Younger Recommended Screening Age Can Lessen Colorectal Cancer Burden
Researchers investigated the health benefits, utilization, harms, and costs associated with the use of alternative methods for colorectal cancer screening in Australia.
Decreasing the recommended starting age to screen for colorectal cancer (CRC) has the potential to significantly reduce global CRC burden, according to authors of a study published in ESMO Gastrointestinal Oncology.1With the help of free immunochemical fecal occult blood tests (iFOBTs) given to Australians twice a year, lowering the screening start age to 45 was considered the most favorable recommendation.
“CRC is the second most common cause of cancer death in Australia,” wrote authors of the study. “The overall incidence and mortality rates are decreasing, but incidence rates of early-onset CRC in people under 50 have been increasing, rising from 6.1 per 100,000 in 1990 to 10.1 per 100,000 in 2020. This increase is reflected in trends observed internationally.”
In a review of early-onset CRC incidence published in Cancers, researchers found that it is projected to more than double in the US by the year 2030. They also found that the rise in early-onset CRC was significantly more prominent when compared with late-onset CRC, leading researchers to suggest an earlier screening start age.2
With recent recommendation shifts and differences in guidelines amongst various countries, further evidence was needed regarding CRC screening age. | image credit: H_Ko / stock.adobe.com
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Prior to conducting their research, authors of the current study noted the most recently available guidelines for recommended CRC screening, which were known as the 2017 Clinical practice guidelines for the prevention, early detection, and management of CRC. These guidelines confirmed a model that provides 2 annual screenings a year for patients 50 to 74 with an optimal screening balance for the Australian population.1
While the current literature explores the change in screening start age from 50 to 45, US recommendations have already begun decreasing. In 2021, the US Preventative Services Task Force (USPSTF) recommended that all adults 50 to 75 years old regularly screen for CRC, while screening start age should begin from 45 to 49 rather than 50 years old.3
With recent recommendation shifts and differences in guidelines amongst various countries, more research was needed regarding overall benefits of lowering the CRC screening start age.
“This study aimed to assess the health benefits, resource utilization, potential harms, and costs associated with alternative approaches to population-level CRC screening of asymptomatic individuals in Australia. To generate timely evidence on the implications of differing screening recommendations, a predictive modeling approach was used,” continued the authors.1 “This study was conducted to provide evidence for the 2023 updated population screening chapter of the clinical practice guidelines for the prevention, early detection, and management of CRC, which were approved by the Australian Government National Health and Medical Research Council (NHMRC).”
Using the Policy1-Bowel predictive model for CRC incidence and screening, researchers conducted a microsimulation to determine the observed and projected age-, year-, and sex-specific CRC incidence rates in Australia from 1982 through 2040. To further stratify their results and determine a standard screening alternative, they also explored 4 separate screening strategies.
The alternative screening strategies included: 2 yearly screenings with iFOBT for patients 50 to 74; 2 yearly screenings for various age ranges including 50 to 79, 50 to 84, 45 to 74, 45 to 79, 45 to 84, 40 to 74, 40 to 79, or 40 to 84; one iFOBT a year for patients 50 to 74; and finally, 5-year stool biomarker screening.1
“This study found that lowering the start age for 2 yearly iFOBT screening to 45 or 40 could reduce CRC incidence and mortality versus screening from 50 to 74, while being cost-effective and a relatively efficient use of colonoscopy services,” they wrote. “Compared with starting at age 45, starting screening from age 40 was found to incrementally increase effectiveness while also increase harms and costs.”
With benefits identified when lowering the screening start age, they also discovered significant harms when increasing the recommended screening ages. Increases in screening age resulted in much less reductions in CRC incidence and mortality when compared with groups that decreased their screening age. They also discovered that increasing screening age led to a rise in cost and colonoscopy-related adverse events.
“Offering 2 yearly iFOBT screening to people from 40 or 45 could provide an efficient balance of health benefits, potential harms, and costs in the face of increasing incidence of early-onset CRC. These findings supported the recent extension of the [National Bowel Cancer Screening Program] to people aged 45-49 on an opt-in basis,” concluded authors of the study.1
READ MORE: Education Is Crucial to Close Gaps in Colorectal Cancer Risk Awareness
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