With Gastroenterologist Stephen Kucera, MD
Colorectal cancer is now the leading cause of cancer death in people under 50 in the United States. In 2022, it was fourth.
According to the latest study from the American Cancer Society, the overall cancer mortality rate for people under 50 in the US has decreased by a whopping 44% over the last 25 years. This is largely due to substantial advances made in the diagnosis and treatment of four of the five leading causes of cancer-related death: breast cancer, lung cancer, brain cancers, and leukemia.
Meanwhile, mortality rates for young people with colorectal cancer have continued to rise steadily since the 1990s.
“The incidence of colon cancer being diagnosed in people between ages 45 and 50 is worse than it was in 50-year-olds 20 years ago, before we did routine screening,” says Stephen Kucera, MD, medical director of gastroenterology and endoscopic oncology at Sarasota Memorial. “When you look at all diagnosed colon cancer cases, an alarming—and growing—percentage are in people younger than 50.”
Experts worldwide are baffled as to the cause of the increase but are united in their response: routine colorectal cancer screening should begin at age 45, not age 50, as guidelines previously advised.
Colon Cancer Incidence Rises; Screening Age Lowers
Colorectal cancer may be the leading cause of cancer-related deaths in the United States, Dr. Kucera says, but it doesn’t need to be. And he agrees that screening for colorectal cancer should begin at an earlier age.
The math bears it out, he says.
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, at least.
“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.
VISUAL EXAMS
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.
STOOL TESTS
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 reduced continuously and dramatically, says Dr. Kucera. This is because a thorough colorectal cancer screening, such as a colonoscopy, finds cancer before it fully forms, so you and your doctor can stop it before it becomes a serious threat to your health.
But how do you find cancer before it's there? The answer is "pre-cancerous polyps."
Pre-cancerous polyps are minor growths in the lining of the colon that don't typically cause symptoms but, if left untreated, 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 offers G.I. cancer screening and advanced testing at 8 convenient locations in Sarasota County, including the state-of-the-art Endoscopy Center, located on Hillview Street in Sarasota, providing 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.
Written by Sarasota Memorial copywriter Philip Lederer, MA, who crafts a variety of external communications for the healthcare system. SMH’s in-house wordsmith, Lederer earned his Master’s degree in Public Administration and Political Philosophy from Morehead State University, KY, and needs to eat more fiber.