Why lowering the colorectal cancer screening age to 45 is saving lives—but not reaching everyone at risk

Why lowering the colorectal cancer screening age to 45 is saving lives

Colorectal cancer screening rates among people aged 45 to 49 have jumped in recent years, thanks to updated guidelines that lowered the recommended screening age from 50 to 45. New data from the American Cancer Society show a 62% increase in screening between 2019 and 2023. That change has triggered a surge in early-stage diagnoses, improving the outlook for many patients who previously would have been diagnosed too late, the Wall Street Journal reported.

Earlier detection improves survival chances

The shift in timing means cancers are being caught when they are more treatable, requiring less intensive therapy and offering better outcomes. Rebecca Siegel, an ACS epidemiologist, called the trend "thrilling," noting it will likely reduce deaths and enhance quality of life for many. Between 2021 and 2022 alone, early-stage diagnoses rose by 50% among people in their late 40s, marking a clear impact from screening expansion.

Simple outreach methods could boost uptake

Despite the gains, screening rates still lag among some groups. A recent trial of 20,000 people showed that automatically mailing stool tests significantly increased participation compared to waiting for patients to opt in. Dr. Folasade May, who led the study, suggested bypassing the ask: "We probably shouldn’t be wasting time asking patients first; we should send them what they need."

Concerns persist for those under 45

People under 45 are not covered by current routine screening guidelines, even as colorectal cancer becomes the leading cause of cancer death among men in that age group. Some of the sharpest rises in cancer incidence are among those in their 20s and 30s. Doctors like Dr. Michael Cecchini at Yale Cancer Center warn that young patients showing symptoms often get overlooked: "We need to be thinking about it on our list of possible diagnoses."

Access and education gaps limit progress

While screening rates among the newly eligible 45-to-49 group are rising, disparities remain. Rates are lower among people without insurance or with less than a high school education. Even within this group, only 28% received a colonoscopy by 2023, up from 20% in 2019. Alternative tests like stool DNA kits rose modestly to 7.1%. These figures remain well below ideal targets for cancer prevention.

The long view on reducing mortality

Researchers caution that while earlier diagnosis is promising, it will take years to see a measurable drop in deaths. Caitlin Murphy, a cancer epidemiologist at the University of Chicago, noted, “Ultimately, the goal of screening is to reduce mortality, and we haven’t seen that quite yet, simply because not enough time has gone by.” Still, the trends mirror past successes in older age groups and suggest more lives can be saved with continued outreach and access.