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- Colorectal cancer screening is expected to begin at age 45, according to the new draft guidelines from the US Preventive Services Task Force.
- Current recommendations suggest that people begin screening for colorectal cancer at the age of 50, continuing until age 75.
- Doctors explain why the recommended age has been increased and what colorectal cancer screening entails.
People should be screened for colorectal cancer by the age of 45, according to the new draft guidelines from the US Preventive Services Task Force (PSTF).
The guidelines were issued on Tuesday and are not yet official. “Overall, people between the ages of 45 and 75 should be screened to reduce the risk of dying from this disease,” reads a bulletin on the draft guidelines. Current recommendations suggest that people begin screening for colorectal cancer at the age of 50, continuing until age 75.
The PSTF points out in its bulletin that the draft recommendations apply to “adults without symptoms and who do not have a personal history of colorectal polyps, or a personal or family history of genetic diseases that increase the risk of colorectal cancer.” straight “.
Colorectal cancer is the third leading cause of cancer deaths in the United States According to estimates by the American Cancer Society (ACS), 104,610 new cases of colon cancer and 43,340 new cases of rectal cancer will be diagnosed this year. Colorectal cancer doesn’t always cause symptoms immediately, but as it progresses it can lead to a change in bowel habits, rectal bleeding, blood in the stool, abdominal pain, and involuntary weight loss.
“Despite strong evidence that colorectal cancer screening is effective, about a quarter of people between the ages of 50 and 75 have never been screened,” the PSTF says.
“I believe the new draft guidelines are justified and an important step in the diagnosis and prevention of colorectal cancer in younger patients,” says Joshua Meyer, MD, vice president of translational research in the Department of Oncology Radiotherapy at the Fox Chase Cancer Center. “A lot has to change in terms of the screening mentality at a young age.”
Why was the recommended age for colorectal cancer screening increased?
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While the rate at which people are diagnosed with colorectal cancer is declining among those 65 and over, it is actually increasing in younger people. According to data from the ACS, approximately 12% of colorectal cancer cases, approximately 18,000, will be diagnosed in people under the age of 50.
This has been happening for a while. Colon cancer rates in adults under age 50 have risen since the mid-1980s, with younger age groups seeing the steepest increases.
Young people are also diagnosed in later stages. A 2017 study published in Journal of the National Cancer Institute found that people under the age of 55 were 58% more likely to be diagnosed with advanced colorectal cancer than older people. Because? The authors wrote that it is “largely due to the delayed follow-up of symptoms, sometimes for years, because cancer typically isn’t on the radar of young adults or their providers.”
That’s why early screening is “a step in the right direction,” according to Hisham Hussan, MD, a gastroenterologist at Ohio State University’s Comprehensive Cancer Center. She explains that the new guidelines will help doctors get approval from insurance companies to make screening more accessible for younger patients.
There are also racial disparities. Black Americans have one of the worst colon cancer survival rates of any racial or ethnic group in the United States, according to a 2020 report from the ACS. Colorectal cancer rates are about 20% higher in blacks than in non-Hispanic whites; mortality rates are nearly 40% higher. Alaskan natives are also particularly affected: their death rate is about double that of black Americans.
It is unclear why these racial disparities exist, but a meta-analysis of previous research suggests that black Americans have a higher risk of being diagnosed at a later stage, possibly due to lower screening rates in minorities and a inadequate access to health care.
Mark Friedman, MD, a gastroenterologist at the Moffitt Cancer Center, says he hopes early screening can help pinpoint who is most at risk of developing colorectal cancer. “Most colorectal cancers in these younger individuals appear to be sporadic and we have yet to identify who is at greatest risk and who should be screened more aggressively,” he says. When screening occurs earlier, doctors have a better chance of detecting colorectal cancer at an earlier and easier-to-treat stage.
What does colorectal cancer screening involve?
“Just because the age of screening can start at 45 does not mean that young people are not at risk, even if that risk does not rise to the level that makes screening an appropriate step,” points out Dr. Meyer. “Therefore, if a person in their 20s, 30s or 40s has persistent rectal bleeding, changes in bowel habits, or persistent abdominal / pelvic pain, they should discuss further tests with their doctor, including a possible colonoscopy. “
The PSTF recommends two forms of colorectal cancer screening tests: direct visualization tests (which examine the structure of the colon and rectum for abnormalities) and stool-based tests (which check stool for signs of cancer) . Recommended tests include the following, according to the ACS:
- A fecal immunochemical test (FIT), looking for blood in the stool
- A guaiac-based fecal occult blood test (gFOBT), which finds hidden blood in the stool through a chemical reaction
- A stool DNA test, which looks for hidden blood and abnormal sections of DNA from cancer or polyps (a cluster of cells that develops along the lining of the colon, which can be precancerous)
- A colonoscopy, where a doctor looks the entire length of the colon and rectum with a colonoscope, a finger-wide flexible tube with a light, small video camera at the end
- A CT colonography, who uses a CT scan and x-ray of the colon and rectum to look for abnormal areas
- A flexible sigmoidoscopy, a procedure similar to a colonoscopy except it does not examine the entire colon
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