May 28, 2022

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American guidelines adjusted colorectal cancer screening to 45 years old

JAMA: American expert guidelines adjusted the age of colorectal cancer screening to 45 years old



American guidelines adjusted colorectal cancer screening to 45 years oldDue to the recent alarming increase in colorectal cancer cases among people under the age of 50, an independent panel of experts recommends that individuals with an average risk of the disease should be screened at the age of 45 instead of the traditional 50.


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Due to the recent alarming increase in colorectal cancer cases among people under the age of 50, an independent panel of experts recommends that individuals with an average risk of the disease should be screened at the age of 45 instead of the traditional 50.

The United States Preventive Services Task Force (USPSTF) has published changes to screening guidelines in this issue of the Journal of the American Medical Association (JAMA). It updated its 2016 recommendations and is consistent with the recommendations of the American Cancer Society, which lowered the age at which screening began to 45 in 2018.


Colorectal cancer (CRC) is a preventable malignant tumor because of its slow progress and the provision of screening tests, which can screen and detect the disease at an early stage. Since the mid-1980s, the overall incidence of colorectal cancer among people 50 years of age and older has steadily declined, mainly because of increased screening and changed patterns of risk factors.

However, Dr. Kimmie Ng of the Dana-Farber Cancer Institute said: “Since the mid-1990s, the incidence of colorectal cancer (early-onset colorectal cancer) has increased in the young and middle-aged population (that is, people under 50). In 2020, the incidence of colon cancer among people under the age of 50 is 11%, and the incidence of rectal cancer is 15%, compared with 5% and 9% in 2010, respectively.” Dr. Ng is the Dana-Farber Cancer Institute Early Onset The director of the Center for Sexual Colorectal Cancer and the first author of this article.

The reason for the increased incidence of early-onset colorectal cancer is still unclear.

Lowering the recommended age for starting screening “will allow millions of people in the United States to be screened for colorectal cancer. This is very important. We hope that early detection of colorectal cancer and prevention of colorectal cancer can save more lives,” Ng Say.

USPSTF is an independent expert group funded by the US Department of Health and Human Services. The working group’s recommendation means that insurance companies need to cover preventive tests for early detection of colorectal cancer, such as colonoscopy and stool testing.

Studies have shown that screening at the age of 45 avoids more early deaths than at the age of 50, and the incidence of colonoscopy complications is relatively small. For individuals between the ages of 76 and 85, the USPSTF’s 2016 recommendation is to select selective screening. This recommendation has not changed today, because research shows that the benefit of patients is only a slight increase in lifespan.

The editorial in this issue of the Journal of the American Medical Association asks whether the screening age should be lowered to under 45. Although most early-onset colorectal cancer diagnoses and deaths occur in people aged 45 to 49 years, the incidence of the youngest patients is the fastest growing. The incidence of colon cancer among people aged 20-29 years increases by 2% per year, while that among people aged 40 to 49 years only increases by 1.3%. The incidence of rectal cancer among people aged 20 to 29 and 30 to 39 years old increased by 3.2% per year, while the rate of increase for people aged 40 to 49 years was 2.3%.

“We now see some patients who are far younger than 45 years old-in their 20s or 30s, who are diagnosed with colorectal cancer and are usually at an advanced stage,” Ng said. “Obviously, the USPSTF’s recommendation to start screening at the age of 45 is not enough to detect young patients.”

According to the author, in the end, the best colorectal cancer prevention and early detection for people under the age of 45 requires in-depth research on the underlying causes and risk factors of early-onset colorectal cancer, and these are still difficult to determine.

They pointed out that despite the preventive benefits of colorectal cancer screening, only 68.8% of individuals in the United States have been screened. In the uninsured and underinsured people, low-income people and ethnic minorities, this proportion is even lower. Current obstacles include lack of awareness of the importance of screening, concerns about the invasive nature of colonoscopy, and lack of access to screening.

The new proposal “represents an important policy change,” the author wrote, “it is expected to promote a reduction in the incidence and mortality of colorectal cancer.”

 

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