45 is the new 50 (for colorectal cancer screening)

by Craig Wilson ([email protected]) 744 views 

I’ve got a date this summer. It’s not a date about which I’m terribly excited. In fact, I’m not looking forward to it at all, but I know it’s my time.

This important date has been on my schedule since last year, when a panel of national experts in disease prevention and evidence-based medicine, the U.S. Preventive Services Task Force (USPSTF), recommended lowering the age for colorectal cancer screening from age 50 to age 45. I’m not embarrassed about keeping my date, because it could save my life.

It is estimated that 1,530 Arkansans will be diagnosed with colorectal cancer in 2022, and 560 of those are expected to die from the disease. More than half of new colorectal cancer diagnoses in Arkansas in 2017 were late-stage, according to a report developed by the Arkansas Center for Health Improvement (ACHI) in partnership with national nonprofit Fight Colorectal Cancer.

From 2014 to 2018, Arkansas ranked fifth highest in rates of new colorectal cancer cases and eighth highest in rates of colorectal cancer deaths in the U.S. Rates of new cases and deaths are higher in men and African Americans.

Notably, the recommendation to start screening at age 45 is for people at average risk. For people at increased risk — those with inflammatory bowel disease, certain genetic syndromes, or a family history of colorectal cancer — screening at an earlier age may be needed. While colorectal cancer typically affects older adults, incidences among young adults are on the rise. By 2030, colorectal cancer is estimated to become the number one cause of cancer-related deaths for 20- to 49-year-olds.

Screening is the key to reducing colorectal cancer deaths. New affordable, non-invasive, take-home options for screening have been added to the traditional colonoscopy to encourage more detection. However, screening rates remain low compared to rates for breast and cervical cancer screenings. This is due to multiple barriers, including patient fear or embarrassment, knowledge gaps, scheduling difficulties, language or cultural differences, or financial barriers.

Fortunately, there has been some progress on removing financial barriers. The federal Patient Protection and Affordable Care Act requires Medicare and most health plans to cover certain USPSTF-recommended preventive services such as cancer screenings at no out-of-pocket cost for the patient. In addition, state and federal policymakers have recently acted to protect patients in most insurance plans from cost-sharing associated with a follow-up colonoscopy after a positive at-home test.

In this National Colorectal Cancer Awareness Month, know the facts and tell someone you care about. Talk to your doctor about any concerns or symptoms — such as blood in your stool, changes in bowel habits, or unexplained weight loss — that you may be experiencing. If you are age 45 or older or at increased risk for colorectal cancer, it’s time to get your own date with your doctor to create an individualized screening plan.

Editor’s note: Craig Wilson, J.D., M.P.A., is the director of health policy for the Arkansas Center for Health Improvement, an independent, nonpartisan health policy center in Little Rock. The opinions expressed are those of the author.