Key result
Lowering CRC screening age to 45 linked to ~23% annual growth in locoregional CRC incidence.
Why the study?
Major guidelines lowered the colorectal cancer screening age from 50 to 45, but the impact on locoregional colorectal cancer incidence overall and by socioeconomic factors was unclear.
Does lowering the CRC screening age to 45 increase the incidence of locoregional CRC diagnoses among adults aged 45-49?
Observational (n=14,123)
Yes
Does lowering the CRC screening age to 45 increase the incidence of locoregional CRC diagnoses among adults aged 45-49?
The lowering of the recommended CRC screening age to 45 was associated with a sharp increase in locoregional CRC incidence among 45-49 year olds, with greater increases seen in higher socioeconomic areas.
Answers are grounded in this paper and cite their sources.
May reflect higher screening uptake in adults aged 45-49; leaves open effects on mortality and disparities.
e15686 Background: Colorectal cancer (CRC) screening guidelines from the American Cancer Society recommended lowering the starting age from 50 to 45 in 2018, and the US Preventive Services Task Force followed suit in 2021. We examined the impact of these guideline changes on locoregional CRC incidence overall and by county-level socioeconomic factors. Methods: We used the SEER Research Plus database to identify locoregional CRC cases diagnosed in 2013-2022 in adults aged 45-49. We calculated age-adjusted annual incidence rates (IRs) per 100,000 persons by county-level median household income, educational attainment, and urbanicity. We measured IRs for 2013-2022 and used NCI’s Joinpoint Regression Program v5.4.0 to estimate annual percent change (APC) trends. Results: We identified 14,123 locoregional CRC cases during the study period. Joinpoint regression detected an APC trend change in 2020. For overall incidence, the APC was 1.41% (95% CI -3.08-3.29) from 2013-2020 and increased to 23.07% (95% CI 10.47-30.25) from 2020-2022. The sharp rise in APC was observed across all income categories, but the magnitude of increase was larger with higher income, higher educational attainment ( < 20% adults with less than a high school education), and urban residence (Table 1). Conclusions: Following CRC screening guidelines updates, locoregional CRC incidence among adults aged 45–49 years rose across all groups, though the relative magnitude of increase differed by socioeconomic status. Counties with higher income, higher educational attainment, and located in urban areas saw greater relative increases in locoregional CRC, which have a more favorable prognosis. This may indicate higher screening uptake in areas with higher socioeconomic status. These findings underscore the need to improve access and address disparities in early CRC screening. Trends in locoregional CRC incidence by county-level socioeconomic factors. Socioeconomic Factor 2013-2020 APC (95% CI) 2020-2022 APC (95% CI) APC change (2020-2022) vs (2013-2020) Lowest income quintile 0.08 (-4.53-1.90) 17.87 (6.20-25.54) 17.79 Highest income quintile 2.19 (-4.25-4.69) 24.94 (9.93-35.26) 22.75 Low education -2.81 (-15.20-12.94) 13.61 (-5.19-29.61) 16.42 High education 1.77 (-1.88-3.49) 23.42 (11.52-30.16) 21.65 Rural -0.94 (-6.00-0.98) 16.82 (3.98-25.46) 17.76 Urban 1.83 (-1.83-3.54) 23.70 (11.83-30.60) 21.87
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Kong et al. (2026) conducted an observational in Locoregional colorectal cancer (n=14,123). Updated CRC screening guidelines (lowering starting age to 45) vs. Pre-guideline update period (2013-2020) was evaluated on Annual percent change (APC) in overall locoregional CRC incidence (95% CI 10.47-30.25). Updated CRC screening guidelines lowering the starting age to 45 were associated with an increase in the annual percent change of locoregional CRC incidence from 1.41% to 23.07% (95% CI 10.47-30.25).
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