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Additional Thoughts On Colorectal Screening

By:  Timmy Lanier
According to the US Preventive Services Task Force (USPSTF), colorectal cancer is the third leading cause of cancer death for both men and women, with an estimated 52,980 persons in the US died of colorectal cancer in 2021. Colorectal cancer is most frequently diagnosed among persons aged 65 to 74 years. It is estimated that 10.5% of new colorectal cancer cases occur in persons younger than 50 years.  Incidence of colorectal cancer (specifically adenocarcinoma) in adults aged 40 to 49 years has increased by almost 15% from 2000-2002 to 2014-2016.  In 2016, 25.6% of eligible adults in the US had never been screened for colorectal cancer and in 2018, 31.2% were not up to date with screening.
I took the time to research the recommended age to begin colorectal cancer screening because it is subject to change based on the results of new studies that take place almost constantly.  Here’s what I’ve found:

CDC (Centers for Disease Control and Prevention)- Regular screening, beginning at age 45, is the key to preventing colorectal cancer and finding it early. The U.S. Preventive Services Task Force (Task Force) recommends that adults age 45 to 75 be screened for colorectal cancer. The Task Force recommends that adults age 76 to 85 talk to their doctor about screening.

American Cancer Society (ACS)- The ACS recommends that people at average risk* of colorectal cancer start regular screening at age 45. This can be done either with a sensitive test that looks for signs of cancer in a person’s stool (a stool-based test), or with an exam that looks at the colon and rectum (a visual exam). People who are in good health and with a life expectancy of more than 10 years should continue regular colorectal cancer screening through the age of 75.  For people ages 76 through 85, the decision to be screened should be based on a person’s preferences, life expectancy, overall health, and prior screening history.  People over 85 should no longer get colorectal cancer screening.

U.S. Preventive Services Task Force (USPSTF)- The USPSTF recommends offering colorectal cancer screening starting at age 45 years. Although the absolute risk of developing colorectal cancer is much lower in adults younger than 50 years (20.0 new colorectal cancer cases per 100,000 persons aged 40 to 49 years, 47.8 new cases per 100,000 persons aged 50 to 59 years, and 105.2 new cases per 100,000 persons 60 years or older14), age-period-cohort analysis indicates a recent trend for increasing risk of colorectal cancer in birth cohorts of adults younger than 50 years.  The USPSTF recommends that clinicians selectively offer screening for colorectal cancer in adults aged 76 to 85 years. Evidence indicates that the net benefit of screening all persons in this age group is small.
It is very important to take the possibility of colorectal cancer seriously.  It’s happening more and more every year and it’s affecting younger ages now.  “A concerning increase in colorectal cancer incidence among younger individuals (ie, younger than 50 years; defined as young-onset colorectal cancer) has been documented since the mid-1990s, with 11% of colon cancers and 15% of rectal cancers in 2020 occurring among patients younger than 50 years, compared with 5% and 9%, respectively, in 2010,” said Kimmie Ng, MD, MPH, first author of an editorial in JAMA accompanying the article about the guideline change of the USPSTF.

This is one of the items that I stress with my patients during wellness visits and even during routine visits.  As unpleasant as laying down on a table for a colonoscopy may seem, it’s a no brainer when the alternative is laying down in a casket for a funeral.  Besides, when there is no personal and family history, I usually opt for the “Poop and Scoop” test where my patients mail a stool sample to the lab to be tested for indicators of potential colorectal cancer.   Colorectal cancer is expected to cause about 52,550 deaths in 2023, according to the American Cancer Society.  This is why I emphasize testing to all of my patients of age.

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