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


Those at higher risk, due to their personal or family history, may be urged to get screening earlier or more often. The new recommendations detail six screening options, which include kits that allow patients to collect a sample at home and send it directly to a lab that looks in the stool for microscopic blood-the presence of which would then likely necessitate a colonoscopy. Based on microsimulation modeling that showed a favorable risk:benefit ratio for screening at age 45, the recommendation comes with the "expectation that screening will perform similarly in adults ages 45 to 49 as it does in adults for whom screening is now recommended".

Over 140,000 Americans are expected to be given a diagnosis of colon or rectal cancer this year.

The experts cite a worrisome rise in the number of younger adults diagnosed with the nation's third leading cause of cancer deaths.

The vast majority of colorectal cancers are still found in older people, with almost 90 percent of all cases diagnosed in people over 50.

The new recommendations apply to people at average risk for colon and rectal cancer.

The Multi-Society Task Force on Colorectal Cancer, which includes representatives from several gastroenterology groups, urges African-Americans to start routine screening at 45 because they carry a higher burden of colorectal cancer but advises others at average risk to start screening at 50.

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, the cancer group said. We just have to face reality.

And past studies by Church and other researchers across the country, were used to come up with today's new guideline. The recommendation for regular screening in adults aged 50 years and older is designated as a 'strong recommendation, ' on the basis of the greater strength of the evidence, as well as the overall benefit. The test should still be repeated every ten years, unless otherwise medically indicated. They do not call for everyone to have a colonoscopy, the gold standard of colon cancer screening.

But when the data pointed to a "persistent increase" among younger people across demographic groups, the society made a decision to recommend younger screening ages for all adults, said Richard Wender, chief cancer control officer for the group. "So there may be some other factors that we don't understand".

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When an organization like the American Cancer Society changes its recommendations, insurance companies typically follow suit. As an advocacy organization, we have heard the urgency from our survivor community to lower the screening age.

"When we began this guideline update, we were initially focused on whether screening should begin earlier in racial subgroups with higher colorectal cancer incidence.", said Richard C. Wender, MD, ACS cancer control officer. "The evidence is now absolutely clear, and I can't emphasize how carefully this was done".

Chang, of MD Anderson, said he thought that 45 years old "makes sense" for the start of screening. "But those things do not fully explain the rise". 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.

Andrea Cercek, an oncologist at Memorial Sloan Kettering Cancer Center in NY, said the updated guidelines may "capture a population at risk". However, there has been a 51% increase in CRC among those under age 50 since 1994.

"I'm very excited about it", said Georges, from Fort Wayne.

Like the 2013 final report, the current rapid report therefore concluded that the benefit of screening for under 55-year-olds with a family history of colorectal cancer is unclear.

For any adult, no matter how old, Chang said that paying attention to your body and bowel habits are important for tracking your overall health - and that alerting your doctor to any changes is key.

If this new guideline is adopted, lives will be saved.

The ACS paper said colonoscopies, visual tests and a high-sensitivity stool-based test are effective means of detecting colorectal cancer.