July 16, 2018
The incidence of colorectal cancer is increasing among young adults, according to a data analysis by the American Cancer Society. As a result, the ACS recently revised its screening recommendations to include earlier screening and alternative testing options.
The new recommendations say screening should begin at age 45 for people at average risk. Previously, the guideline recommended screening begin at age 50 for people at average risk.
"Most oncologists are seeing younger and younger patients with colon cancer. The American Cancer Society reviewed the data and determined that testing average-risk patients earlier would help decrease colon cancer deaths," said Raed Al-Rajabi, MD, medical oncologist at The University of Kansas Cancer Center. "Currently, the way the numbers are trending, if intervention isn't taken, we will begin seeing significantly more patients with colorectal cancer in their 20s and 30s."
Screening options
Dr. Al-Rajabi said the guidelines provide several options for screening, including:
- Stool-based tests that detect blood
- Colonoscopy or sigmoidoscopy
- CT/MRI scan of the colon or other structural evaluation
"The guidelines don't suggest that everyone who is 45 should get a colonoscopy. They do recommend that conversations begin and some form of screening be performed," he said.
Unexplained increase
While there currently is no scientific explanation for the increase in colorectal cancer among younger patients, Dr. Al-Rajabi said multiple factors are likely at play.
Lifestyle is one. Obesity is on the rise because of unhealthy eating habits and diets that include too much alcohol, red meat and processed foods. Physical inactivity is another consideration. Together, these increase a patient's risk for colorectal cancer, he said.
Revised recommendations
"With the new guidelines, doctors will begin talking with patients at age 45 about screening,” said Dr. Al-Rajabi. “After discussing the risks and benefits of testing, we will help our patients determine which screening tests are right for them.”
For patients at average risk, and who do not have an abnormal screening result at age 45, follow-ups are recommend up to age 75. Depending on the type of screening a patient chooses, the follow-up period varies from one to 10 years, Dr. Al-Rajabi said. Many stool-based tests should be performed annually, while colonoscopy should be done every 10 years.
Patients with abnormal screening tests should see a specialist for additional testing, he said.
Additionally, patients of any age who have symptoms that don't improve or are unexplained should consider screening, Dr. Al-Rajabi said. "It's common for a colon cancer diagnosis to go undetected, because everyone assumes that a patient is too young for it to be considered.
“If a patient experiences unknown anemia, blood in the stool, persistent abdominal pain that doesn't improve or relentless fatigue, he or she should seek medical attention that includes a colorectal cancer screening. Age shouldn't be a factor that rules out this kind of diagnosis anymore."
High-risk patients with a family or personal history of colorectal cancer, or other health issues that increase their risk, should seek the advice of their physician and be screened for colorectal cancer before the age of 45.
Screening gets results
"Colon cancer deaths are going down in the United States," said Dr. Al-Rajabi. "The biggest reason for this is screening. Through screening, we find cancer in earlier stages and can treat it better. We can find polyps before they develop into cancer and remove them. Screening is a tremendous tool in decreasing deaths related to colorectal cancer."