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Lowering the Starting Age for Colorectal Cancer Screening to 45 Years: Who Will Come…and Should They?

Published:August 13, 2018DOI:https://doi.org/10.1016/j.cgh.2018.08.023
      Until recently, most major professional organizations recommended starting average-risk colorectal cancer (CRC) screening at age 50. Some organizations, specifically, the American College of Gastroenterology in 2009
      • Rex D.K.
      • Johnson D.A.
      • Anderson J.C.
      • et al.
      American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected].
      and the American College of Physicians in 2012,
      • Qaseem A.
      • Denberg T.D.
      • Hopkins Jr., R.H.
      • et al.
      Screening for colorectal cancer: a guidance statement from the American College of Physicians.
      recommended screening African Americans beginning at ages 45 and 40 years, respectively. In 2017, the US Multi-Society Task Force endorsed screening African Americans at age 45.
      • Rex D.K.
      • Boland C.R.
      • Dominitz J.A.
      • et al.
      Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer.
      For the US population as a whole, however, the basis for starting at age 50 is population-based data showing increasing CRC incidence beginning around age 50, along with studies reporting the effect of screening on CRC incidence and mortality
      • Atkin W.S.
      • Edwards R.
      • Kralj-Hans I.
      • et al.
      Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial.
      • Holme O.
      • Bretthauer M.
      • Eide T.J.
      • et al.
      Long-term risk of colorectal cancer in individuals with serrated polyps.
      • Schoen R.E.
      • Pinsky P.F.
      • Weissfeld J.L.
      • et al.
      Colorectal-cancer incidence and mortality with screening flexible sigmoidoscopy.
      • Shaukat A.
      • Mongin S.J.
      • Geisser M.S.
      • et al.
      Long-term mortality after screening for colorectal cancer.
      • Baxter N.N.
      • Warren J.L.
      • Barrett M.J.
      • et al.
      Association between colonoscopy and colorectal cancer mortality in a US cohort according to site of cancer and colonoscopist specialty.
      • Brenner H.
      • Chang-Claude J.
      • Seiler C.M.
      • et al.
      Protection from colorectal cancer after colonoscopy: a population-based, case-control study.
      • Kahi C.J.
      • Pohl H.
      • Myers L.J.
      • et al.
      Colonoscopy and colorectal cancer mortality in the Veterans Affairs Health Care System: a case-control study.
      • Kahi C.J.
      • Imperiale T.F.
      • Juliar B.E.
      • et al.
      Effect of screening colonoscopy on colorectal cancer incidence and mortality.
      and simulation models showing a good-to-optimal balance of benefits and risks.
      • Zauber A.
      • Knudsen A.
      • Rutter C.M.
      • et al.
      Evaluating the benefits, burden, and harms of colorectal cancer screening strategies: a collaborative modeling approach. AHRQ publication no. 14-05203-EF-02.
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