The age for checking for colorectal cancer has changed

Grant Boone
June 3, 2018

Doctors should discourage anyone over age 85 from screening, the cancer society said.

According to the Centers for Disease Control and Prevention, colon and rectal cancers are the second leading cause of deaths in the USA for cancers that affect both men and women. "Nothing that would have indicated that she would have colon cancer at such a young age", said Sanford.

"If you find for example a polyp and remove it at the same time then you have prevented a future cancer in that person", says O'Neil. The risk of rectal cancer for someone in their twenties increased from 0.9 per million for those born in 1950, compared with 4 per million for someone born in 1990.

For comparison, the incidence of colon cancer in those over age 50 was 119 per 100,000 in 2013 - several orders of magnitude higher. They now suggest starting those screenings at age 45 instead of 50.

Kenny Lin, MD, MPH, professor of clinical family medicine at Georgetown University, offered a counterpoint to predictions that the new guidance would save lives.

Doctors believe rising obesity rates, more sedentary lifestyles and diets high in processed foods are contributing factors to the increase in colorectal cancer.

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The updated guidelines come on the heels of what seems to be a rise in colorectal cancer among younger adults.

The data that influenced the American Cancer Society found that the lower screening age would result in about a 6 percent increase in the benefit of screening and would require a 17 percent increase in colonoscopies. For people aged 76-85, the ACS says doctors and patients should decide on a case-by-case basis whether it makes sense to continue screening, based on life expectancy and preference. "So it's preventative, not just early diagnosis", she said, adding that she thinks the risks of screening younger outweigh the benefits. About 50,000 people are expected to die of colorectal cancer this year.

Most colon cancer occurs in adults 55 and older, and the good news is rates of cases and deaths have been falling for decades. But is this the safest approach? The race focuses on early screenings and detection for colon cancer.

USA Today was one of the few outlets that called attention to these potential harms, which include bowel perforation and complications from anesthesia. That evidence includes a major analysis led by ACS researchers. It also categorized tests for the 45-50 age group as a "qualified recommendation" and tests for those over 50 as a "strong recommendation".

However, Hoffman wondered whether clinicians have enough data to make these kinds of discussions meaningful. Those claims are speculative and may be plausible, but they are not yet proven.

As the ACS researchers explained in the paper announcing the new screening guidelines, the rise in colon and rectal cancer cases can not simply be explained by the fact that screening is more common, so more cases are being found. People in this younger age range are not often screened, and death rates for young people are increasing, too.

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