March 31, 2020 by Peter B. Laird
New Guidelines for Colorectal Cancer Screenings Explained
Research has clearly established that people are being diagnosed with colorectal cancer at younger ages, a trend so concerning that the American Cancer Society (ACS) has modified its screening guidelines. People should start getting screened for colorectal cancer at age 45, instead of 50, the ACS now says.
The trend toward younger adults is striking and still somewhat of a mystery. The new guidelines were published May 30 in CA: A Cancer Journal for Clinicians, which is an American Cancer Society journal. The aim of colorectal cancer screenings – with the colonoscopy still being the No. 1 recommended option — is to catch potentially cancerous polyps early, or identifying actual cancerous changes. During a colonoscopy, physicians can remove most polyps quickly and with minimal to no pain.
“In the early stages, there are no symptoms,” says Hanif Williams M.D., a primary care physician with Baptist Health Primary Care and chief of the Family Medicine department at Baptist Hospital. “About one-third of colon cancers are found during the screening process in patients without any symptoms. So the takeaway is not to wait until you’re symptomatic. Get screened. These are considered ‘silent tumors.’ They grow slowly and don’t produce symptoms. But if detected early, you can be cured.”
The U.S. Preventive Services Task Force, the independent, volunteer panel of national experts in prevention and evidence-based medicine, has not changed its recommendation for adults at average risk to be screened for colorectal screening beginning at age 50. The task force, however, does recommend earlier screenings for those at above-average risk.
Anyone with questions about whether they should be screened for colorectal cancer should consult with their primary care physician.
The ACS Updated Guidelines
The new screening-age recommendations are for those at average risk for colorectal cancer. Here are the updated ACS guidelines:
- People at average risk of colorectal cancer should start regular screening at age 45.
- People who are in good health and with a life expectancy of more than 10 years should continue regular colorectal cancer screening through the age of 75.
- People ages 76 through 85 should make a decision with their medical provider about whether to be screened, based on their own personal preferences, life expectancy, overall health, and prior screening history.
- People over 85 should no longer get colorectal cancer screening.
What About Adults at Higher-Than-Average Risk?
This is where things get more complicated because many people may not realize they are at a higher risk for colorectal cancers. The three primary factors that makes a person at higher risk of developing colorectal cancer are:
- A strong family history of colorectal cancer or certain types of polyps;
- A personal history of colorectal cancer or certain types of polyps;
- A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease).
“Men and women should begin screening earlier and more often if they have a family history of colorectal cancer or polyps,” said Rosendo Collazo, D.O., an internal medicine physician with Baptist Health Primary Care. “If you have any of these risk factors, you should talk to your primary care physician about screening at an earlier age and find out how often you will need to be screened.”
What Prompted the Updated Screening Guidelines?
Colorectal cancer is the third most commonly diagnosed cancer in Americans, according to the ACS. Colon cancer will be diagnosed in more than 95,000 people this year, and nearly 40,000 will be diagnosed with rectal cancer. The two cancers will kill more than 50,000 people this year.
The overall rate of colorectal cancer has declined steadily over the past two decades in people 55 and older because of increased screenings that result in the removal of polyps, as well as changes in exposure to risk factors. But there has been a 51 percent increase in colorectal cancer among those under age 50 since 1994. Death rates in this younger age group have also begun to rise in recent years, the ACS says.
“When we began this guideline update, we were initially focused on whether screening should begin earlier in racial subgroups with higher colorectal cancer incidence, which some organizations already recommend,” said Richard C. Wender, M.D., chief cancer control officer for the American Cancer Society. “But as we saw data pointing to a persistent trend of increasing colorectal cancer incidence in younger adults, including American Cancer Society research that indicated this effect would carry forward with increasing age, we decided to reevaluate the age to initiate screening in all U.S. adults.”
Will Your Insurance Cover Colorectal Cancer Screening Before Age 50?
Health insurance plans may or may not yet cover the screening test for those in the new recommended age range. This could result in out-of-pocket expenses.
Before scheduling a screening test, it’s important to check your insurance coverage for each test option. There are several screening options, and some may be more affordable than others, particularly when paid out of pocket. Consult your primary care physicians about all screening options and out-of-pocket expenses.
Lifestyle Risk Factors
Lifestyle factors, including a persistent obesity epidemic in the United States, is considered a contributor to the rise in colorectal cancer among younger people.
Lifestyle risk factors for colorectal cancer, those that people can control, include cigarette smoking; excess body weight, physical inactivity, and a high consumption of alcohol. Dietary choices also play a big role: Too much red and processed meat in the diet can increase your risk. Too little consumption of fruits and vegetables, dietary fiber, and dietary calcium can also raise your risk.
“Before a screening, I have a discussion with my patients, advising them of the risk factors for developing colon cancer, especially the importance of weight control, not smoking and following a proper diet,” says Dr. Williams. “I give the talk before the procedure because most people tend to return to bad habits afterward if everything turns out normal.”