Every 10 minutes, a person dies from colorectal cancer. With the recent change in recommendations from the American Cancer Society to begin screening for colorectal cancer at the age of 45 instead of 50, we could see a positive change in this number. The new guidelines published in CA: A Cancer Journal for Clinicians was sparked by research noting, despite overall decreases in the number of deaths from colorectal cancer over the past 25 years, there has a been a 50% rise in rates in those under 50. Other studies have shown those born in 1990 have twice the risk of being diagnosed with colon cancer and 4 times the risk of being diagnosed with rectal cancer. Of those diagnosed under the age of 50, nearly 50% are 45-49 years of age. Fifty has been the recommended start age for screening in average risk patients, causing many of these patients to unsuspectingly “miss the boat” and be diagnosed too late with more advanced disease being found at the initial presentation.
Colorectal cancer is preventable. It begins as a polyp, which is a small bump formed along the inner lining of the large intestine. If left to grow, these polyps can enlarge, become cancerous, and spread through the intestine to the blood stream, nearby structures, and even distant organs. If diagnosed early, 5-year survival can be up to 95%; however, in cases where the cancer has spread to other areas of the body, survival may be less than 20%. The goal of colorectal cancer screening is to find and remove these polyps before they reach this stage.
The recently released guidelines suggest doctors offer a choice of screening options to maximize the chance patients will actually undergo screening, While a colonoscopy every 10 years has traditionally been the most commonly recommended colon screening test, several other screening options are recommended in the guidelines: fecal immunochemical test every year; guaiac‐based fecal occult blood test every year; stool DNA test every 3 years; CT colonography every 5 years; and flexible sigmoidoscopy every 5 years. Each of these test have strengths and weaknesses. Patients should discuss these various screening options with their healthcare providers, as ultimately the best test is the test the patient will actually undertake.
This new recommendation of initiating screening at 45 instead of 50 does not change the fact that regardless of age, if symptoms of bleeding, pain, or unexplained changes in bowel habits or weight are present, a colonoscopy should be performed. Also, if a first-degree family member was diagnosed at an early age, screening should begin 10 years before the age of the affected family member. Additionally, this recommendation does not ensure automatic changes in what the various health insurers will pay. Other national organizations still recommend screening for average risk patients at 50. Even more, the change in recommendations does not answer the “why” in the increase of colorectal cancer in younger patients. But, ultimately, this change presents opportunities to find and remove more precancerous polyps and earlier-staged cancers, thereby decreasing the numbers of patients dying from this preventable disease.
