Lowering the bowel cancer screening age to 45 shows benefits in the US

After a stable 15-year trend, local-stage colorectal cancer (CRC) incidence increased steeply in adults aged 45 to 49 from 2019–2022, including a 50% relative increase between 2021 and 2022. This trend contrasts with consistent increases of distant-stage diagnoses in this age group and likely reflects the diagnosis of prevalent asymptomatic cancer through first-time screening due to recommendations for adults to begin screening at age 45 instead of age 50.

From 2019 to 2023, CRC screening increased among U.S. adults aged 45 to 49, consistent with a previous report among certain commercially insured adults aged 45 to 49 in late 2021–2022. This trend is encouraging because screening reduces CRC mortality, mostly through the detection and removal of potentially precancerous lesions.

In a randomized clinical trial to determine the most effective population health outreach strategy to promote colorectal cancer screening in adults aged 45 to 49, the three strategies requiring active choice through the electronic patient portal were significantly less effective than default unsolicited mailed fecal immunochemical test (FIT) outreach. Overall screening rates were low, underscoring the need for more effective strategies to engage this age group.

The research is published in four studies in the journal JAMA.