Recent research indicates a sharp rise in colorectal cancer screening among adults aged 45 to 49 following updates to national screening guidelines. The American Cancer Society (ACS) reports a 62% increase in colorectal cancer screening rates from 2019 to 2023 in this age group, leading to earlier detection of the disease.
The change comes after the ACS recommended in 2018 that adults at average colorectal cancer risk begin screening at age 45 instead of 50. The U.S. Preventive Services Task Force adopted the same recommendation in 2021, prompting widespread insurance coverage and influencing primary care practices.
“It’s thrilling to see this,” said Rebecca Siegel, an epidemiologist at the ACS and an author of the new research. “It means fewer deaths and higher quality of life for people who are diagnosed.”
Newly published studies in the Journal of the American Medical Association highlight how the updated guidelines are contributing to higher screening rates and increased detection of early-stage colorectal cancer, when treatment is more effective and less intensive.
Early-stage colorectal cancer diagnoses rise significantlyThe ACS reports that early-stage colorectal cancer diagnoses among adults aged 45 to 49 rose by 50% from 2021 to 2022. This trend marks a shift in outcomes for a population that historically faced later-stage diagnoses due to limited screening access.Data also show that colorectal cancer incidence among adults aged 45 to 49 increased at a 12% annual rate between 2019 and 2022, compared to about 1% annually from 2004 to 2019. Experts attribute this shift primarily to improved screening availability and utilization, though a post-Covid rebound in healthcare visits may also play a role.
Caitlin Murphy, a cancer epidemiologist at the University of Chicago, said the trend resembles earlier improvements seen in older adults. “Ultimately, the goal of screening is to reduce mortality, and we haven’t seen that quite yet, simply because not enough time has gone by.”
Barriers persist despite improvements in colorectal cancer screening
While colorectal cancer screening has improved overall, disparities remain. Screening rates among uninsured individuals and those with less than a high school education in the 45 to 49 age group have not significantly changed. Screening rates for this age group also remain lower than for those aged 50 and older.
A colonoscopy remains the preferred screening method, with up-to-date usage rising from 20% in 2019 to 28% in 2023 among adults aged 45 to 49. Non-invasive stool-based tests that detect blood or DNA changes also saw a rise in use, increasing from 1.3% to 7.1% over the same period.
In a trial involving over 20,000 people aged 45 to 49, researchers found that screening uptake increased when individuals were automatically mailed stool tests rather than asked if they wanted to be screened. However, overall participation remained low, at just 19%.
“We probably shouldn’t be wasting time asking patients first; we should send them what they need,” said Dr. Folasade May, the trial’s senior author and a gastroenterologist at the University of California, Los Angeles. “We have a long way to go.”
Colorectal cancer remains the leading cause of cancer death among men under 50. Researchers continue to investigate factors such as diet, lifestyle, and environmental exposure that may contribute to rising colorectal cancer rates in younger populations.
“I have patients in their 20s in my practice that would never fit the guidelines,” said Dr. Michael Cecchini, a medical oncologist at Yale Cancer Center. “We need to be thinking about it on our list of possible diagnoses.”
