With Gastroenterologist Stephen Kucera, MD
Medical experts agree: Routine colorectal cancer screening should begin at age 45, not age 50 as guidelines previously advised.
The American Cancer Society, the U.S. Preventive Services Task Force and medical professionals across the country recently modified colorectal-cancer screening recommendations and now call for regular screenings to begin at age 45. The change came in the wake of more than 2 decades of research that showed a rise in colorectal cancer and precancerous polyps in those ages 45 to 50.
Rising Incidence of Colon Cancer
“The incidence of colon cancer being diagnosed in people between ages 45 and 50 is the same now as it was in 50-year-olds 20 years ago, before we did routine screening,” explains gastroenterologist Stephen Kucera, MD, who serves as medical director of gastroenterology and endoscopic oncology at Sarasota Memorial. “When you look at all diagnosed colon cancer cases, 10% are in people younger than 50.”
And this year, colon cancer is estimated to be the fourth most commonly diagnosed cancer among men and women age 30 to 39 in the U.S.
Its these kinds of findings that have convinced physicians that screening for colorectal cancer should begin at an earlier age, to counter the rising incidence among younger patients.
Colon cancer remains the third leading cause of cancer-related deaths in the United States, Dr. Kucera says, but it doesn’t need to be.
With regular colonoscopies every 10 years, beginning at age 50, physicians estimate that 310 life-years are gained per 1,000 patients screened. By starting such screening at age 45, an additional 27 life-years are gained.
“And that’s an incredible number,” says Dr. Kucera.
Colorectal Cancer Screening Options
Though the colonoscopy remains the gold standard, many types of colorectal-cancer screening are available. Not all are as effective or thorough, and some may miss what another would catch. It’s important to find the one that’s right for you; talk to your doctor about your options.
Colonoscopy: For this test, a physician inserts an endoscopic camera through the anus to visually inspect the entire colon for polyps or abnormalities, which can be biopsied or removed during the procedure. This is the most thorough and comprehensive screening available, yet the procedure takes only 15 to 20 minutes and only needs to be done once every 10 years.
CT Colonography: Essentially a virtual colonoscopy, colonography uses non-invasive imaging. It’s not quite as thorough as a standard colonoscopy and must be done every 5 years. If polyps or suspicious areas are found, a colonoscopy must then be performed to address them.
Flexible Sigmoidoscopy: This test is similar to a colonoscopy, except that it does not examine the entire colon; so while it’s quicker, it’s not as thorough and leaves more than half of the colon unchecked.
Fecal Immunochemical Test (FIT) & Guaiac-Based Fecal Occult Blood Test (gFOBT): These tests check the stool for traces of blood, which can be an indication of polyps or cancer in the colon. They can be performed in the privacy of one’s home, but can miss many polyps and cancers and must be done every year. If blood is found, a colonoscopy likely will be necessary to investigate further.
Stool DNA Test: This test not only checks the stool for trace amounts of blood but also for DNA abnormalities known to indicate cancer or polyps. It can be done in the privacy of one’s home and must be done every 3 years, but can miss many polyps and cancers. If the test comes back positive, a colonoscopy will be required to investigate further.
Finding Cancer Before It’s Cancer
In the years since regular colorectal cancer screening began for those age 50 and older, the number of new colon cancer cases diagnosed in that population each year has been reduced dramatically (by 3.6% per year), says Dr. Kucera.
This is because a thorough colorectal cancer screening, such as a colonoscopy, has the ability to find cancer before it forms, giving you and your doctor time to stop it before it becomes a serious threat to your health.
Pre-cancerous polyps appear only as minor growths in the lining of the colon and do not typically cause noticeable symptoms, but if left untreated, they can lead to cancer.
With a colonoscopy, your doctor can reliably find and remove these polyps early, which is why the procedure remains the gold standard for detecting and diagnosing all colorectal concerns.
And if cancer has already formed, finding it early gives you the best shot at the best treatment outcome.
“Five-year survival rates for early stage colon cancer are incredibly high,” says Dr. Kucera. “But it’s even better to prevent the cancer altogether.
“And that’s really the goal.”
When to Get Screened for Colorectal Cancer
Routine colorectal cancer screening is recommended for those:
- Age 45 or older.
- Experiencing warning signs, such as persistent lower abdominal pain, bloody stool or changes in bowel habits. If you experience any of these symptoms, notify your doctor.
Where to Get Screened for Colorectal Cancer
Like most cancer screenings, you’ll need a physician order for colorectal cancer screenings, including colonoscopies. Talk to your doctor about your options or reach out to our HealthLine team (941-917-7777 or HealthLine@smh.com) for referral assistance.
Sarasota Memorial’s, state-of-the-art Endoscopy Center, located on Hillview Street in Sarasota, offers a comfortable, relaxed atmosphere; convenient outpatient access; and an expanding menu of services that includes routine diagnostic and therapeutic endoscopy and colonoscopy, as well as advanced interventional endoscopic procedures. Click here to learn more.
*Originally published March 9,2021