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Jama: USPSTF colorectal cancer screening final suggestion: starting age updated from 50 to 45 years old

The final suggestion of the US Prevention Medical Working Group (USPSTF) pointed out that colorectal cancer screening should now start at the age of 45 instead of the age of 50. The proposal was finalized to the draft guide released in October 2020, and stipulated the insurance scope to ensure that the patient’s insurance condition can be obtained equally.



The final suggestion of USPSTF is also consistent with the suggestions of the American Cancer Association. In 2018, the association reduced the beginning of CRC screening to 45 years.

The main author of the new guide Jama, Kimmie NG, director of the young colorectal cancer center of Boston, Boston, Massachusetts, commented: “New statistical data prediction, by 2040, the incidence of young colorectal cancer will be It will rise amazingly, and it is expected to be the main cause of cancer death in patients aged 20 to 49. “

She emphasized: “We must take bold steps to reduce the incidence and mortality of the starting age of the screening of the screening.”

On May 18, the US Prevention Medical Working Group (USPSTF) proposal and a large amount of evidence were published online.

As the author of USPSTF pointed out, age is one of the most important risk factors of CRC, and nearly 94%of CRC new cases occur in adults who are 45 and over. CRC screening The beginning of age is based on the simulation model, indicating that the start of screening at the age of 45 is expected to be related to the increase of the 22 to 27 life year.

USPSTF continues to recommend CRC screening for all adults 50 to 75 years old, reducing the screening age to 45 years old: In 2020, 11%of colon cancer and 15%rectal cancer occur at the age of 50 under 50 years of age. Among the patients.

Clinician colorectal cancer screening summary

USPSTF also concluded that among adults 76 to 85, which have been screened before, there are “low net benefits” for CRC screening.

However, the decision to screen for patients in this age group should be based on the individual risk factors of CRC, the overall health status and personal preference of the patient. Perhaps it is self -evident that adults who have never received CRC screening at this age group have been more likely to benefit from CRC screening than adults who have received CRC screening before.

Similar to the previous guidelines released in 2016, the updated USPSTF recommends continuing to provide screening strategy menu, although the screening frequency of each screening strategy is different. The recommended screening strategy includes:

· The higher the high sensitivity, the more the wooden stool is detected or the stool immunochemical test (FIT) once a year

· Diren DNA-FIT detection every 1 to 3 years

· CT colon imaging examination every 5 years

· Soft sigmoid colonoscopy examination every 5 years

· Soft sigmoid colonoscopy is added to FIT once a year every 10 years

· Colonoscopy screening every 10 years

USPStf member Martha Kubik said in a statement: “According to evidence, there are many examinations that can effectively screen colorectal cancer. The correct examination is to complete the examination.”

Eligible patients

NG pointed out in the editorial that at present, less than 70%of patients in the United States have received CRC screening. In addition, CRC’s impact on African -American patients is not proportional. Compared with other patients, African -American is 20%higher than CRC, and the possibility of death to CRC is 40%higher. Studies published with USPSTF’s recommendations show that regardless of race and gender, screening has the same benefits, which emphasizes the importance of screening compliance, especially among patients who are influenced by CRC.

Colorectal cancer is the third cause of death of male and female cancer. It is expected that 52,980 people in the United States died in colorectal cancer in 2021. Colorectal cancer is the most common among people aged 65 to 74. It is estimated that 10.5%of the cases of newly developed colorectal cancer occur in people under 50. From 2000-2002 to 2014-2016, the incidence of colorectal cancer (especially adenocarcinoma) of adults aged 40 to 49 increased by nearly 15%. In 2016, 26%of eligible adults in the United States have never received colorectal cancer screening. In 2018, 31%of adults have not been screened so far.

Primitive source:

US Preventive Services Task Force; Karina W Davidson, Michael J Barry et al. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021 May 18;325(19):1965-1977.  doi: 10.1001/jama. 2021.6238.

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