Implications of the United States recommendations for early-age-at-onset colorectal cancer screening in Canada

Abstract

The United States Preventive Services Task Force (USPSTF) recently issued an updated recommendation for population-based colorectal cancer (CRC) screening starting at age 45, due to a sustained increase in the incidence of early-age-at-onset CRC (eoCRC). A similar increase in the incidence of eoCRC has been observed in Canada since the early 2000s. However, the inherent differences between the US and Canadian health care systems with many different reimbursement and capacity considerations limit the applicability of the recommendations to the Canadian context. In order to facilitate further discussion around Canadian guidelines and recommendations, several research gaps need to be addressed: 1) a detailed understanding of trends in histology, topography, initial stage at diagnosis, and mortality among eoCRC; 2) a detailed analysis of cost-effectiveness outlining the impacts to the current screening programs with potential harms and benefits; 3) a comprehensive understanding of risk factor profiles that may lead to meaningful recommendations for screening decisions within the 40–49 age group in the absence of wide-spread screening programs; and 4) an evaluation of the effectiveness of current and novel screening tests or biomarkers specifically in the 40–49 age group. In the meantime, we suggest that physicians and patients begin discussions about screening at age 45 by reviewing family history and alerting patients to symptoms of CRC, which may increase screening adherence at age 50. This issue will remain an active area of debate with Canada as a careful laggard in changing recommendations, while attempting to balance system considerations with eoCRC trends and patient outcomes.