Experts Available for Comment About New Colorectal Cancer Screening Age Guideline

Pearl Mccarthy
June 1, 2018

The American Cancer Society now says colorectal cancer screening should start at age 45, not 50. Today's action by the American Cancer Society does not mean colorectal cancer screening tests will now be covered by insurance plans.

Church is a member of American Cancer Society Guideline Development Group which is responsible for updating cancer screening guidelines. The change comes in response to a 51 percent rise in colon and rectal cancers since 1994 in adults younger than 50. It is the first organization that has recommended that average risk colorectal cancer (CRC) screening in the United States should begin at age 45 rather than 50 for both men and women and for all races and ethnicities.

The group does not recommend routine screening for those under 45 because the absolute rates of cancer in those age groups are still very low and there are risks associated with procedures like colonoscopies, including a perforated bowel.

"If we catch the cancer in its early stages", he explained, "the cure rate is practically 90 percent, but if we wait until the cancer has spread, the cure rate drops to 30-40 percent, or even less, depending on how far the cancer has spread".

Colorectal cancer incidence has declined steadily over the past two decades in people 55 and over because of screening that results in removal of polyps, as well as changes in exposure to risk factors.

"While the causes of this increase are not understood, it has been observed in all adult age groups below the age when screening has historically been offered, and is contributing significantly to the burden of suffering imposed by premature CRC mortality", the report says.

And a recent study found adults born around 1990 are twice as likely to be diagnosed with colon cancer and four times as likely to be diagnosed with rectal cancer than adults born around 1950.

Because it is almost impossible to ask large cohorts of people to start colorectal cancer screening at different ages and then follow the outcomes of these cohorts, determining the best age to start and stop screening, and the optimal frequency of screening, depends on sophisticated mathematical models.

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While they differ on the age of first screening, both groups suggest that screening over age 75 should be a joint decision between patient and doctor.

"We'd be saving a lot of lives", Aurora Health Care medical director of surgical oncology Dr. Aaron Chevinsky said.

The organization, which announced the change in its guidelines Wednesday, said extensive analysis showed that lowering the starting age for screening would save lives.

Previously, 50 was the recommended screening age.

Chang, of MD Anderson, said he thought that 45 years old "makes sense" for the start of screening. "It allows you to find polyps before they become cancer".

If you are in your mid-40s and have not been screened for colorectal cancer, it may be time to do so.

The current study worked with the MISCAN model, adjusting the lifetime incidence of colorectal cancer to reflect the most current data, which includes higher incidence younger in the lifespan.

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