Changing colon cancer screening guidelines to age 45: Has it made a difference?

Area of Science:

• Oncology
• Public Health
• Epidemiology

Background:

• Early-onset colorectal cancer (CRC) rates have increased, prompting guideline changes.
• The American Cancer Society (ACS) recommended lowering the CRC screening age from 50 to 45 in 2018.
• The national impact of this guideline change on CRC detection remains unclear.

Purpose of the Study:

• To evaluate the effect of the 2018 ACS guideline change on the stage of colon cancer at diagnosis.
• To assess if lowering the screening age to 45 led to earlier detection of colon cancer.

Main Methods:

• Utilized the National Cancer Database to identify patients aged 45-49 diagnosed with colon cancer.
• Compared patients diagnosed in 2017 (early cohort) to those diagnosed in 2019 (late cohort).
• Analyzed the relationship between the time period and disease stage at presentation using univariate and multivariable logistic regression.

Main Results:

• 5,479 patients met inclusion criteria; median age at diagnosis was 47 for both cohorts.
• No significant difference in the odds of stage III-IV disease between the late and early cohorts (OR, 1.05).
• A slight increase in the odds of higher T-stage (pT3 or pT4) disease was observed in the late cohort (OR, 1.20).

Conclusions:

• The 2018 guideline recommending earlier colorectal cancer screening did not result in a clinically meaningful earlier shift in colon cancer stage.
• Further research is needed to understand screening uptake and identify areas for improvement.
• Provider and patient adherence to new screening guidelines requires further investigation.