Colorectal Cancer Screening Recommended Age Is Now 45 Instead of 50—And That Change Is Important for Health Equity

By the year 2030, colorectal cancer is projected to overtake breast cancer as the leading cause of cancer deaths among people between the ages of 20 and 49. To allow earlier detection, the U.S. Preventive Services Task Force (USPSTF) has lowered the recommended colorectal cancer screening age from 50 to 45. This means younger patients can access screening without jumping through insurance loopholes.

“The concerning increase in colorectal cancer in young individuals under the age of 50 (defined as young-onset colorectal cancer) has been documented since the mid-1990s, with 11 percent of colon cancers and 15 percent of rectal cancers now occurring in patients under the age of 50 in 2020, compared to 5 percent and 9 percent, respectively, in 2010,” says Kimmie Ng, MD, MPH, oncologist and director of the Young-Onset Colorectal Cancer Center at Dana-Farber Cancer Institute, in a statement.

This new guidance from the USPSTF aligns with the American Cancer Society’s (ACS) 2018 recommendation to lower the screening age to 45. However, the ACS recommendation was nothing more than a recommendation. The recommendation from the preventative services task force, however, is recognized by the Affordable Care Act, meaning insurance providers have to cover the screening in all individuals who are at average risk for colorectal cancer.

“For screening, people are considered to be at average risk if they do not have a personal history of colorectal cancer or certain types of polyps, a family history of colorectal cancer, a personal history of inflammatory bowel disease, or a confirmed or suspected hereditary colorectal cancer syndrome, for example, Lynch syndrome,” says Dr. Ng, who also co-authored the JAMA article accompanying the guideline change from the task force. Just as before, people younger than the recommended screening age who have a higher risk of developing colorectal cancer can work with their doctors to get coverage for early screening.

Lowering the recommended screening age has the potential to greatly impact Black patients, who are about 20 percent more likely to get colorectal cancer and about 40 percent more likely to die from the disease, compared to other patient populations. Black Panther star Chadwick Boseman was only 43 when he died from colon cancer in 2020. The disparity for Black patients is tied to differences in risk factors and in health care access.

“[African Americans] often experience greater obstacles to cancer prevention, detection, treatment, and survival, including systemic racial disparities that are complex and go beyond the obvious connection to cancer,” explains the ACS. While socioeconomic status plays a role in this, so does racism in the medical field. A 2016 study conducted by researchers at the University of Virginia found that some white doctors are less likely to believe the pain of Black patients, therefore disregarding their symptoms and allowing ailments to go untreated or undertreated.

Screening can often prevent colorectal cancer by finding and removing growths in the colon and rectum before they have a chance to become cancer, explains the ACS. Additionally, screening can find colorectal cancer early when it hasn’t spread and is easier to treat.

“Less than 70 percent of eligible individuals in the United States currently undergo screening, which is critical for [colorectal cancer] prevention,” says Dr. Ng. Lowering the recommended age to initiate screening “will make colorectal cancer screening available to millions more people in the United States, and hopefully, many more lives will be saved by catching colorectal cancer earlier, as well as by preventing colorectal cancer.”

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