Achieving Maximum Benefit from Colorectal Cancer Screening: Start Younger, Offer Choice, Find Advanced Precancerous Lesions

Colorectal cancer screening is one of the most effective interventions in all of preventive care. Screening programs in many high-resource nations have resulted in marked declines in colorectal cancer mortality rates in the screening age population. For several decades, the incidence of colorectal cancer in individuals below 50 years of age (early-onset colorectal cancer) has been steadily increasing in each successive birth cohort. This increase in incidence has driven rising colorectal cancer mortality in people below 55 years of age. Two studies in this issue of the journal provide useful guidance for addressing this shifting incidence and information about choice of screening test to cost-effectively reach a higher percentage of the total population. Moving screening to 45 years of age should occur in all high-resource countries experiencing rising incidence. Although a menu of screening options is needed to reach the highest possible number of eligible individuals, detecting advanced precancerous lesions is a critical aspect of any screening program. Affordable, acceptable noninvasive screening options with high sensitivity for cancer and advanced precancerous lesions combined with primary and follow-up colonoscopy should be deployed to reach the most people and prevent the most deaths from colorectal cancer. See related article by Chia and colleagues, Cancer Epidemiol Biomarkers Prev 2025;34:990-7 See related article by Rui et al., p. 1111.