Colon cancer screening should begin at 45, not 50: ACS

Last Updated: 2018-05-30

By Lisa Rapaport

(Reuters Health) - U.S. adults should get screened for colorectal tumors starting at age 45 instead of 50 under new guidelines driven by rising cancer rates in younger populations.

The recommendations released today by the American Cancer Society reflect a shift in who is getting these malignancies.

"It is safe to say that the risk of developing colorectal cancer in your late 40s is now similar to that of someone in their early 50s back in the 1990's, when we were first recommending age 50 as the starting age," said Dr. Andrew Wolf, lead author of the updated guidelines and a professor at the University of Virginia School of Medicine in Charlottesville.

The proportion of adults 55 and older developing colon and rectal tumors and dying from them has been declining for several decades, aided in part by screening, researchers note in the guidelines published in CA: A Cancer Journal for Clinicians.

But among adults 55 and younger, diagnoses and deaths have been climbing. Diagnosis rates climbed 51% from 1994 to 2014, and death rates have increased 11% from 2005 to 2015.

"Folks need to understand that colorectal cancer is not just a disease of older people, and it is reaching into younger and younger age groups," Wolf said by email.

This year alone, more than 140,000 Americans will be diagnosed with colon and rectal cancers, leading to 50,000 deaths annually.

The U.S. Preventive Services Task Force, a government-backed independent panel that assesses the evidence for medical procedures, recommends screening with colonoscopy or fecal occult blood testing (FOBT) supplemented with sigmoidoscopy starting at age 50 for adults who don't have inflammatory bowel disease or a family history of colon cancer.

The new guidelines from the American Cancer Society echo these recommendations but stress the importance of starting at 45.

Many Americans, however, already fail to get recommended screenings, and getting people to start at an earlier age won't happen overnight, Wolf said.

"Right now, fewer than half of Americans are getting screened in their early 50's, so if we can raise awareness to the point that everyone is getting screened by age 50, we've moved the ball significantly down the field," Wolf added.

One open question, however, is whether health insurance will cover routine screenings for people under 50, said Dr. Robin Mendelsohn, co-director of the Center for Young Onset Colorectal Cancer at Memorial Sloan Kettering Cancer Center in New York City.

That's because the new recommendations are "qualified," due to limited research in screening outcomes for people under 50 and a lack of data on the benefits and harms of doing this.

"I think this may be an issue with insurance, especially because it is a 'qualified' recommendation," Mendlesohn, who wasn't involved in the new guidelines, said by email. "The prices for colonoscopy vary, but can be over $3,000 in some places."

SOURCE: https://bit.ly/2sqhhXz

CA: A Cancer Journal for Clinicians 2018.