From the Guidelines
I would inform the 45-year-old female that colonoscopy screening typically starts at age 45 for individuals at average risk, as recent guidelines suggest starting screening at this age for average-risk individuals 1. For average-risk individuals without family history of colorectal cancer or other risk factors, the standard recommendation has been evolving, with some guidelines now suggesting starting at age 45 for average-risk individuals. Some key points to consider include:
- The American Cancer Society recommends beginning screening at age 45 y with any test (qualified recommendation) for average-risk adults in good health with a life expectancy of more than 10 y 1.
- The US Multi-Society Task Force on Colorectal Cancer suggests average-risk CRC screening begin at age 45, supported by increasing CRC incidence and mortality in individuals under age 50, as well as emerging data showing the rate of advanced colorectal neoplasia in average-risk individuals ages 45 to 49 is similar to advanced neoplasia rates observed in screening cohorts of those ages 50 to 59 1.
- For high-risk patients with family history of colorectal cancer, personal history of inflammatory bowel disease, or genetic syndromes like Lynch syndrome, screening begins earlier and occurs more frequently. Since she's already presenting at age 45, I would evaluate her risk factors to determine if this current screening is appropriate. The rationale for age-based screening is that colorectal cancer risk increases significantly with age, and the benefit-to-risk ratio of screening becomes more favorable around age 45 for average-risk individuals, according to recent guidelines 1.
From the Research
Screening Guidelines
The patient is a 45-year-old female who has come for colonoscopy screening. According to the latest guidelines, screening for colorectal cancer (CRC) in average-risk adults is recommended to start at the age of 45 years, as stated in the study 2.
Risk Categories
The options provided are:
- A. Age
- B. Low risk average risk
- C. High risk
Based on the study 2, the correct answer is related to age, as the recommended age for starting CRC screening in average-risk adults has been lowered to 45 years.
Key Points
- The USPSTF recommendation for CRC screening in average-risk adults aged 45-49 years has been updated to start screening at 45 years 2.
- The study found that clinicians increased their screening ordering rate for patients aged 45-49 years after the guideline change 2.
- There is no direct evidence in the provided studies to support a specific answer for low risk average risk or high risk categories in relation to the starting age of screening.
- However, studies 3, 4, and 5 discuss the importance of colonoscopy surveillance, risk factors for CRC development, and updates in colon polyp classification and management, which may be relevant for determining the risk category of a patient.