Colorectal cancer screenings now recommended beginning at age 45

The U.S. Preventive Services Task Force lowered the age after extensive scientific study.

It’s official: The panel of national experts in prevention and evidence-based medicine known as the U.S. Preventive Services Task Force now recommends colorectal cancer screening for Americans to begin at age 45, rather than at 50, as was previously the standard.

The new recommendations, finalized and published on May 18 in the Journal of the American Medical Association, make an additional 21 million adults eligible for insurance-covered screening. Options include direct visualization tests such as colonoscopy, flexible sigmoidoscopy, or stool-based tests such as the FIT.

But who are the people making these recommendations? And how do they go about it?

The U.S. Preventive Services Task Force (USPSTF), established in 1984, is an all-volunteer panel of 16 primary care physicians and nurses from across the country. They span disciplines — from psychology to family medicine to internal medicine to obstetrics and gynecology — and work together to evaluate scientific research and come up with preventive screening recommendations to improve the health of Americans of all ages.

“We have preventive therapy recommendations that really go from birth to death,” says Carol Mangione, MD, MSPH, chief of general internal medicine at the David Geffen School of Medicine and UCLA Health and vice chair of the USPSTF, of which she has been a member since 2016.

The task force was developed “with the notion that it would be primary care experts making recommendations that providers in primary care delivery could then follow,” she says. The group’s recommendations are based on the best evidence in scientific literature and aim to protect and improve the health of asymptomatic individuals.

"We are a panel of volunteers and we are independent of the U.S. government,” Dr. Mangione says.

The USPSTF is also independent of any insurance company, though the passage of The Patient Protection and Affordable Care Act in 2010 requires the USPSTF’s screening recommendations to be covered benefits without out of pocket costs for patients by public and private health insurance.

“We actually do not consider insurance coverage or cost when we make our recommendations,” Dr. Mangione says. “Our recommendations are really grounded in trying to improve the health of all Americans by balancing the benefits versus the harms of any screening test, preventive medication, or behavioral treatment that we might be recommending.”

Prospective members of the task force are extensively vetted before being invited to join the group, she adds, to ensure they haven’t received large amounts of financial support from pharmaceutical or diagnostics companies for their past research or have other potential financial or intellectual conflicts of interest.

Members of the USPSTF are all experienced researchers as well as primary care providers who use their expertise to evaluate scientific studies and develop timely health recommendations. They typically reassess these recommendations every five years or so.

That interval can be shortened when new compelling scientific evidence arises. In the case of colorectal cancer screenings, “there were some important scientific papers that showed that there was a trend toward people getting colon cancer at younger ages, and there was also some evidence showing that Black persons are more likely to get colon cancer and are more likely to die from it,” Dr. Mangione says. “So with that new evidence, we started revising this topic a little bit sooner.”

The group last issued recommendations on colorectal cancer screening in 2016. It released its new draft guidelines in November, 2020, which were finalized in May, 2021.

Once the task force examines all relevant research, it publishes a draft of recommendations which are open to public commentary. Every public comment is reviewed and considered prior to drafting the final recommendation, Dr. Mangione says.

The group’s entire process is transparent, she says, adding, “I think the public providers really trust what the task force does.”

Dr. Mangione says helping to guide primary care providers and serve as a voice for preventive public health through the USPSTF is a great honor.

“For somebody like me, who’s had a long career doing research, the U.S. Preventive Services Task Force recommendations are really right at that interface of clinical research, evidence and policy that affect care delivery to the public,” she says. “It's an incredible privilege to be working at that interface and to be using my experience to help contribute to a process that really tries to make very strong, well-grounded, evidence-based recommendations for our primary care providers and patients to follow.”

To learn more, visit our colorectal cancer screening page.