Discussing The New USPSTF Colon Cancer Screening Guidelines

The anticipated draft recommendation from the U.S. Preventive Task Force Services (USPSTF) is here…and it brought forth great news for the colorectal cancer (CRC) community. This independent panel of experts has proposed lowering CRC screening age for average-risk adults from 50 to 45 years.

The B grade recommendation means private insurance plans must cover this preventive service without the individual paying anything out-of-pocket (no copayment, coinsurance, or deductible). A key provision of the Affordable Care Act is that private health insurance plans must cover preventive health care services recommended by expert medical bodies without cost-sharing.

Members of CCF’s Medical Advisory Council welcomed this recommendation.

Judy Yee, MD, FACR Chair of Radiology at the Albert Einstein College of Medicine and Montefiore Medical Center, said, “The new USPSTF draft guidelines will help to increase screening in patients younger than 50. Specifically, for individuals between the ages of 45-49, the B rating by the USPSTF indicates that colorectal cancer screening must be covered by private health plans.” Dr. Yee is a proponent of providing patients the option of validated screening tests such as CT colonography (virtual colonoscopy). “CT colonography is a structural exam, like colonoscopy, and can find polyps before they turn in to cancer, which is an advantage over the stool-based tests. Knowing about all the options is important and ultimately the best test is the one that actually gets done.”

Kimmie Ng, MD, MPH, Director of the Young-Onset Colorectal Cancer Center and Co-Director of the Colon and Rectal Cancer Center, Dana-Farber Cancer Institute, told CCF, “45 is the new 50!” Dr. Ng strongly believes that the revised screening age recommendation “is hugely impactful, will change standard of care in preventive medicine, and lead to insurance coverage of screening for people starting at age 45. However, research must continue into what the underlying causes of young-onset colorectal cancer are, as this new guideline will not benefit the many patients who are diagnosed younger than 45.”

Cindy Borassi, Interim President of the CCF, said, “The Colon Cancer Foundation applauds the USPSTF for taking a step in the right direction by lowering the screening-age recommendation for CRC screening. With early-age onset colon cancer a growing concern in both the U.S. and globally, initiating screening at 45 years instead of 50 among individuals with an average risk of CRC will lead to earlier diagnosis, potentially before the disease progresses to an advanced stage, which can dramatically improve patient outcomes. This is a significant boost to our foundation’s promise of raising awareness of the importance of early detection of CRC.”

A study published in JAMA Network Open earlier this year that analyzed CRC incidence in 1-year age increments found a steep rise in incidence among people in their early 50s, reflecting the large number of CRCs detected during first screening, which would be at the existing recommendation of 50 years. The proposed recommendation by USPSTF, once finalized, will help diagnose these early-onset cases much before they progress to an advanced stage.

It is important to remember that these are draft recommendations and the USPSTF is inviting stakeholders to provide comments till November 23, 2020. It is imperative that the CRC community prepare to spread the message on early screening within the population and primary care centers once the final recommendation is released early next year.

USPSTF has proposed lowering the screening age for CRC to 45! Lend your support and send in your comments directly to USPSTF by November 23.

https://uspreventiveservicestaskforce.org/uspstf/colorectal-cancer-screening-draft-recommendation-statement-questionnaire