Colorectal cancer screening should start at age 45, according to new draft guidelines from the U.S. Preventive Services Task Force.
Current recommendations suggest that people start screening for colorectal cancer at age 50, continuing until they’re 75.
Doctors explain why the recommended age has been bumped up, and what colorectal cancer screening entails.
People should be screened for colorectal cancer starting at age 45, according to new draft guidelines from the U.S. Preventive Services Task Force (PSTF).
The guidelines were issued Tuesday and are not official yet. “Overall, people ages 45 to 75 should be screened to reduce their risk of dying from this disease,” a bulletin on the draft guidelines states. Current recommendations suggest that people start screening for colorectal cancer at age 50, continuing until they’re 75.
The PSTF stresses 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 health history of genetic disorders that increase the risk of colorectal cancer.”
Colorectal cancer is the third leading cause of cancer deaths in the U.S. According to American Cancer Society (ACS) estimates, there will be 104,610 new cases of colon cancer and 43,340 new cases of rectal cancer diagnosed this year. Colorectal cancer doesn’t always cause symptoms right away, but as it progresses, it can lead to a change in bowel habits, rectal bleeding, blood in the stool, abdominal pain, and unintended weight loss.
“Despite strong evidence that screening for colorectal cancer is effective, about a quarter of people ages 50 to 75 have never been screened,” the PSTF says.
“I believe the new draft guidelines are justified and an important step in diagnosing and preventing colorectal cancer in younger patients,” says Joshua Meyer, M.D., vice chair of translational research in the Department of Radiation Oncology at Fox Chase Cancer Center. “A lot needs to change in terms of mindset around screening at a younger age.”
Why was the recommended age for colorectal cancer screening bumped up?
While the rate at which people are diagnosed with colorectal cancer is dropping in those who are 65 and older, it’s actually increasing in younger people. According to data from the ACS, an estimated 12% of colorectal cancer cases—about 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 50 have been rising since the mid-80s, with younger age groups seeing the steepest increases.
Younger people are also being diagnosed at later stages. A 2017 study published in the Journal of the National Cancer Institute found that people under the age of 55 are 58% more likely to be diagnosed with late-stage colorectal cancer than older people. Why? The authors wrote that it’s “largely due to delayed follow-up of symptoms, sometimes for years, because cancer is typically not on the radar of young adults or their providers.”
That’s why earlier screening is “a move in the right direction,” according to Hisham Hussan, M.D., a gastroenterologist with The Ohio State University Comprehensive Cancer Center. He explains that the new guidelines will help doctors get approval from insurance companies to make screening more affordable for younger patients.
There are racial disparities, too. Black Americans have one of the worst colon cancer survival rates of any racial or ethnic group in the U.S., a 2020 report from the ACS found. Colorectal cancer rates are roughly 20% higher in Blacks than non-Hispanic whites; death rates are almost 40% higher. Alaska Natives are also hit particularly hard: Their death rate is about double those in Black Americans.
It’s unclear why these racial disparities exist, but one meta-analysis of previous research suggests Black Americans have a higher risk of being diagnosed at a later stage, possibly due to lower screening rates in minorities and inadequate access to healthcare.
Mark Friedman, M.D., a gastroenterologist at Moffitt Cancer Center, says he hopes earlier screening will help pinpoint who is most at risk of developing colorectal cancer. “The majority of colorectal cancers in these younger individuals appears to be sporadic and we have yet to identify who is at the greatest risk and who should be more aggressively screened,” he says. When screening happens earlier, doctors have a better chance of detecting colorectal cancer at an earlier, easier-to-treat stage.
What does screening for colorectal cancer involve?
“Just because the screening age may start at 45 does not mean that younger people are not at risk, even if that risk does not rise to the level that makes screening an appropriate step,” Dr. Meyer stresses. “Therefore, if a person in their 20s, 30s, or 40s has persistent rectal bleeding, change in bowel habits, or abdominal/pelvic pain that persists, they should discuss further workup with their doctor, including a possible colonoscopy.”
The PSTF recommends two forms of screening tests for colorectal cancer: direct visualization tests (which look at the structure of the colon and rectum for abnormalities) and stool-based tests (which check the stool for signs of cancer). The recommended tests include the following, according to the ACS:
A fecal immunochemical test (FIT), which looks 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 clump of cells that develops along the colon lining, which can be precancerous)
A colonoscopy, where a doctor looks at the entire length of the colon and rectum with a colonoscope, a flexible tube about the width of a finger with a light and small video camera on the end
A CT colonography, which uses a CT scan and X-ray of the colon and rectum to look for abnormal areas
A flexible sigmoidoscopy, a procedure that is similar to a colonoscopy except is doesn’t examine the entire colon
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