After experts lowered the recommended age to start colorectal cancer screening to 45, there was a small but significant increase in screening among younger people, according to a study published in the journal JAMA Network Open. .
The U.S. Preventive Services Task Force, which previously recommended starting testing at age 50, changed its guidelines in 2021.
Colorectal cancer cases have increased in people under 50 years of age in the last two decades. The Working Group is not the first to have suggested lowering the testing age. In 2018, the American Cancer Society also recommended starting screening at age 45.
However, this body’s recommendation carries weight, because if it endorses an exam for a particular group, insurance will cover it.
The new study found that colorectal cancer screening among people ages 45 to 49 remains low overall, but has increased following the 2021 guideline change.
“It’s interesting to see how quickly this increase occurred after the guidelines were published, especially given that the pandemic hampered screening,” said Sunny Siddique, lead author of the study and a cancer researcher at the Faculty of Health. Yale Public.
Siddique and his team analyzed patient data from more than 10 million people with Blue Cross Blue Shield insurance. On average, researchers found that colorectal testing rates among people ages 45 to 49 increased from about 0.5% before the 2021 guidelines to 1.5% a year and a half later.
“A 1% increase seems small, but this is hundreds of thousands of people,” Siddique said.
Although everyone in the study had health insurance, researchers noted disparities in insurance coverage of the exam. People living in wealthier areas experienced the greatest increase in testing rates.
“Even without taking into account the insurance factor, we still see differences,” Siddique said. “If you live in an area with a low socioeconomic level, your chances of accessing these services are lower.”
About 11% of colorectal cancer cases are diagnosed in people under age 50—about 20,000 people, according to the American Cancer Society.
“Early-onset colorectal cancer is a big problem. If screening is not done in time, these cancers will be detected at an advanced stage,” said Dr. Christopher Lieu, co-director of gastrointestinal medical oncology at the University of Colorado School of Medicine.
Lieu said the study results are promising, suggesting that awareness around the new recommended testing age is increasing, but noted that testing among the uninsured (and who were not included in the study) is probably minor.
The increase in testing among insured patients, according to Lieu, could also be due in part to the more widespread use of non-invasive tests, such as the Cologuard, a stool test that has a 92% accuracy rate, and the Shield, a blood test that detects colorectal cancer in 83% of people who suffer from it.
If these tests come back positive, the doctor will perform a follow-up colonoscopy.
Colonoscopy is the gold standard for screening for colorectal cancer, as it detects not only cancerous tumors, but also precancerous polyps that can be removed before they turn into cancer.
But other cheaper and less invasive methods, such as blood and stool tests, are important to increase the number of people who undergo these tests. Still, they are not for everyone.
“For people who have had colon cancer, or those who have a very strong family history, there is no alternative to colonoscopy,” Fakih determined.