Lowering Age for CRC Screening Boosts Uptake

Liam Davenport

December 19, 2019

Uptake of colorectal cancer (CRC) screening among people in their mid to late 40s in the United States increased significantly in the year following the American Cancer Society's (ACS's) lowering of the recommended age for screening, a new study has found.

In 2018, the ACS lowered the recommended starting age for CRC screening from 50 to 45 years.

In the year that followed, CRC screening rates increased significantly among adults aged 45–49 years, but remained stable for those in their 50s.

The finding was published online December 18 in Cancer.

The authors, led by Stacey Fedewa, PhD, an epidemiologist at the ACS, comment that the new guidelines and the "accompanying scientific and lay media attention may have raised provider and patient awareness of asymptomatic and symptomatic testing for CRC."

They point out that "similar abrupt changes in screening following release of updated guidelines have been reported for prostate and breast cancer, as have short-term gains in CRC screening following media campaigns."

However, Fedewa noted that "it is unknown whether the recent accelerating CRC screening rates among people 45–49 years will be sustained.

"Commercial health insurers are only required to cover average-risk screening beginning at age 50, following recommendations from the US Preventive Services Task Force. Also, it's possible those who quickly adopted updated guidelines may have been those at increased risk," she said in a statement.

Increase in Incidence in Younger Adults

Fedewa and colleagues explain that the ACS lowered the age for average-risk CRC screening from 50 to 45 years after reports of a dramatic rise in the incidence of CRC in younger adults.

To determine whether it had an impact on screening among people in the targeted age group, they examined data on persons aged 45–59 years who responded to the 2018 National Health Interview Survey.

They included 5800 individuals; 1796 persons were aged 45–49 years, 1877 were aged 50–54 years, and 2127 were aged 55–59 years.

Just over half of the respondents were women, approximately two thirds were non-Hispanic whites, and around three quarters were privately insured.

During 2018, the rate of CRC screening rose among people aged 45–49 years from 4.8% in the first quarter (Q1) to 6.6% in Q2, 8.8% in Q3, and 11.7% in Q4.

The team calculates that screening rates in Q3 were 4.1% higher than in Q1, and rates in Q4 were 7.0% higher. This equates to 226,656 people being screened in Q1 vs 592,531 in Q4.

In contrast, there was no increase in CRC screening among people in their 50s. As a consequence, increases in screening rates were significantly higher among people aged 40–49 years than among those aged 50–54 and 55–59 years.

For comparison, the team points out that physician visit and breast cancer screening rates among people aged 45–49 years did not vary by quarter in 2018.

Impact of Insurance

In another study, US researchers assessed the impact of insurance for the treatment of CRC in young adults (up to age 26 years).

Specifically, the authors evaluated the impact of the 2010 Dependent Coverage Expansion (DCE) of the Affordable Care Act (ACA), which allows adults up to age 26 years to be covered by their parents' private health insurance.

They found that not only were eligible patients more likely to be diagnosed at an earlier stage following the introduction of DCE, they were also more likely to receive chemotherapy after surgery and that it was given in a more timely manner.

This study, which was led by Leticia Nogueira, PhD, from Surveillance and Health Service Research at the American Cancer Society, was published online December 19 in the Journal of the National Cancer Institute.

The authors say: "Our results have important implications for young adults diagnosed with colorectal cancer who may experience interruptions in their insurance coverage due to loss of dependent coverage or other life transitions.

"Our findings highlight the role of the ACA in improving access to potentially life-saving cancer care, including a shift to early-stage diagnosis and more timely receipt of adjuvant chemotherapy," they add.

The ACS funded the analysis, interpretation, and presentation of the manuscript by Fedewa and colleagues. All authors are employed by the ACS, which receives grants from private and corporate foundations, including foundations associated with companies in the health sector for research outside of the submitted work. The authors are not funded by nor are key personnel for any of these grants, and their salary is funded solely through ACS funds. The study by Noqueira and colleagues was funded by the Intramural Research Department at the ACS. The authors have disclosed no relevant financial relationships.

Cancer. Published online December 19, 2019. Abstract

J Natl Cancer Inst. Published online December 19, 2019. Abstract

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