New studies indicate a positive impact from the U.S. Preventive Services Task Force (USPSTF) decision in 2021 to lower the recommended age for colorectal cancer screening from 50 to 45. This adjustment was made in response to a concerning increase in advanced colorectal cancer cases observed in younger adults. As health journalist Helen Branswell noted in a recent social media post, "New studies suggest the new policy is working."
The USPSTF, an independent panel of medical experts, officially finalized its recommendation on May 18, 2021, advising that individuals at average risk for colorectal cancer begin screening at age 45. This updated guideline aligns with a similar recommendation issued by the American Cancer Society in 2018, aiming to prevent more deaths from the disease by enabling earlier detection. The decision was primarily driven by a significant rise in early-onset colorectal cancer.
Research published in the American Journal of Preventive Medicine by the American Cancer Society found that screening rates among adults aged 45 to 49 increased from 19.3% in 2019 to 22.4% in 2022 following the guideline change. Furthermore, a study from The University of Texas MD Anderson Cancer Center, published in JAMA Network Open, reported an increase in the detection of early-stage colorectal cancers and precancerous polyps in this age group since the updated guidelines. These findings underscore the effectiveness of the revised screening age in identifying malignancies at a more treatable stage.
The incidence of colorectal cancer in individuals younger than 50 has been steadily increasing since the mid-1990s, even as rates in older adults have declined. According to the Centers for Disease Control and Prevention (CDC), from 2011 to 2020, the incidence rate of colorectal cancer rose by 1.8% annually in people under 50. This alarming trend has prompted public health bodies to re-evaluate traditional screening protocols.
While the USPSTF's recommendations are widely adopted and influence insurance coverage, the body has faced legal challenges regarding its authority. Notably, the HHS Secretary, Xavier Becerra, has been involved in defending the Affordable Care Act's mandate for no-cost preventive services, which relies on USPSTF recommendations. This legal dispute, known as Kelley v. Becerra, questions the constitutionality of the USPSTF's role due to its members not being presidentially appointed and Senate-confirmed, rather than criticizing the medical validity of its guidelines. The Biden administration has appealed a federal judge's ruling against this mandate, emphasizing the importance of these preventive services for public health.