If Average Risk, Begin Colon Cancer Screening at 45 instead of 50

The American Cancer Society (ACS) recently updated its guidelines for colon and rectal cancer screening, recommending that adults at average risk get screened starting at age 45 instead of 50, as previously advised.

Dr. Linda Miller, gastroenterologist at Lourdes Medical Center of Burlington County, says she supports this change 100 percent.

“Colon and rectal cancers are typically slow-growing, but we are finding them more in younger patients,” said Dr. Miller. “The tumors we find are also more advanced. Colorectal cancer is the #2 cause of cancer deaths in the US. We’re currently not making a dent in lowering the incidence of these cancers that we’d like to. It’s my hope that this new guideline will help us catch more cancers at an earlier stage and save more lives.”

According to the ACS, the updated recommendation is based on new evidence of rising colorectal cancer incidence and modeling studies that showed an improvement in the number of life years gained. Although the incidence of colorectal cancer has been steadily declining in individuals aged 55 years and older, there has been a 51% increase among those younger than 50 years since 1994. Mortality rates in this population have also begun to rise.

In her own experience, Dr. Miller says the data supports what she’s seeing in the office. “I’ve increasingly been diagnosing patients younger than 50 with colorectal cancers. Obesity may play a primary role in early onset colorectal cancer. There are currently more people in the general population with a body mass index (BMI) greater than 30, which is considered obese. We know that obesity is a risk factor for colorectal cancer.”

The link between obesity and colorectal cancer could be a change in the microbiota of the gut. More research is needed to know for sure, said Dr. Miller. Researchers are also looking at a possible link between obesity and its disturbances in microbiota to other gastroenterological conditions, such as irritable bowel syndrome and irritable bowel disease. With that research, there is more emphasis on the role probiotics play. Physicians hope to have more information about this link in the future.

The colorectal screening guidelines for African-Americans has always been age 45. African-Americans have the highest rate of colorectal cancer (reasons are not yet understood). Also, among those at higher risk for colon and rectal cancers is Alaska Natives, and people with a family history or a personal history of colon or rectal polyps. For those with a prior or family history of colorectal cancer or polyps, screenings should begin even earlier—at age 40 or 10 years before the family member had the disease, whichever is sooner.

The ACS is one of numerous organization who have issued colorectal cancer screening guidelines. Other organizations include the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology, which issued a joint guideline; the U.S. Preventive Services Task Force; the American College of Physicians; the American College of Gastroenterology; and the National Comprehensive Cancer Network.

The ACS recommendation comes about two years after the last USPSTF guideline update. Experts say the newest data is the reason for the age change.

Dr. Miller urges patients with normal risk who are age 45 and have not had a colon cancer screening to talk with their physicians, as well as a representative from their health insurance plan. She said that while this is the new recommended age guidelines, and many physicians support the change, it may take a while for insurance companies to catch up in covering the cost.

Colon polyps can occur in anyone, but people over age 50 are still considered most at risk, as are those who are overweight, smoke or have a family history of colorectal cancer or colorectal polyps.

“Regular screening remains the most powerful weapon for preventing colorectal cancer,” said Dr. Miller. “Early on, colorectal cancer does not cause any symptoms, so many people don’t go to the doctor until their disease has reached a late stage. Colon screening can detect cancer early, when it is most treatable.”

According to the American Cancer Society, when symptoms do occur, they can include the following signs. See your physician right away if you’re experiencing any of them:

• Changes in bowel movements, including constipation, diarrhea, or narrow stools that last for more than a few days
• Dark patches of blood in or on stool, or rectal bleeding with bright red blood
• Abdominal pain, cramping, discomfort or bloating
• Unexplained fatigue or weight loss

In addition to regular colon screenings, prevention techniques also include a healthy diet and regular exercise.

To schedule a screening appointment with a Lourdes colorectal specialist, please call 1-888-LOURDES or visit www.lourdesnet.org.