Published: Fri, June 01, 2018
Medical | By Marta Holmes

Cancer group says colon screening should start at 45, not 50

Cancer group says colon screening should start at 45, not 50

Screening for colorectal cancer (CRC) should begin at age 45 for people of average risk, according to newly updated American Cancer Society guidelines.

Most of the nation's 140,000 annual cases and 50,000 deaths from colon and rectal cancer still occur among people over age 55. In fact, the risk of developing colon cancer is twice as high as it was years ago and the risk of developing rectal cancer is four times higher.

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.

Additional reporting from Newsy affiliate CNN.

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While colorectal cancer rates dropped steadily for people born between 1890 and 1950, they have been increasing for every generation born since 1950.

The move comes as a recent stud here showed that there has been a marked increase in colorectal cancer incidence, particularly rectal cancer, among younger individuals.

"Think of it this way", Dwyer says, "if screening started at age 20, you'd have maximum benefit but also a huge burden. Therefore, what we've observed with the rising incidence is not simply a result of detection bias", Chang said. A potential harm from screening tests also remains unclear: For instance, harm can be caused by people being wrongly allocated to the risk group, causing unnecessary psychological stress.

Adults 45 and older with an average risk of colorectal cancer undergo regular screening with either a high-sensitivity stool-based test or a structural (visual) exam, depending on patient preference and test availability, the Cancer Society said in a news release. Insurance providers consider available evidence, clinical guidelines and recommendations from organizations such as the American Cancer Society to understand when preventive screenings are needed. "And we don't really know why".

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By contrast, the cancer society said the tests are equally acceptable - though worrisome results on any test other than a colonoscopy need to be followed up with a colonoscopy.

If the test is positive, a colonoscopy is recommended, Wender says, but only one in five people test positive for blood in their stool.

"This was the first trial ever done of colorectal cancer screening in the world".

"It is the only one of those tests that actually prevents cancer".

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"If you take into account the fact that people develop colon cancer or rectal cancer over many years, and that there's a step wise progression from having no abnormalities to then having polyps and then developing cancer, this gives us a real opportunity to stop people from ever developing cancer by moving screening ages younger", said Azad, who was not involved with the guidelines. And they typically do not show the traditional risk factors - obesity, smoking, physical inactivity or high-fat diets. They do, however, advise earlier screening for certain people at heightened risk - such as those with a strong family history of the disease. With that, we've noted that the incidence is going up in younger people, even younger than 45.

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