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Colorectal cancer screening now recommended at 45

July 17, 2018 | UCI Health
doctor advising young patient to get colon cancer screening

A rise in colorectal cancer among younger patients has led the American Cancer Society to recommend lowering the regular screening age to 45 from age 50 in order to protect against the deadly – but highly preventable – disease.

UCI Health experts welcome the recommendation, but say even earlier testing may be warranted, especially for patients with a family history of colorectal cancer.

“One-third of all patients with colorectal cancer are now under age 55,” says UCI Health colorectal surgeon Joseph C. Carmichael, MD, an associate professor and UCI School of Medicine’s chief of the Division of Colon & Rectal Surgery.

Cancer screening saves lives

Colorectal cancer is the second leading cause of cancer-related death in the United States, claiming 50,000 lives a year. Screening to detect and remove precancerous polyps in people beginning at age 50, has led to an overall decline in the cancer rate for the population as a whole.

But a 2014 UC Irvine study showed a significant increase in colorectal cancer among young adults between the ages of 20 and 39, a population that doesn’t undergo routine screening. And those patients are more likely to be diagnosed with a more advanced stage of the disease.

The cancer society estimates that 97,000 new cases of colon cancer and 43,000 new cases of rectal cancer will be diagnosed this year. An estimated 16,450 of these cancers will be diagnosed in Americans under age 50.

Missing the signs in younger patients

There’s a real danger of the disease being ignored among younger people, say Carmichael and his colleague Jason Samarasena, MD, a UCI Health gastroenterologist who specializes in colonoscopy. That’s because doctors don’t expect to see these cancers at such a young age, so they may attribute symptoms to something like hemorrhoids and elect to “keep an eye on it.”

“Unfortunately, I’ve seen many patients in their 40s be diagnosed with colon cancer, and it’s terrible when it happens,” says Samarasena, an associate professor in the Division of Gastroenterology. “These new guidelines will allow us to screen people earlier, catch more cases and protect more people.”

Colon cancer slow to develop

Colorectal cancer develops slowly over 7 to 10 years, primarily from polyps that can be detected and removed through colonoscopy.

“These are wholly preventable cancers,” Carmichael says. “We need to be thinking of screening five to 10 years before they’re diagnosed.”

The cancer society has taken the lead in reducing the age that colorectal cancer screening should be initiated. Other organizations recommend screening at age 50, except for some high-risk groups such as African Americans where guidelines already call for screening to begin at 45.

“I’m really excited that the cancer society has taken this leading step, and I can’t wait for the other organizations to follow suit,” Carmichael says, noting that it may take some time for insurers to catch up and begin covering the cost of screening at ages 45 to 49.

Screening methods vary

While Carmichael and Samarasena say colonoscopy is the gold standard for screening, the cancer society includes it as one of six recommended screening methods. Others are sigmoidoscopy, virtual colonoscopy and three different stool-sample tests.

Stool sample tests aren’t conclusive, but at least can start the process. A sigmoidoscopy checks only part of the colon and a colonography a uses a CT scan to check the colon.

Many people put off colonoscopies, in large part due to the preparation, which can involve a liquid diet and colon cleansing for 24 hours before the procedure.

“The society’s goal is to give people a menu of options for screening,” Samarasena says, adding that “the best screening test is the one you will do.”

A low-residue approach to prep

Samarasena is studying ways to make it more comfortable for patients to prepare for colonoscopy. Patients in his clinical trial may eat a low-residue diet consisting of eggs, white bread, macaroni and cheese, potatoes and chicken nuggets the day before the procedure.

Patients, he says, aren’t as tired and hungry after the procedure, where previously they might not have eaten solid food for 40 hours or so by the time the exam was finished. Even though the study of this approach is ongoing, some of Samarasena’s colleagues are so impressed with preliminary results that they’re following these eating guidelines for patients who are undergoing colorectal surgery.

Tips for preventing colon cancer 

  • Don’t ignore symptoms. See a doctor for constipation and diarrhea that doesn’t go away after a few days. Other symptoms, such as stools that are thinner in diameter than usual, persistent rectal bleeding, abdominal cramping, weakness, and fatigue should be investigated.
  • Don’t automatically stop screening at age 75. Patients in good health at age 75 could live another 10 or 20 years, so colorectal screening should not stop for this group.
  • Do what you can to prevent colorectal cancer. Don’t smoke; drink no more than one glass of alcohol per day for women, two for men; limit red meat in diet; watch weight; and get routine exercise.

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