The Time to Act Is Now: The Rationale to Start Colorectal Cancer Screening at Age 45

Abstract

Colorectal cancer (CRC) in adults <50 years is referred to as early onset colorectal cancer (EOCRC). Despite a significant reduction in CRC incidence among older adults, the incidence of CRC in adults aged 20–49 years old has increased by almost 50%. Currently, nearly half of EOCRCs occur between the ages of 45 and 49 years. Recent data show that the prevalence of advanced colorectal neoplasia in patient’s aged 45–49 is equivalent to that of patient’s aged 50–54. EOCRC tumors are more often late stage, compared to CRCs in older adults. Models estimating the benefits versus risks of screening support average-risk CRC screening at 45 years. Screening at this age can be cost effective, safe, and there is a capacity within the US health system. There is an opportunity to curtail the alarming rise in EOCRC and associated burden by implementing CRC screening beginning at age 45 years.