A new American Cancer Society guideline says colorectal cancer screening, like colonoscopy, should now begin at age 45 – five years younger than previously recommended – for all individuals. Age 50 was the long-held standard age for adults to begin colorectal cancer screening. This new recommendation, to lower the age by five years, is based on data showing rates of colorectal cancer are increasing in young and middle-aged populations.
The updated screening guideline recommendation is based on colorectal cancer incidence rates, results from modeling that demonstrated a favorable benefit-to-burden balance of screening beginning at age 45, and the expectation that screening will perform similarly in adults ages 45 to 49 as it does in adults 50 and over.
The American Cancer Society now recommends:
- Adults ages 45 and older to begin regular colorectal screening.
- As a part of the screening process, all positive results on non-colonoscopy screening tests should be followed up with timely colonoscopy.
- Adults in good health with a life expectancy of greater than 10 years should continue colorectal cancer screening through age 75. Clinicians should individualize colorectal cancer screening decisions for individuals ages 76 through 85, based on patient preferences, life expectancy, health status, and prior screening history. Clinicians should discourage individuals over age 85 from continuing colorectal cancer screening.
According to the American Cancer Society, colorectal cancer incidence has declined steadily over the past two decades in people 55 and over primarily due to increased colonoscopy screening that results in removal of polyps, as well as changes in exposure to risk factors.
“It is important to note that there are multiple options for someone to be screened for colon cancer, but patients should be informed that colonoscopy is still the gold standard and the procedure by which all others are measured,” says Dr. Jayant Talreja, a gastroenterologist with Richmond-based Gastrointestinal Specialists, Inc. “With colonoscopy, if an abnormality is found, the added benefit is that a therapeutic intervention can be performed during the procedure. If precancerous polyps are found, they can be removed. In the unfortunate scenario of a cancer, it can be biopsied. Colonoscopy has been very effective in bringing about the decline of colorectal cancer and related deaths in the over 50 population. If alternative screening tests are found to be abnormal, then a colonoscopy will generally still be required.”
However, according to the American Cancer Society, there has been a 51% increase in colorectal cancer among those under age 50 since 1994. Death rates in this age group have also begun to rise in recent years. A recent analysis found that adults born around 1990 have twice the risk of colon cancer and four times the risk of rectal cancer compared with adults born around 1950, who have the lowest risk.
“In my five years of practice, I have anecdotally seen a rise in the incidence of colon cancer in the younger population and that observation has been supported by the experiences of my colleagues,” says Talreja. “In many of these cases, patients may not have a typical presentation of symptoms and in some cases, the patients had no symptoms. The underlying cause could only be detected with colonoscopy.”
While the colorectal cancer incidence rate among adults 45 to 49 is lower than it is among adults 50 to 54, the higher rate in the 50-54 age group is partially influenced by the uptake of screening at age 50, which leads to an increase in the incidence rate due to detection of prevalent cancers before symptoms arise. Since adults in their 40s are far less likely to be screened than those in their 50s, the true underlying risk in adults aged 45-49 years is likely closer to the risk in adults ages 50 to 54 than the most recent age-specific rates would suggest. Importantly, studies by the American Cancer Society suggest the younger age cohorts will continue to carry the elevated risk forward with them as they age.
“Lowering the age to begin screenings is expected to benefit not only the segments of the population who suffer disproportionately from colorectal cancer – African-Americans, American Indians and natives of Alaska – but also all individuals considered to be at an average risk… which really is, everyone,” says Talreja. “We believe this
recommendation by the American Cancer Society is very positive, the correct decision and will likely save many lives.”
About Gastrointestinal Specialists, Inc.
Gastrointestinal Specialists, Inc. (GSI) is a group of 18 board-certified gastroenterologists and ten nurse practitioners/physician assistants who have been providing comprehensive GI care for more than 30 years throughout the Greater Richmond area treating the entire spectrum of gastrointestinal and liver diseases. GSI has four primary offices in the Richmond region and sees patients at all area hospitals. Procedures are performed at two conveniently located and fully accredited endoscopy centers, allowing for fast, easy access to routine diagnostic and therapeutic procedures.
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Supporting documentation
Article: American Cancer Society Updates Colorectal Cancer Screening Guideline; https://www.cancer.org/latest-news/american-cancer-society-updates-colorectal-cancer-screening-guideline.html
Article: Colorectal Cancer Screening for Average-Risk Adults: 2018 Guideline Update from the American Cancer Society; CA: A Cancer J for Clin doi: 10.3322/caac.21457. Lead author Andrew M. D. Wolf, M.D., Chair of the Committee Subgroup for CRC Guideline Update.
