More younger people are getting colonoscopies, a new study suggests

After the recommended age for colorectal cancer screening was reduced from 50 to 45, there was a slight rise in screening with individuals of the younger age group as identified by a study in JAMA Network Open. 

The change in the screening age was made early this year by the USPSTF that had previously proposed the starting age of 50. 

The incidence of colon cancer has increased over the past two decades among individuals younger than 50 years. It is not the first group to propose lowering the screening age though – the American College of Obstetricians and Gynecologists said the same in 2004. The American Cancer Society also increased their recommended starting age for screenings in 2018, to 45. 

That recommendation does matter, though, because if the USPSTF Task Force recommends a screening for a certain population, then insurance will pick up the tab. 

A new study revealed that 45-49-year-olds’ colorectal cancer screening rates are still unusually low, but tripled after the guideline update in 2021. 

“The level of adoption to this change has been rather swift that we have witnessed it after the publication of the guidelines especially given that the pandemic has slowed down lower densities screening”.

Siddique and his team used data from Blue Cross Blue Shield insurance of over 10 million patients.Specifically, the researchers found overall screening rates for colorectal cancer among those ages 45 to 49 rising from around 0.5 percent before the 2021 guidelines to 1.5 percent a year and a half after the change. published in the journal JAMA Network Open. 

The lower screening age was put into place in 2021 by the U.S. Preventive Services Task Force, which previously recommended starting screenings at age 50. 

Colorectal cancer cases have been rising in people younger than 50 over the last two decades. The U.S. Preventive Services Task Force isn’t the first group to suggest lowering the screening age. In 2018, the American Cancer Society also recommended to start getting checked at 45. 

The U.S. Preventive Service’s Task Force’s recommendation carries weight, however, because if the group endorses a screening for a particular group, insurance will cover it. 

The new study found that colorectal cancer screening among 45 to 49-year-olds remains low overall, but increased threefold following the 2021 guideline change. 

“It’s interesting to see how rapidly we have seen this uptake take place after the guidelines were released, especially in light of the pandemic creating roadblocks for screening,” said lead study author Sunny Siddique, a cancer researcher at the Yale School of Public Health.

Siddique and his team looked at patient data from more than 10 million people with Blue Cross Blue Shield insurance. On average, the researchers found, colorectal screening rates among people ages 45 to 49  increased from around 0.5% before the 2021 guidelines to 1.5% a year and a half after the change.

“It is true that when you add one percent it does not sound much but in terms of hundreds of thousands of people,” Siddique said. 

As much as participants were insured, the researches observed inequality in screening uptake among the people. They found that persons resident in the richest zones, they enjoyed the highest relative rise in utilization rates.   

“Well, even if you strip insurance from the situation, we are still looking at disparities,” Siddique noted. “In communities with the low socioeconomic status, people are less likely to gain access to these services.”

There is evidence now that a small but significant population of colorectal cancer sufferers are under fifty; approximately 20,000 cases are, in fact, diagnosed in those under fifty years old. 

Colorectal cancer with onset before the age of fifty can be referred to as early-onset CRC and is a serious deal. If a patient is not screened early, the cancers are going to be detected at an advanced stage said Dr. Christopher Lieu of the University of Colorado School of Medicine of gastrointestinal medical oncology.Lieu said he expects that with the results of the study are good because early awareness on the new recommended screening age is slowly making its way around but he argued that screening among people with no insurance who were not in the study is relatively low.creening age was put into place in 2021 by the U.S. Preventive Services Task Force, which previously recommended starting screenings at age 50. 

Colorectal cancer cases have been rising in people younger than 50 over the last two decades. The U.S. Preventive Services Task Force isn’t the first group to suggest lowering the screening age. In 2018, the American Cancer Society also recommended to start getting checked at 45. 

The U.S. Preventive Service’s Task Force’s recommendation carries weight, however, because if the group endorses a screening for a particular group, insurance will cover it. 

The new study found that colorectal cancer screening among 45 to 49-year-olds remains low overall, but increased threefold following the 2021 guideline change. 

“It’s interesting to see how rapidly we have seen this uptake take place after the guidelines were released, especially in light of the pandemic creating roadblocks for screening,” said lead study author Sunny Siddique, a cancer researcher at the Yale School of Public Health.

Siddique and his team looked at patient data from more than 10 million people with Blue Cross Blue Shield insurance. On average, the researchers found, colorectal screening rates among people ages 45 to 49  increased from around 0.5% before the 2021 guidelines to 1.5% a year and a half after the change.

“An increase of 1% seems small, but this is hundreds of thousands of people,” Siddique said. 

Although all of the people in the study were insured, the researchers still saw disparities in screening uptake. People who lived in the richest areas, they found, experienced the greatest increase in screening rates.   

“Even if you take out the factor of insurance, we are still seeing differences,” Siddique said. “If you live in an area that is in the low socioeconomic range, your likelihood of having access to these services is lower.”

About 11% of colorectal cancer cases are diagnosed in people younger than age 50 — about 20,000 people, according to the American Cancer Society. 

“Early-onset colorectal cancer is a big deal. If you’re not screening early, you’re going to find those cancers at a later stage,” said Dr. Christopher Lieu, co-director of gastrointestinal medical oncology at the University of Colorado School of Medicine. 

Lieu said the results of the study are promising, suggesting awareness around the new recommended screening age is increasing, but he noted that screening among those who don’t  have insurance, who weren’t included in the study, is likely lower. 

“Perhaps one of the largest determinations of whether or not you’re receiving the appropriate cancer screening for your age is having insurance,” Lieu said. 

The increase in screening among the insured, Lieu said, could also be attributable to increased use of less invasive colorectal cancer screening tests such as Cologuard, a stool test that is 92% accurate, and a blood test called Shield which detects colorectal cancer in 83% of patients with the disease. If these tests are positive, a doctor will then do a colonoscopy follow up. 

“We’re taught since medical school that the best screening test is the test that gets done,” said Dr. Marwan Fakih, co-director of the gastrointestinal program at City of Hope, a cancer research and treatment organization in Los Angeles.

Colonoscopy is still considered the best method of screening for colorectal cancer because the scope can not only identify cancerous tumours but also precancerous polyps that may be removed before developing into cancer. However, less costly, and invasive approaches including stool and blood test are vital in increasing the number of people who will be screened. However, the tests aren’t for everyone. 

“The folks that have had colon cancer in the past or have strong family history of colon cancer, there is no screening test, other than the colonoscopy,” Fakih said.