LAUSR

Despite increased awareness, advances in treatment and innovation in surgical approaches, colorectal cancer (CRC) is still a worldwide public health issue [1]. The cause is multifactorial, but physical inactivity, gut bacteria, unhealthy diet, being overweight or obese, smoking and alcohol use all play a role. Small decreases in overall incidence rates are overshadowed by the exponential rise in early onset CRC. In 2021, there will be an estimated 149,500 new cases and 52,980 deaths from CRC in the United States (US) alone [2]. While the majority of CRCs are diagnosed in adults aged 50 and older, 12% are now diagnosed in individuals younger than age 50; the equivalent of 49 new cases daily. Colorectal cancer is the second most common cancer and the third leading cause of cancerrelated death in those less than 50 [3]. Based on current trends, by 2030 the colon cancer incidence will increase by 90% among adults 20– 34 and 27% for those 35– 49 years old; rectal cancer will increase 124% among adults 20– 34 and 46% in people 35– 49 years old [4]. These earlyonset CRCs are characterized by a more advanced stage at diagnosis, worse differentiation and cell histology, and poor correlation with known CRC risk factors, making detection and treatment more difficult [3]. The US Preventive Services Task Force and American Cancer Society responded to this trend by lowering the recommended age for routine CRC screening to 45 [2,5]. If simply lowering the recommended screening age is enough to impact change remains to be determined. While there is widespread knowledge of CRC prevalence, compliance remains low with CRC screening guidelines. Only 56% of those ≥45 years of age are up to date with CRC screening [6]. Furthermore, when examining the number needed to screen (NNS), populationbased screening programmes are expensive and inefficient in addition to disparate participation rates. 450 patients would need to be screened with flexible sigmoidoscopy and 900 with FOBT to prevent one death from CRC. The recent collection of studies on quantitative faecal immunochemical test (qFIT) use in symptomatic patients in Colorectal Disease [7– 10] and its widespread adoption as a screening modality in Europe has compelled reflection on its use in practices for both asymptomatic and symptomatic CRC detection and screening in the US. Other healthcare structures are similarly structured.