Doctors discuss CRC guidelines, available screening options for young patients

In the new Annals of Internal Medicine Beyond the Recommendations Feature: A primary care physician and a gastroenterologist discuss the recommendation to start rectal cancer (CRC) screening at age 45, review the options for rectal cancer screening, and discuss how to choose between the available options. All Beyond the Guidelines features are based at the Department of Grand Rounds Medicine at Beth Israel Deaconess Medical Center (BIDMC) in Boston and include printed materials, videos and educational components published in Annals of Internal Medicine.

CRC is the third leading cause of cancer death among men and women in the United States. It is most often diagnosed in people aged 65 to 74 years. However, among people younger than 50, the incidence rate has been increasing since the mid-1990s. In 2021, partly because of the rising incidence, the US Preventive Services Task Force (USPSTF) recommended CRC screening for adults aged 45 to 49 years. The USPSTF does not recommend a specific screening test, but both stool-based and direct imaging tests are available and cost-effective.

BIDMC Grand Rounders Carol M. Mangione, MD, MSPH, Chair of the US Preventive Services Task Force and Chief of General Internal Medicine and Health Services Research and Professor of Medicine at the David Geffen School of Medicine, and David S. Weinberg, MD M.D., M.D., chairman of the department of medicine at Fox Chase Cancer Center and professor of medicine at Temple University School of Medicine, recently discussed the case of Ms. N., a 44-year-old woman who decided to undergo screening for CRC variants after receiving a recommendation from her physician.

In their assessments, doctors. Mangione and Weinberg agree that Ms. N. should undergo a screening test, which she is likely to agree to. This consensus is consistent with current USPSTF guidelines, but Dr. Weinberg notes that there are no age-specific empirical data on screening effectiveness and that in younger populations, the false-positive rate, especially for stool testing, is likely higher and the cost-effectiveness relatively lower. Dr. Mangione agrees with the USPSTF recommendation that Ms. N should be screened at age 45 rather than at age 50 because the task force determined that screening adults between the ages of 45 and 49 has a modest benefit in reducing mortality from CRC and increasing the number of years of life.

However, Dr. Weinberg is concerned that there is no direct evidence that people between the ages of 45 and 49 will benefit as much from CRC screening. Panelists also agree that reaching the 80% screening target for people aged 50 to 74 is important as clinicians begin to think about screening people aged 45 to 49, who we both identify and eliminate bar’ eri screening the wider population.

A full list of topics outside the guidelines is available at www.annals.org/grandrounds.