Published: Sat, June 02, 2018
Medicine | By Brett Sutton

American Cancer Society: Colorectal cancer screening should start at age 45

American Cancer Society: Colorectal cancer screening should start at age 45

Fritsche went in for his first screening colonoscopy at 50 but discovered he already had advanced colon cancer.

The American Cancer Society's newly updated guidelines for colon and rectal cancer screening recommend that adults at average risk get screened starting at age 45 instead of 50, as previously advised. In updated guidelines released Wednesday, it inched the recommended age to 45. The recommendations apply to adults who are at average risk of the disease; this includes most people in the United States. "Nobody knows why really clearly, and that's a big area of interest, but nobody's questioning that it's happening". Studies have not yet figured out the cause of the increase, he said. Experts aren't sure why there has been a 50 percent increase in cases in younger adults since 1994.

While the colorectal cancer incidence rate among adults aged 45 to 49 is lower than it is among adults aged 50 to 54 (31.4 vs. 58.4 per 100,000), the higher rate in the 50-54 age group is partially influenced by the uptake of screening at age 50, which leads to an increase in the incidence rate, due to detection of prevalent cancers before symptoms arise. Recent studies have shown that the risk of colorectal cancer is double for someone born in 1990 compared to someone born in 1950. Importantly, studies suggest the younger age cohorts will continue to carry the elevated risk forward with them as they age.

"If we catch the cancer in its early stages", he explained, "the cure rate is practically 90 percent, but if we wait until the cancer has spread, the cure rate drops to 30-40 percent, or even less, depending on how far the cancer has spread".

But the American Cancer Society this week changed its advice and is recommending that screening start five years earlier. As part of the review process, the USPSTF took into account three computer simulations that considered different starting ages and screening intervals.

"Incorporating this epidemiological shift into contemporary modeling of CRC screening demonstrated that the benefit-burden balance is improved by lowering the age to initiate CRC screening to 45 years". The results showed a consistent benefit with screening strategies that started at age 45. Based on microsimulation modeling that showed a favorable risk:benefit ratio for screening at age 45, the recommendation comes with the "expectation that screening will perform similarly in adults ages 45 to 49 as it does in adults for whom screening is now recommended". Colon cancer, combined with rectal cancer, is the second leading cause of cancer death in the U.S. This year, more than 140,000 Americans are expected to be diagnosed with it, and about 50,000 will die from it.

Colon cancer is not just a disease of older people.

Shares of diagnostic company Exact Sciences Corp, which makes Cologuard devices that helps detect colorectal cancer, jumped more than 10 percent after the guideline was revealed. A vaccine can prevent transmission of HPV. The new recommendations detail six screening options, which include kits that allow patients to collect a sample at home and send it directly to a lab that looks in the stool for microscopic blood-the presence of which would then likely necessitate a colonoscopy. Patients who test positive for signs of cancer on a non-colonoscopy screening method should follow up with a colonoscopy quickly, the group said. The cancer organization believes that the underlying risk of the younger group is probably close to that of the older group. Only about two-thirds of people 50 and older have been following screening guidelines.

Media personality Katie Couric, a longtime advocate in the fight against colon cancer, applauded the move.

Andrea Cercek, an oncologist at Memorial Sloan Kettering Cancer Center in NY, said the updated guidelines may "capture a population at risk".

"At the time of the Task Force's review, there was limited data on screening adults younger than age 50".

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