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Colon Cancer Screening Guideline Age Lowered

Last year a study published in the Journal of the American Medical Association (JAMA) caused some concern when it showed that not only were colon cancer deaths rising among younger white people, but that the cancers diagnosed in this population were more advanced and more deadly than those normally found in older Americans. That study confirmed results from others released in the last few years.

Your primary care doctors at Cohen Medical Associates in Delray Beach, Florida, began receiving queries from our younger patients about whether or not we recommended colon cancer screening for them, so we want to provide some background here.

At the time the JAMA article was published last summer, most experts hadn’t come to a conclusion about the advisability of expanding colon cancer screening below the long-standing recommendation of age 50.

Now an influential organization, the American Cancer Society (ACS), has taken a stand. Last month it recommended that screening for the disease begin at age 45. The surge in colon cancer among the young is not insignificant: Since 1994, there has been an increase of 51 percent in those younger than 50 who have been diagnosed with colon cancer, and the death rate has increased. For Americans older than 50, the incidence has been declining steadily, which experts attribute to more widespread screening.

No one knows the reason for the appearance of these cancers in younger and younger people. The usual theories of an unhealthy diet including more processed foods, environmental pollution, obesity, or other unknown causes don’t seem to apply in this case, because African Americans and other population groups all face similar challenges, but only younger whites, ages 20 to 54, are showing an increase.

The figures regarding colon and rectal cancer deaths are already significant. The ACS says that colorectal cancer is the third leading cause of cancer-related deaths in this country, and projects that this year more than 97,000 Americans will be diagnosed with colon cancer, and 43,000 with rectal cancer. It estimates that 50,000 people will die from one of the two cancers.

The new guidelines emphasize individual preference and choice in testing options, of which there are several. These are basically broken into two categories: the stool-based tests, which are recommended every one to three years, and visual exams, including colonoscopy, every five to ten years. The ACS stresses that these screening tests must be repeated regularly to be effective, and that any abnormal test result should be followed up with a colonoscopy, which it considers to be the gold standard in colorectal cancer screening.

Not everyone agrees with the ACS recommendation. The problem is, rather than studies, the ACS is basing its recommendation on modeling projections, because few clinical trials have included people younger than 50.

The U.S. Preventive Services Task Force (USPSTF), a government-appointed volunteer scientific advisory board, still has not lowered its recommended screening age of 50, deciding that earlier screening—except for those considered at higher risk due to family history—would provide only a “modest” benefit when weighed against the costs and risks of including more people in the screening population. In addition, a 2014 study showed colorectal cancers appearing in people as young as 20 years old, so one could foresee eventual recommendations that all adults be tested for these cancers, with unknown benefits at this point.

So what should you do? Talk to us. Each individual has different preferences and concerns, and we can help you sort through the pros and cons of the various available approaches. If you are not currently experiencing concerning symptoms and have no family history of the disease, you may want to take a more conservative approach. If you are experiencing abdominal pain, weight loss, constipation, bloody stool, or changes in bowel patterns, we may recommend more aggressive types of screening.

As the ACS’s Dr. Rich Wender says, “All of these tests are good tests, and the choice should be offered to patients. The best test is the test that gets done.”

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