Overall, the incidence of CRC in people age 50 and older is declining, the task force noted. However, there has been a rising incidence of CRC in younger Americans, for reasons that are unclear. While the relative incidence in younger people remains low, the increasing trend of young onset CRC is nevertheless a “major public health concern,” the MSTF stated in its recommendations. In addition, it suggested beginning screening earlier in the African-American population—at age 45.
The MSTF re-evaluates recommendations for screening periodically as new evidence emerges and evaluated seven different types of screening tests for this report. It ranked tests into three “tiers” according to the strength of the recommendation for average-risk people. Not surprisingly, colonoscopy was in tier 1.
The American Cancer Society’s “Colorectal Cancer Facts & Figures 2017– 2019” indicates that the geographic pattern of CRC has changed dramatically over the past several decades. In contrast to the 1970s and 1980s, when death rates were highest across the Northeast and lowest in the South, rates are currently highest in parts of the deep South and Midwest. Factors that contribute to geographic disparities include regional variations in risk factors and access to screening and treatment, which are influenced by socioeconomic factors, legislative policies and proximity to medical services.