Colorectal cancer screenings should start at 45, new guidelines say

The updated recommendations come a few months after ‘Black Panther’ star Chadwick Boseman died at 43, having been diagnosed with colon cancer in 2016.

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Chadwick Boseman, star of the “Black Panther,” arrives at the premiere of the film in Los Angeles in 2018.

Chadwick Boseman’s death from colon cancer at s43 earlier this year has sparked heightened awareness of the disease.


Doctors should begin screeing people for colorectal cancer at 45 rather than 50, under a new recommendation from the U.S. Preventive Services Task Force, a volunteer panel of national experts in prevention medicine.

“We hope that this recommendation to screen people ages 45 to 74 for colorectal cancer will encourage more screening and reduce people’s risk of dying from the disease,” said task force chair Dr. Alex Krist, a professor of family medicine and population health at Virginia Commonwealth University. 

The task force recommends two types of tests to screen for colorectal cancer: direct visualization tests and stool-based tests. Symptoms of colorectal cancer include a change in bowel movements, rectal bleeding, blood in the stool and abdominal pain.

The American Cancer Society recommended earlier screening about two years ago based on computer simulations. But experts say input from the task force carries a lot of weight.

Dr. John Kisiel, a gastroenterologist and associate professor of medicine at the Mayo Clinic, said most employer-based health insurers and Medicare and Medicaidbase their coverage on these recommendations. These insurers don’t cover screenings before 50 for people with no symptoms or family history, but Kisiel expects that to change soon. 

Deaths from colon and rectal cancers have been declining for several decades due to improved screening and treatment measures. Yet deaths among young people have been increasing slightly in recent years, according to researchers.

Colorectal cancer — which includes colon and rectal cancer — is expected to cause more than 50,000 deaths in 2020, including 3,640 deaths in people under 50, according to the American Cancer Society.

About 30% of colorectal cancer diagnosed today is in people under 55, said Dr. Nilofer Azad, an associate professor of oncology at Johns Hopkins Medicine.

“We are seeing more people in their 30s and 40s who are developing colorectal cancers, often because they’re having symptoms that aren’t thought to be cancers,” she said.

The updated recommendations come a few months after “Black Panther” star Chadwick Boseman died in August at 43, having been diagnosed with colon cancer in 2016.

“New science about colorectal cancer in younger people has enabled us to expand our recommendation to screen all adults starting at age 45, especially Black adults, who are more likely to die from this disease,” said Dr. Michael Barry, a member of the task force who is a Harvard Medical School professor and clinician at Massachusetts General Hospital.

Some critics might say screening at an earlier age won’t prevent many cases of cancer, Kisiel said, that should be focused on older populations, in which more cancer can be found and screening compliance continues to be suboptimal.

But he said it’s possible to start screening at an earlier age and focus on older patients at the same time.


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