The US Preventive Services Task Force (USPSTF) has just released new colorectal cancer screening recommendations that lower the screening age for average-risk adults. This change will increase the number of people covered by private insurance coverage for colorectal cancer screening.
Screening for colorectal cancer is a life-saving practice. Several tests are available that can be used to screen for colon cancer, including stool-based tests that detect chemicals called biomarkers that indicate an increased risk of colon cancer. In addition, there are a number of bowel examinations that can be performed, including colonoscopy, which involves inserting a thin tube into the colon and taking pictures to look for abnormalities.
Currently, the USPSTF recommends screening all adults aged 50 to 75 years with fecal-occult blood testing (FOBT) or sigmoidoscopy for colorectal cancer. It also recommends selective screening for asymptomatic adults aged 76 to 85 years, based on their overall health, prior screening history and preferences.
A high-risk population includes those with a family history of colorectal cancer or who have a personal or family history of genetic disorders that put them at higher risk for developing the disease. These patients should receive early screening with a colonoscopy, and genetic counseling or testing may be recommended.
In its final recommendation published in the journal JAMA, the USPSTF assigned a B grade to the new screening recommendation for adults at average risk, stating that “there is high certainty that the net benefit of screening is moderate or there is moderate certainty that the net benefit is moderate to substantial.” The recommendation is now effective and will be covered by many private insurance plans with no copays.
The B grade is a reminder that while the evidence for screening is strong, it is not conclusive and should be considered in individual patient contexts. Clinicians should educate their patients about the various screening options, discuss the benefits and harms of each option, and consider the patient’s overall health and preferences before making a screening decision.
As a result of the new recommendation, millions more Americans will be covered by private insurance for this important screening service. This will save more lives.
However, some individuals may not be eligible for the new USPSTF recommendation due to medical or other reasons. If this is the case, the clinician should still screen them for colorectal cancer and follow up with a colonoscopy if necessary.
Increasing the percentage of women who meet the USPSTF guidelines is an important part of achieving the Healthy People 2030 goals for cancer screening uptake. In particular, the AAFP believes that continued efforts are needed to focus on increasing the proportion of women who face economic barriers and therefore are less likely to meet guidelines.
The USPSTF cites a variety of factors that affect the rate at which women meet the USPSTF recommendations, such as income, education and employment. In addition, the AAFP encourages providers to include women in discussions about screening and help them understand the benefits and risks of screening. Finally, it is crucial to address issues with cost and insurance coverage.
