A nonprofit publication of the Kentucky Center for Public Service Journalism

Panel says colorectal cancer screenings should begin at 45, following cancer society guidelines


By Melissa Patrick
Kentucky Health News

A federal task force now recommends that adults with a normal risk for colorectal cancer get their first screening at age 45, instead of 50, as the American Cancer Society has recommended since 2018.

Kentucky already requires health insurance plans to start screening for colorectal cancer at 45, and pay for it without any patient cost sharing, under legislation passed by the 2019 General Assembly.

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But many other states still follow the U.S. Preventive Services Task Force guidelines, making this new guidance a welcome change in policy, Dr. Whitney F. Jones, founder of the Colon Cancer Prevention Project, said in a news release.

“This long-anticipated and overdue course correction proposed by USPSTF is welcome in our state and nationally by patients and advocates,” said Jones. “In Kentucky, the potential to prevent colorectal cancers and reduce colorectal deaths for the 225,000 people between age 45 and 49 will further advance our nation-leading improvements in colorectal cancer screening rates.”

Kentucky leads the nation in colon cancer, but is nationally recognized for getting its citizens screened for it, with about 70% of Kentuckians who are 50 and older reporting they have been screened for it. In the last 10 years, Kentucky colon cancer screenings have resulted in a 25% reduction in incidence and a 28% reduction in death, according to the prevention project website.

The state law on screening, sponsored by Sen. Ralph Alvarado, R-Winchester, also requires health plans to cover genetic tests for cancer, including those for colon cancer. It took effect Jan. 1.

The federal task force’s proposal is still a draft open for public comment until Nov. 23. The task force is an independent group of experts appointed by the Department of Health and Human Services.

Once finalized, private insurance plans that are subject to the Patient Protection and Affordable Care Act and Medicare plans would be required to cover colorectal-cancer screening with no co-pay or out-of-pocket cost, according to a group of colorectal-cancer organizations.

Like the Cancer Society’s advice two years ago, the task force’s decision is largely driven by increases in colorectal cancer in younger adults. The society says 12% of colorectal cancers will be diagnosed in people under 50.

“Rates have been increasing since the mid-1980s in adults ages 20-39 years and since the mid-1990s in adults ages 40-54 years, with younger age groups experiencing the steepest increase,” the society says. It also reports that in African Americans, colorectal-cancer rates are about 20% higher than whites, and death rates are almost 40% higher.

Timely screening is important because colorectal cancer usually starts from polyps in the colon or rectum that can only be found during a screening so that they can be removed before they ever turn into cancer. Further, there are no symptoms for polyps or early colon cancer.

“It is estimated that six out of 10 deaths from colon cancer could be prevented if everyone were screened at 45,” says the prevention project.

The draft recommendations cover two types of screenings for colorectal cancer, including a direct visualization tests, such as a colonoscopy, or tests that can detect signs of cancer from a stool sample.

Stool-based tests are noninvasive and can be done at home, but must be done more frequently. Colonoscopies are generally recommended every 10 years after the first one is done, as long as the patient is considered low risk.

For people aged 76 to 85, the task force continues to recommend that the decision to be screened be made on an individual basis.


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