According to the American Cancer Society, colorectal cancer is the third most common cancer diagnosed in both men and women in the U.S. It’s also the third leading cause of cancer-related deaths among men and women. While it’s expected to cause about 53,200 deaths this year, not all the news is bleak. The number of colorectal cancer-related deaths has actually been dropping for several decades. One reason for the decrease — more people are getting regular screenings and because of this, colorectal polyps are being discovered and removed before they become cancerous.
The U.S. Preventive Services Task Force (Task Force), an independent, volunteer panel of national experts in prevention and evidence-based medicine, now recommends that screenings for colorectal cancer start at age 45, as compared to the prior recommendation of age 50. While a five-year difference might not seem like much, colorectal surgeon, David Liska, MD, FACS, FASCRS, and director of the Sanford R. Weiss Center for Hereditary Colorectal Cancer believes that this is very encouraging news — especially when it comes to saving lives.
Why is this recommendation significant?
While the American Cancer Society has been making the recommendation that people start getting screened regularly for colorectal cancer at 45 for the last few years, the U.S. Preventive Task Force’s recommendation impacts screening and treatment options for people everywhere in a very positive way.
Dr. Liska explains.
“The U.S. Preventive Task Force now has followed the lead from the American Cancer Society, which has been recommending that we start screening at age 45 for two years now. The importance of the Task Force’s recommendation is that it will help determine what Medicare, Medicaid and private insurance, in most cases, will cover. This will also help guide primary care providers in regards to what they will recommend for patients in terms of screening. With this changing guideline, I do anticipate a big rise in the number of patients who are going to get screened under the age of 50.”
While the rate of colorectal cancer diagnoses has dropped significantly year after year since the mid-1980s, mainly among the 55 and older population, the American Cancer Society has reported that diagnoses for those under the age of 55 increased by 2% each year between 2007 and 2016.
With this new recommendation, Dr. Liska is hopeful that the rate will start to decrease for the 45 to 50 age group as well.
“Screening, especially with a colonoscopy, does not only detect cancer but it can also help prevent cancer by allowing us to find polyps so we can remove them before they have a chance to turn into cancer. Now while this is all great news, unfortunately, we’ve learned that the incidence of colorectal cancer is increasing in patients under 50. This is a very alarming trend that we’ve watched, and sadly, these patients haven’t been able to benefit from screening because the recommendation has usually been to start at age 50. So, based on our experience, we can now assume that since the incidence of cancer has risen among patients under the age of 50, we’ll start seeing the same benefit that we saw with people over the age of 55 when they have regular screenings.”
Who is at risk for colorectal cancer?
Dr. Liska says the current recommendation is mainly for average-risk individuals, meaning those who don’t have a family history of colorectal cancer or symptoms. If you have a strong family history, inflammatory bowel disease or a hereditary cancer syndrome, you’d be considered higher risk and might need to be screened before the age of 45.
African Americans, tend to have the highest colorectal cancer incidence and mortality rates of all racial groups in the US. Again, with the Task Force’s recommendation, Dr. Liska hopes this will change as well.
“The incidence of colorectal cancer has been higher in African Americans, especially in African American men, and this is also a population that does not get as much screening as recommended. So, we’re hoping this new guideline will also significantly increase screening, especially among African Americans starting at age 45, because they are at a higher risk. Unfortunately with this population, we have seen colorectal cancer being diagnosed at a later stage when it is harder to cure,” he says.
Other risk factors for colorectal cancer
With colorectal cancer, there are a number of risk factors. Some can be reduced while others are beyond your control.
Risk factors that you can control
- Being overweight.
- Not exercising regularly.
- Too much red or processed meats in your diet.
- Not enough vitamin D in your diet.
- Smoking.
- Heavy alcohol use.
Risk factors that are beyond your control
- Being older.
- A history of colorectal polyps, colorectal cancer or inflammatory bowel disease (IBD).
- A family history of colorectal cancer or polyps.
- Having a hereditary cancer syndrome like Lynch syndrome or Familial adenomatous polyposis (FAP).
- Your race or ethnic background.
- Being diagnosed with type 2 diabetes.
If you have symptoms, talk to your healthcare provider as soon as possible
Dr. Liska says to watch out for rectal bleeding, changes in bowel movements (meaning going from having frequent ones to being constipated or having diarrhea), abdominal pain and weight loss. If you’re experiencing these symptoms, contact your healthcare provider immediately for a diagnosis.
“One of the alarming things that we have seen with patients under 50 is that they get diagnosed with colorectal cancer after having symptoms for quite some time. And sometimes when the symptoms are brought up to their physicians, they’re often attributed to hemorrhoids or other conditions. We really need to educate the public and physicians so they know that colorectal cancer is more common among younger people and if anyone has symptoms, regardless of the age, we should recommend evaluation through a colonoscopy.”
Colonoscopies are nothing to fear
If you’ve never had a colonoscopy before, don’t just assume the worst and ignore your healthcare provider’s screening recommendation. If you feel a little uncertain or uneasy about the process, talk to your provider. They can help put you at ease. But not doing anything is never the right answer.
“Right now, approximately two-thirds of people who are recommended to get screened are getting screened. A third is not. We still have a lot of work to do to make sure that everyone who receives screening recommendations gets screened. That was actually one of the criticisms of extending the screening age to below 50. The thought was to first work on making sure that those over 50 were getting screened, but I don’t believe this issue is mutually exclusive. We can work on both populations, meaning increasing screening for those between 45 and 50 and also for those who are older than 50. The way we do this by educating people about the benefits of screening, and also by helping them realize there are other screening methods available besides a colonoscopy.”
Dr. Liska says there are also tests that can be done at home and if they come back abnormal, they will help indicate that a colonoscopy is needed.
“If somebody is afraid or embarrassed about having a colonoscopy, it is not the only test to do. There are a few tests that can be done at home, and if they aren’t normal, they would then trigger a colonoscopy. But everyone should realize that talking about symptoms is not something to be embarrassed about. On the other hand, if you’re afraid of a colonoscopy, talk to your physician about it. They can talk you through it or find a different option for you. Ultimately, when it comes to your colorectal health, keep this in mind —the best screening test is the one that gets done.”
