What Happens When Colorectal Cancer Screening Guidelines Expand?

By Thomas Crocker
Friday, September 10, 2021

New guidelines have lowered the recommended starting age for colorectal cancer screening. One expert says clinicians need to do more to increase screening access and compliance while ensuring no patient population is left behind.

In May 2021, the U.S. Preventive Services Task Force revised its colorectal cancer screening recommendation to call for screening of average-risk patients to begin at age 45 instead of 50. The new recommendation came as welcome news to clinicians, given that the colorectal cancer rate among individuals younger than 50 has more than doubled since the 1990s, according to the National Cancer Institute. To reap the most benefit from earlier screening initiation, however, clinicians and health systems may need to think big.

“I think that as these new guidelines come into play, we need to be even more vigilant about using a population health approach to colorectal cancer screening,” says Shivan Mehta, MD, MBA, MSHP, Associate Chief Innovation Officer at Penn Medicine and Assistant Professor of Medicine and Health Policy at the University of Pennsylvania. “We can’t just rely on patients coming into our offices and waiting for us to tell them to get screened. We have to have systems-based approaches with outreach engaging our patients outside of traditional clinical venues to increase screening rates.”

That approach, Dr. Mehta says, must include commitment to demographic and racial equity to ensure individuals undergo screening at a reasonable rate and receive appropriate follow-up care.

All Hands (and Screening Options) on Deck

To increase access to colorectal cancer screening, Dr. Mehta calls for two significant actions:

  • Providers should offer more widespread use of stool testing as an adjunct to colonoscopy. Stool testing is more appealing to certain patients and may increase screening rates in areas where colonoscopy is absent or scarce.
  • Primary care practices and health systems should devote more resources to counseling, education and navigation around colorectal cancer screening. Dr. Mehta characterizes this approach as “leveraging the entire practice.” By that he means the entire team, including nurses and medical assistants, follow up with patients who are not up to date with or did not follow through on screening.

Making it easier to be screened is effective as part of a broader strategy, Dr. Mehta explains: “if you can make it easier to schedule, get the prep and follow through, those are other things clinicians can do [to increase screening rates and compliance, along with] counseling about the procedure and education. We know from behavioral science that making the right and easy choice, and framing screening as the default option, explaining why this is important and everyone else is doing it, could increase screening rates.”