to early CRC typically takes more than 10 years, providing an important opportunity for screening and early detection8,9
HIGHER RATES OF SCREENING ARE ASSOCIATED WITH A REDUCTION IN CRC INCIDENCE AND MORTALITY12
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.3
- Incidence in this age group is currently increasing, in contrast to the declining incidence in all age groups after age 54 years.3
Only 48%
of the 50 to 54 years old population are up-to-date on screening.1
References
1 Siegel RL, Miller KD, Goding Sauer A, et al. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17-48.
2 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.
3 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.
4 Shaukat AK, Kahi CJ, Burke CA, et al. ACG clinical guidelines: colorectal cancer screening 2021. Am J Gastroenterol. 2021;116(3):458-479.
5 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.
6 American Cancer Society. Colorectal cancer facts & figures 2023-2025. Atlanta: American Cancer Society; 2023.
7 National Colorectal Cancer Roundtable. 80% in every community. Accessed June 4, 2023. http://nccrt.org/
8 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.
9 Winawer SJ, Fletcher RH, Miller L, et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterol. 1997;112(2):594-642.
10 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.
11 National Cancer Institute. Cancer stat facts: colorectal cancer. Accessed June 4, 2023. https://seer.cancer.gov/statfacts/html/colorect.html
12 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.
13 American Cancer Society. Survival rates for colorectal cancer, by stage. Accessed June 4, 2023. https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/survival-rates.html
Footnotes
a 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.
b Based on people with CRC in stage I, stage IIa, or stage IIb between 2012 and 2018.
c Per American Joint Committee on Cancer’s (AJCC) staging system: Localized = stage I, IIa, IIb. Regional = stage IIc and III. Distant = stage IV.13
Last updated: 06/04/2023