The United States Preventive Services Task Force (USPSTF), an independent, volunteer panel of national experts in prevention and evidence-based medicine, released a draft recommendation today on screening for colorectal cancer. The taskforce’s new recommendation aligns closely with the American Cancer Society’s guideline, which calls for screening to start at age 45.
The USPSTF recommends screening for colorectal cancer for all individuals start at age 45 to age 75. It is recommended that the decision to screen individuals aged 76 to 85 years be individualized based on screening history and overall health status.
The American Cancer Society updated its colorectal cancer screening guideline in 2018, lowering the age to begin screening to 45 (from 50), in an effort to address the rising incidence of colorectal cancer in younger adults.
Robert Smith, PhD, senior vice president, cancer screening, shares his perspective on the USPSTF’s draft recommendation in a Q&A that can also be found in the ACS pressroom:
Big picture: what do you think of the draft recommendation statement?
The major change in the USPSTF’s draft recommendation statement for colorectal cancer screening is an important modification in their 2016 recommendation, specifically to lower the age to begin regular screening for colorectal cancer from age 50 to age 45. We agree with this proposed change, which addresses the rising incidence of colorectal cancer in younger adults.
How does this draft compare to the current ACS guideline?
In 2018, ACS updated its colorectal cancer screening guideline by reducing the age to begin screening from age 50 to age 45, so the two guidelines will be essentially the same if the USPSTF retains the proposed change after the comment period. Although there are small differences, the ages to begin screening, the screening test options, and undergoing shared decision about screening from age 76 to 85 are the same. Both organizations do not recommend colorectal cancer screening after age 85.
How would these changes affect the potential for colorectal cancer screening to reduce colorectal cancer mortality?
Given the rising risk and the fact that the risk of colorectal cancer at age 45 today is similar to the risk at age 50 about 20 years ago, the opportunity to prevent colorectal cancer or detect it early will improve if adults begin screening at age 45. To date it has been discouraging that most adults do not begin screening at age 50, and on average start screening later in their 50s, meaning that we miss opportunities to prevent colorectal cancer and avert preventable deaths. We hope that the agreement between the ACS and USPSTF guideline will stimulate more health care providers to promote beginning colorectal cancer screening at age 45, so screening begins earlier on average than it has to date.
How will these guidelines impact health insurance coverage for colorectal cancer screenings?
These draft guidelines now classify screenings for average-risk individuals ages 45-49 as grade “B” and ages 50-75 as grade “A.” Because colorectal cancer screenings are considered essential health benefits under the Affordable Care Act (ACA) and health insurance plans are required to cover all preventive services that receive an “A” or “B” grade from USPSTF, if this draft is finalized as is, individuals with ACA-compliant plans ages 45-49 who previously were not eligible to get coverage for colorectal screenings will gain access at no cost.
When the USPSTF finalizes these updated colorectal screening guidelines, ACS’s advocacy affiliate, the American Cancer Society Cancer Action Network (ACS CAN) will continue to aggressively work to notify relevant state and federal policymakers, insurance commissioners and state Medicaid directors about the evidence in support of screening individuals aged 45-49, and the importance of expanding insurance coverage of screening for this age group. ACS CAN will work with state insurance commissioners to ensure state plans follow the new coverage requirements. ACS CAN will also continue to advocate that all individuals have access to comprehensive health coverage, including for recommended cancer screenings, regardless of where they live.
The USPSTF’s recommendation is open for public comment until November 23, 2020. The USPSTF is not able to specify a date when they will issue a final recommendation, but generally it is within six months after the comment period ends.
For more information on screening for colorectal and other cancers, see Cancer Screening Guidelines on cancer.org.