Start colon cancer screening at 45, not 50, ACS urges

Stefanie Joho who was diagnosed with colon cancer at 22 has been in remission since February 2016 thanks to an immunotherapy drug that targets a genetic mutation

The American Cancer Society now says colorectal cancer screening should start at age 45 instead of 50.

But the shift by the cancer society is based on new information about the rise in colon and rectal cancer among younger adults, said Andrew Wolf, an associate professor of medicine at the University of Virginia.

When the cancer society started to update its recommendations, it initially focused on racial groups that have higher death rates from the disease, primarily African Americans.

Analyst Brian Weinstein, with the William Blair investment firm, praised the American Cancer Society for its "forward thinking", but cautioned that the updated guideline may not be a big boost for Cologuard right away. "Whether it's 45 or 50, the most important thing is for people to get screened and keep screening".

Of course, the implications of increasing colorectal cancer incidence among young people go beyond the need for adjusted screening recommendations. "One of the most significant and disturbing developments in CRC is the marked increase in CRC incidence-particularly rectal cancer-among younger individuals", wrote the authors.

"Screening for colon cancers is at age 45 rather than at age 50 as it was in the past", said Hope Cancer Center Oncologist and Hematologist Dr. Arielle Le.

"Someone born in 1990 has twice the chance of developing colorectal cancer than someone born in 1950", Wolf said. "It's what we call a birth cohort effect. My late husband, Jay Monahan, was just 41 when he was diagnosed more than 20 years ago", she said in a statement.

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The guideline suggests screening either through a high sensitivity stool-based test or visual examination such as colonoscopy.

The most common screening method is a colonoscopy exam that snakes a tiny camera through the rectum to view the colon to search for abnormal tissue growth.

The researchers' new modeling study was an extension of analyses conducted for the US Preventive Services Task Force recommendations, and it assessed the potential risk and benefit of various colorectal screening strategies among black and white men and women in the United States. But not everyone agrees with a starting age of 45.

Meanwhile, cases and deaths have fallen in older adults, at least partly due to screening, which can lead to the detection and removal of polyps before they become cancerous.

He acknowledged that many patients are uneasy about getting colonoscopies, but since they are sedated during the procedure, they do not feel anything, and usually say afterward they are glad they did it. We still have a lot of work ahead of us to understand why this happening.

"We think probably the most accurate way is with the colonoscopy", Dr. Baber explained. ACS represents one of several clinical guidelines for colorectal cancer screening. But the organization noted the higher rate among older adults may be a result of increased screening in that age group.

Outside of the cost and the frequency in which a test is recommended to be done, "all these tests are approximately equal in their value and can be offered", Wender said.

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