Current screening guidelines overlook a significant number of patients treated for colorectal cancer

Abstract

The U.S. Preventive Services Task Force (USPSTF) recommends screening for colorectal cancer (CRC) in adults, beginning at age 50 years and continuing until age 75 years. Screening has led to a decreased incidence of CRC in this subset of patients. Despite these improvements, there has been a significant increase in the incidence of CRC in patients aged 20 to 49 years and those older than age 75 years. We sought to evaluate the appropriateness of the current screening guidelines as it pertained to our patient demographic at Greenville Health System. We retrospectively reviewed the Greenville Health System tumor registry from January 2005 to December 2010. Age at diagnosis, pathologic stage, tumor location, and demographic information were obtained on patients treated for CRC. Data points were stratified across the three age distributions used by the USPSTF. Greater than one-third (34.7%) of patients diagnosed with CRC fell outside of the recommended screening ages. Fifty-eight per cent of patients younger than 50 years old had advanced disease at diagnosis, Stage III or IV, as compared with other groups. Two hundred eight of the 708 patients (29.3%) were diagnosed on screening colonoscopy, whereas 500 patients (70.7%) were found to have CRC on diagnostic colonoscopy or at the time of operation for related complications. There are a significant number of patients who are ultimately treated for CRC that would fall outside the recommended screening parameters at our institution. Re-evaluation of the current CRC screening guidelines and risk factor assessment is needed to account for the changing trends.