Dr Shaukat recaps her presentation from the ACG Postgraduate Course on the increasing numbers of patients who will need screening colonoscopy now that the beginning age for colorectal screening has been lowered to 45 from 50, and methods that gastroenterology can take as a field to improve outreach.

Aasma Shaukat, MD, is the Robert M. and Mary H. Glickman professor of medicine and professor of population health at the NYU Grossman School of Medicine in New York City.

TRANSCRIPT:

Hello, my name is Aasma Shaukat. I'm the Robert and Mary Glickman Professor of Medicine and Professor of Population Health at NYU Grossman School of Medicine. I'm here at ACG and I am here to talk to you about my recent presentation on 45 is the new 50. How do we improve adherence?

I'm going to frame first the context of the talk. We have been noticing that rates of colorectal cancer have been increasing in individuals younger than 50. Along with some modeling data and a lot of other epidemiologic studies showing that this is a very concerning trend, many of the guideline societies have now lowered the screening age from 50 to 45 for average-risk asymptomatic men and women in the U.S. While that's really important that we start our public health efforts, however, that has added another 21 million people between that age group, 45 to 49, to our screening pool.

We were already struggling to improve screening rates in 50 and older, so now we have a bigger problem on our hands. The question is, how do we address it? Let's see what components are needed. First, we need to figure out the how and when. We're going to start at 45 and we need to think about individuals that are never screened, that are overdue for screening, and this newly added eligible pool. We need to think about endoscopic capacity and how do we get all these individuals' access, and we need to think about building resources to be able to accommodate the screening volume. Finally, we need to think about strategies to increase the uptake of adherence. In that regard, we have some great screening options. Colonoscopy and stool-based testing are some of the most important options in the U.S. and we now need to increase our screening capacity.

The key here is to think about organized screening programs, where we're not just waiting for individuals to come to our clinics or offices to see us and get the opportunity to get screened, but we are reaching out to our membership and trying to figure out who is eligible and how do we bring them in. Do we send them letters? Do we invite them? Do we mail them stool kits? Or do we send them postcards to get their colonoscopy scheduled and completed? There's multiple strategies we could use.

Navigation is extremely important. Having some kind of education and outreach, whether it's through media and into our communities, and then finally, having that navigation piece where we can have everybody have good access is the key to getting everybody screened. How we put this together, there's some great evidence-based strategies out there and some I've highlighted in my presentation, but we don't need to reinvent the wheel. We just need to use the tools we have and get started on this effort today. Thank you so much for your attention.