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

Colonoscopy

Colon cancer screening should begin at 45-American Cancer Society

Dr. Robin Mendelsohn of New York City's Memorial Sloan Kettering Cancer Center said the hospital has seen 4,000 new colorectal cancer patients younger than 50 in the last decade. Vital signs: colorectal cancer tests saves lives.

The qualified endorsement of screening at age 45 is reasonable and "will lead to a lot of discussion and investigation", said Douglas Rex, a professor of medicine at Indiana University.

If the test is positive, a colonoscopy is recommended, Wender says, but only one in five people test positive for blood in their stool.

In addition, the ACS recommends people in good health "with a life expectancy of more than 10 years" should receive regular screening until the age of 75.

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

Research shows that adults born around 1990 have twice the risk of colon cancer and four times the risk of rectal cancer than adults born around 1950, who have the lowest risk, said the report in CA: A Cancer Journal for Clinicians, a peer-reviewed journal of the American Cancer Society.

Currently, USPSTF, a government-backed independent panel that assesses the evidence for medical procedures, recommends screening from the age of 50. "Today's announcement recognizes the benefits of recommending screening for younger adults, particularly given the mounting evidence that the incidence of this disease is increasing for people under age 50". Colon cancer, combined with rectal cancer, is the second leading cause of cancer death in the U.S. In its latest advice, the Preventive Services Task Force says head-to-head comparison studies have shown that no one screening test is more effective than another in early cancer detection. As a result, testing could be offered earlier or more often in groups of people at risk (risk-adapted screening). Clinical trials are the "gold standard" for proving that - and most trials of screening have not included people younger than 50. According to the ACS's updated screening guidelines, among adults younger than 55 years, there was a 51 percent increase in the incidence of colorectal cancer from 1994 to 2014 and an 11 percent increase in mortality from 2005 to 2015.

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Some experts have anxious about pre-50 risks of colon cancer in some racial and ethnic groups, and at least one specialty society for gastroenterologists has urged screening of black adults starting at age 45.

Experts say it is unclear why colon cancer rates are on the rise in younger people. Those at a higher risk, including African Americans and Alaska natives, should get screened even earlier.

Andrea Cercek, an oncologist at Memorial Sloan Kettering Cancer Center in NY, said the updated guidelines may "capture a population at risk". Those with a family history or a history of inflammatory bowel disease such as Ulcerative Colitis may need to start much younger.

But the ACS commissioned a "modeling" study in developing the new guidelines.

Screening is generally done routinely every ten years.

"It's hard enough to get people to do it at all", Plescia noted.

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