On May 18^th, 2021, the U.S. Preventive Services Task Force (USPSTF) issued a revised recommendation statement on screening for colorectal cancer. ^[1]US Preventive Services Task Force. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. … Continue reading The new recommendation expands the age range for colorectal cancer screening to include adults at average risk for colorectal cancer who are between the ages of 45 and 75 (previously 50-75).

While it is hoped that earlier screening will result in earlier diagnosis better outcomes in young adults, there is evidence to suggest that the biology of colorectal cancer in this group is more aggressive. At the annual meeting of the American Society of Clinical Oncology (ASCO), investigators shared new data showing that colon cancer patients under age 50 have a 26% higher risk of recurrence and a 19% higher risk of death compared to those over age 50. ^[2]Fontana, E, Meyers, JP, Sobrero, AF, et al. Early-onset stage II/III colorectal adenocarcinoma in the IDEA database: Treatment adherence, toxicities, and outcomes from adjuvant fluoropyrimidine and … Continue reading This observation held true despite a higher rate of completion of adjuvant chemotherapy in the younger patients. More research is needed to better understand these differences and to determine if there may be biologic underpinnings for these outcome differences, and whether new screening or treatment approaches could save more lives.

The team at Carelon has reviewed the USPSTF recommendation and related evidence, and our expert panel recently approved a guideline change to lower the age threshold for screening CT colonography, an alternative to standard colonoscopy. We will continue to stay abreast of the emerging evidence as it becomes available.