Aasma Shaukat, MD, MPH, AGAF

The literature calls early-onset CRC a “distinct disease,” because of its molecular characteristics, challenges in diagnosis, and often poor prognosis.¹ Patients with early-onset CRC often have a close family member with colon cancer, yet often ignore symptoms like abdominal pain. Among individuals with a firstdegree relative with colon cancer, those younger than age 50 years are half as likely to have undergone a colonoscopy as those 50 years and older.² When symptoms do appear, the average time to diagnosis is 128 days for those younger than 50 vs 79 days for those older than 50.³

What is important to consider is the life stage in which these patients find themselves. A cancer diagnosis in a patient’s 40s—accounting for about three-quarters of early-onset cases⁴—comes in the middle of a career, of raising a family, of living a full life. Therefore, noninvasive screening is so important for those at risk of early onset CRC: An easier screening procedure takes less time than a colonoscopy procedure can consume.

CRC screening rates remain suboptimal, even among persons aged 50 and older. As of 2020, approximately 30% to 35% of adults older than 50 in the United States had never been screened for colorectal cancer.⁵ Strategies to improve CRC screening rates include organized outreach programs and use of noninvasive CRC screening tests. These tests do not replace colonoscopy but complement them.

Acceptance of FIT is high and can reduce CRC incidence and mortality.⁶ Industry has been working on devising other noninvasive options, which in their newer iterations are starting to show diagnostic relevance.⁷ These options may help all individuals due or overdue for CRC screening.