In an update to its 2017 guideline on screening for colorectal cancer, the US Multi-Society Task Force on Colorectal Cancer (CRC) has reduced the age for initiation of screening for average risk persons from 50 to 45 years of age.¹  

The recommendation to start screening at a younger age is based on the growing evidence on increasing rates of early-age onset colorectal cancer (EAO-CRC), particularly rectal cancer and the cancer-related mortality rates. The guideline mentions that the prevalence of advanced colorectal cancer in persons aged 45 to 49 years is similar to the rates seen in persons aged 50 to 59 years. “Most CRCs in young patients are identified because of signs and symptoms rather than incidentally or through screening”. Detection and removal of high-risk precancerous polyps on colonoscopy is an important target in screening, emphasizes the Task Force.

The Task Force has also provided guidance about when to stop screening. According to the guideline, the decision to start or continue screening for persons aged 76 to 85 years should be individualized and based on prior screening history, life expectancy, risk for colorectal cancer and personal preference. Screening is not recommended for adults older than 85 years.

Noncolonoscopic screening methods such as fecal immunochemical test should be followed by a colonoscopy as the second step when the first screening gives an abnormal result.

Reference

1. Patel SG, et al. Updates on age to start and stop colorectal cancer screening: recommendations from the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2022 Jan;162(1):285-299. doi: 10.1053/j.gastro.2021.10.007.