Task Force Updates CRC Screening Recommendations

In an update to its 2017 recommendations on when to start and stop screening for colorectal cancer (CRC), the US Multi-Society Task Force (MSTF) has issued a consensus statement that calls for screening of average-risk individuals beginning at age 45 years.

 “This recommendation is based on the increasing disease burden among individuals under age 50, emerging data that the prevalence of advanced colorectal neoplasia in individuals ages 45 to 49 approaches rates in individuals 50 to 59, and modeling studies that demonstrate the benefits of screening outweigh the potential harms and costs,” the MSTF reported.

The MSTF comprises representatives from the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy.

Specifically, the MSTF noted that the incidence rates for CRC among individuals aged 50 to 64 years increased by 1% annually between 2011 and 2016. In addition, both the incidence of CRC and mortality rates among persons aged 50 years or younger—early-age onset CRC (EAO-CRC)—are also increasing, even as overall incidence and mortality rates for CRC have been dropping in the US. “In 2020, 11% of all colon cancer and 15% of all rectal cancer diagnoses were estimated to occur in individuals under age 50,” the authors wrote in the update.

“Emerging data show that the rate of advanced colorectal neoplasia in average-risk individuals ages 45 to 49 is similar to advanced neoplasia rates observed in screening cohorts of those ages 50 to 59.”

Further, the task force concluded that modeling studies show that the benefits of screening outweigh harms in average-risk individuals aged 45 to 49 years, and demonstrate acceptable cost-effectiveness.

“MSTF recommendations on when to stop screening remain unchanged given a lack of new evidence to alter current practice,” the authors wrote. “For individuals ages 76 to 85, the decision to start or continue screening should be individualized. Important considerations include prior screening history, life expectancy, CRC risk, and personal preference, prompting the need for shared decision-making with providers to weigh the risks and benefits of screening. CRC screening is not recommended after age 85.”

—Rebecca Mashaw

Reference:
Patel SG, May, FP, Anderson JC. Updates on age to start and stop colorectal cancer screening: Recommendations from the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2022; 117(1): 57-69 doi: 10.14309/ajg.0000000000001548