On July 31, 2023, the American College of Physicians (ACP) published updated clinical guidance maintaining 50 as the age when clinicians should start screening for colorectal cancer (CRC) in patients who are asymptomatic and at average risk. National advocacy organizations Fight Colorectal Cancer (Fight CRC), Blue Hat Foundation, Colon Cancer Coalition, the Association of Black Gastroenterologists and Hepatologists (ABGH), the American College of Gastroenterology (ACG), American Gastroenterological Association (AGA), and the American Society for Gastrointestinal Endoscopy (ASGE) stand united in upholding the United States Preventive Services Task Force’s (USPSTF) recommendations for colorectal cancer screening starting at age 45.
Since 2021 when groups such as USPSTF and Multi-Society Task Force on Colorectal Cancer lowered the colorectal cancer screening age recommendation from 50 to 45, advocacy organizations and physician groups have worked hard to communicate this change and raise awareness to reach average-risk patients age 45 and older who have not been screened. These guidelines were updated in direct response to the increase in the incidences of early-age onset colorectal cancer (EAO-CRC) and aligns with the American Cancer Society’s 2018 recommendation that screening begin at age 45. These recommendations have become even more urgent since JAMA released a report stating that by 2030, colorectal cancer is projected to be the leading cause of cancer deaths in people under 50. Black Americans are also 20% more likely to get colorectal cancer and 40% more likely to die from it than most other groups. This disease is disproportionately affecting the Black community, and it is more important than ever to ensure that all communities have equitable care and access to screening.
"The ACP's decision to recommend colorectal cancer screening starting at age 50 rather than the USPSTF and ACS recommendation of age 45 is concerning,” said Anjee Davis, MPPA, president of Fight CRC. “Not only does this announcement potentially distract patients and create confusion for primary care physicians, but it also reduces the options available to them, particularly the lack of acknowledgement of noninvasive screening tests. Studies have shown that offering a variety of screening options improves adherence and patient participation. As a patient advocacy group, we firmly believe that a comprehensive approach to screening is crucial, incorporating both age-appropriate recommendations and non-invasive alternatives in addition to colonoscopy. By working together to increase colorectal cancer screening and message that all those over 45 should be screened, we can make significant progress in detecting and preventing this disease."
“Early detection remains the cornerstone of successful CRC management,” said Candace Henley, Founder of Blue Hat Foundation. “Lowering the screening age to 45 could potentially catch many cases earlier, significantly improving survival rates and reducing the impact of CRC as a leading cause of cancer death in younger age groups. Despite the potential costs of lowering the screening age, there are long-term economic benefits to early detection. Treating advanced colorectal cancer is often more costly and resource-intensive than managing earlier stages of the disease; this does not even take into account reduced quality of life or premature mortality associated with late diagnosis. Drawing on the latest research and forecasts, it is imperative that the ACP revise its recommendation to include endorsing colorectal cancer screening from age 45 for individuals at average risk who are asymptomatic. By joining forces with the ACS, USPSTF, and advocacy organizations in this effort, we can make a greater impact in reducing colorectal cancer mortality rates.”
"In an environment where we are seeing a dramatic increase in early-age onset colorectal cancer, it is shocking that ACP would limit availability and screening choices for patients," says Chris Evans, president of the Colon Cancer Coalition. "We know that screening saves lives. Patients should have the choice of the screening option that works best for their personal risk factors, comfort level, and lifestyle, including non-invasive options. The Coalition advocates for screening choice and screening at age 45 to prevent early death and increased quality of life for patients."
"Up to 10% of colorectal cancer diagnoses occur in those younger than age 50," said Sophie Balzora, MD, President and co-founder of the Association of Black Gastroenterologists and Hepatologists (ABGH). "The GI community is incredibly concerned that all the work done to impart the critical importance of timely screening at age 45 to prevent colorectal cancer will be legitimately threatened by this guideline that deviates from the USPSTF and MSTFCRC recommendations.”
“ACG is disappointed with ACP’s recent guidance on colorectal cancer which dismisses the increasing rates of colorectal cancer in individuals under age 50. While we agree that the majority of new colorectal cancer cases occur in those age 50 and older, we have strong evidence that screening reduces the risk of colorectal cancer. The current incidence rates of colorectal cancer in individuals 45-50 years are where we started with 50-year-olds almost 30 years ago. There is also evidence that these cancers are detected at advanced stages,” said ACG President Daniel J. Pambianco, MD, FACG. “In ACG’s 2021 CRC screening clinical guidelines, our approach is to curb this rising trend in younger individuals and reduce the societal impact of young individuals developing and dying from a preventable cancer. We strongly recommend colorectal cancer screening, and starting at age 45 is a simple message that can help with adherence.”
“Studies show that colorectal cancer is increasing in younger patients and we have data backing screening for average risk patients at 45. Bottomline: it saves lives. To release contradictory guidance is reckless." Barbara Jung, MD, AGAF, President, American Gastroenterological Association.
“Conflicting messages from respected authorities causes confusion among the public and providers. This guidance undermines efforts to further lower colorectal cancer incidence in the US and could impact the gains made in screenings and lives saved especially in the most vulnerable populations,” said Jennifer Christie, MD, FASGE, ASGE President. “Screening starting at age 45 saves lives. ACP’s guidance is misguided and runs counter to numerous published evidence-based guidelines including the USPSTF recommendations that are developed using gold standard methods to systematically review the best available evidence.”
The USPSTF, MSTFCRC, and ACG guidelines were developed for average-risk patients. Other professional organizations have developed separate guidelines for those at a higher risk of colorectal cancer due to a family history, genetic mutation, inflammatory bowel disease (IBD), or personal history of colorectal cancer. Also, knowing the signs and symptoms of colorectal cancer is critical. It is important for patients to understand their risk of colorectal cancer and talk with their doctor about screening timing and options.
The collaboration among advocacy organizations such as Fight CRC, Blue Hat Foundation, Colon Cancer Coalition, ABGH, ACG, AGA, and ASGE, highlights the importance of on-time colorectal cancer screening starting at age 45 for average-risk patients; visit their websites for more information.