The United States Preventive Services Task Force (USPSTF), an independent, volunteer panel of national experts in prevention and evidence-based medicine, has released the following draft recommendation statement on screening for colorectal cancer (CRC):
The USPSTF recommends screening for colorectal cancer for all individuals start at age 45 to age 75. It is recommended that the decision to screen individuals aged 76 to 85 years be individualized based on screening history and overall health status.
A draft evidence review and draft modeling report were posted online on October 27 alongside the draft recommendation statement. The public is invited to comment on the draft recommendation through Monday, November 23.
To help understand the change to this important recommendation, Robert A. Smith, senior vice president for cancer screening at the American Cancer Society (ACS), shared the following thoughts on this critical screening update.
Big picture, what do you think of the draft recommendation statement?
The major change in the USPSTF’s draft recommendation statement for CRC screening is an important modification in their 2016 recommendation, specifically to lower the age to begin regular screening for colorectal cancer from age 50 to age 45. We agree with this proposed change, which addresses the rising incidence of colorectal cancer in younger adults.
How does this draft compare to the current ACS guideline?
In 2018, ACS updated its CRC screening guideline by reducing the age to begin screening from age 50 to age 45, so the two guidelines will be essentially the same if the USPSTF retains the proposed change after the comment period. Although there are small differences, the ages to begin screening, the screening test options, and undergoing shared decision about screening from age 76 to 85 are the same. Both organizations do not recommend colorectal cancer screening after age 85.
How would these changes affect the potential for CRC screening to reduce CRC mortality?
Given the rising risk and the fact that the risk of colorectal cancer at age 45 today is similar to the risk at age 50 about 20 years ago, the opportunity to prevent colorectal cancer or detect it early will improve if adults begin screening at age 45. To date, it has been discouraging that most adults do not begin screening at age 50, and on average start screening later in their 50s, meaning that we miss opportunities to prevent colorectal cancer and avert preventable deaths. We hope that the agreement between the ACS and USPSTF guideline will stimulate more physicians and other health care providers to promote beginning CRC screening at age 45, so screening begins earlier on average than it has to date.
How will these guidelines impact health insurance coverage for CRC screenings?
These draft guidelines now classify screenings for average-risk individuals ages 45-49 as grade “B” and ages 50-75 as grade “A.” Because CRC screenings are considered essential health benefits under the Affordable Care Act (ACA) and health insurance plans are required to cover all preventive services that receive an “A” or “B” grade from USPSTF, if this draft is finalized as is, individuals ages 45-49 with ACA-compliant plans who previously were not eligible to get coverage for CRC screenings will gain access at no cost.
When the USPSTF finalizes these updated CRC screening guidelines, ACS’s advocacy affiliate, the American Cancer Society Cancer Action Network (ACS CAN) will continue to aggressively work to notify relevant state and federal policymakers, insurance commissioners, and state Medicaid directors about the evidence in support of screening individuals aged 45-49, and the importance of expanding insurance coverage of screening for this age group. The ACS CAN will work with state insurance commissioners to ensure state plans follow the new coverage requirements. The ACS CAN will also continue to advocate that all individuals have access to comprehensive health coverage, including for recommended cancer screenings, regardless of where they live.
Learn more about screening for colorectal and other cancers. The ACS is a proud Partner in Health of the Ohio Academy of Family Physicians.