Timothy Wilt, MD, MPH: What Age Should Patients Get Screened for Colorectal Cancer?

In 2021, the US Preventive Services Task Force updated its colorectal cancer screening recommendation to lower the screening age from 50 to 45. However, the American College of Physicians (ACP) still suggests starting screening at age 50, citing uncertainty around the benefits and harms of screening in asymptomatic average-risk adults between the ages of 45 - 49.^1,2

In an interview with HCPLive at the 2024 American College of Physicians (ACP) Internal Medicine Meeting in Boston, Timothy Wilt, MD, MPH, professor of medicine and public health in the division of general internal medicine at the Minneapolis VA Health Care System, explained “ACP looks at the evidence and says that the best balance of benefits and harms is beginning screening at age 50 and that clinicians should consider recommending against not screening at age 45 because it would be a better benefit by allocating resources and screening decisions to those at greatest risk and with greatest certainty.”

Wilt pointed out colorectal cancer is “extremely rare” in individuals younger than 50 years of age, citing a 6 per 100,000 increase in incidence over the past 10 years and mentioning screening at age 45 versus age 50 is likely to add only 5 additional days of life gain to one’s entire lifetime.

“ACP believes we could do better to reduce disparities, improve equity, and reduce colon cancer incidence and death by focusing those resources on individuals where there's greater certainty of benefit, and those who need it who have not been getting screened, those between the ages of 50 and 75,” Wilt said.

Looking beyond optimal timing to begin screening, Wilt also discussed when it may be appropriate for patients to “focus on some other things” as they get older, highlighting a decreasing risk of developing cancer and reduced benefit of screening with age. Although he mentioned some patients are hesitant due to their perception of cancer and the emotional toll tied to a cancer diagnosis, Wilt noted it “is not too dissimilar” to other health conditions like heart disease or lung disease.

Wilt has no relevant disclosures.

References:

1. ^{US Preventive Services Task Force. Colorectal Cancer: Screening. May 18, 2021. Accessed April 19, 2021. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening}
2. ^{American College of Physicians. ACP issues updated guidance for colorectal cancer screening of asymptomatic adults. August 1, 2023. Accessed April 19, 2024. https://www.acponline.org/acp-newsroom/acp-issues-updated-guidance-for-colorectal-cancer-screening-of-asymptomatic-adults}