Lowering the Starting Age for CRC Screening to 45 years

Posted by Cancer Center at Wise Regional on March 25th, 2019

In the past, most organizations were of the opinion that average-risk colorectal cancer (CRC) screening should begin at age 50. Things took a turn in recent years with certain organizations recommending that screening, particularly for African Americans begin earlier. The American College of Physicians recommended 40 years while the American College of Gastroenterology recommended 45 years.

With the guidance of epidemiological data, the American Cancer Society (ACS) gave a qualified recommendation that the CRC screening age be lowered to 45 not for African Americans only but for every average-risk individual. A qualified recommendation shows verifiable evidence of benefit but the balance between benefits and harm is less certain.

The new recommendation brings to the fore a new conundrum among the gastrointestinal community. The major things that stand out include:

•    Age is the largest factor for predicting risk for CRC. It, however, is not the only important factor. Others include high body mass index (BMI), a first-degree relative with CRC, cigarette smoking, metabolic syndrome, diet, adherence and use of certain drugs such as hormone replacement therapy, aspirin, and nonsteroidal anti-inflammatory drugs.

•    The change in age would offer several benefits including early detection of CRC thus making it possible to cure it. This would in turn reduce the incidence and mortality rates for 45- to 54-year-olds.Early detection eliminates the need for surgery and other treatment therapies. This translates to a reduction in the cost of care.

•    The biggest liability is that it would make room for the harm that may result from false-positive noninvasive screening. This creates a requirement for a colonoscopy that may not be of use. The whole process may also be costly.

Putting this new recommendation into practice would require careful consideration of the individual patients and histories. It may be better to consider assessing individuals in the recommended age range for risk factors and if none are present, the screening can be pushed forward to age 50. Those presenting with one or two risk factors can undergo non-invasive screening and those with more risk factors, an endoscopic screening.

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North Texas Cancer Center at Wise, a division of Choice Cancer Care, is now operating as the Cancer Center at Wise Regional and is one of the most renowned cancer treatment centers in Texas.