Opting for earlier screening may help reduce mortality among among younger adults, where the incidence of colorectal cancer (CRC) is growing,  Aasma Shaukat, MD, MPH, FACG, stressed during her presentation at the 2022 ACG Annual Scientific Meeting in Charlotte, North Carolina, on October 25.

Dr Shaukat is a professor of population health at New York University Grossman School of Medicine, director of gastrointestinal outcomes research, and holds the endowed Robert M. and Mary H. Glickman Professor of Medicine and Gastroenterology professorship.

Before delving into the new CRC screening guidelines updates, Dr Shaukat spent some time recapping recommendations from 2016 and 2018. According to the US Preventive Services Task Force (USPSTF) recommendations statement, the ideal screening age for CRC was 50 years; however, with the rising incidence of colon and rectal cancer among adults under than 50 years of age, the American Cancer Society (ACS) updated the qualified recommendation to lower the screening age to 45.

Patients could also opt for any of the numerous screening tests available to detect early-stage CRC, such as fecal occult blood test (gFOBT), fecal immunochemical test (FIT), FIT-DNA, flexible sigmoidocscopy (alone or combined with FIT), colonoscopy, CT colonoscopy, and circulating tumor DNA (ctDNA) testing.

By 2021, both ACS clinical guidelines and USPSTF recommendations agreed on lowering the screening age to 45 for average-risk individuals to reduce the incidence of advanced adenoma, CRC, and death from CRC. Dr Shaukat agreed that no matter the screening modality or frequency, “we could avert at least 3 additional cases per 1000 screened individuals, if the screening start age is 45 years.”

The newer ACS recommendations also considered the patient’s family history while deciding on the age for screening.

Citing findings from the US Behavioral Risk Factor Surveillance System 2016, Dr Shaukat mentioned that the overall screening rates for adults aged 50-75 was only 64%, with disparity between races. While 66% of Whites opted for earlier screening, other races such as African American (60%) and Asians (55%) were largely neglected.

She also discussed the prevalence of neoplasia and adenoma detection rate (ADR) among patients between ages 45 and 49, and the quality indicators for endoscopists. While it is common knowledge that ADR is a validated quality indicator for screening colonoscopy, Dr Shaukat said, little is known about the impact of lowering screening age to 45 in asymptomatic individuals on endoscopist ADR.

Regarding the future of CRC screening, Dr Shaukat was hopeful about the blood-based CRC screening called Septin 9 gene DNA test to screen patients 50 years and older at average risk of CRC who have a history of not completing CRC screening.

In conclusion, Dr Shaukat said that with the rising trend of advanced neoplasia and CRC among people aged 45-49 years approaching that among people aged 50-54 years, “there is a strong need to expand CRC screening approaches and lay greater emphasis on adherence.”

—Priyam Vora

Reference:
Shaukat A. Colon cancer screening: What do we need to build and who will come? Presented at: ACG 2022 Annual scientific meeting and Postgraduate course. Charlotte, North Carolina. October 25, 2022.