Friday, 21 September, 2018

Cancer group says colon screening should start at 45, not 50

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Melissa Porter | 01 June, 2018, 18:34

WEDNESDAY, May 30, 2018 (HealthDay News) - Most people should now begin colorectal cancer screening at age 45, say new guidelines that were spurred by the rising rate of the disease among younger Americans.

But the American Cancer Society this week changed its advice and is recommending that screening start five years earlier.

An increase in the number of people diagnosed with colorectal cancer led the American Cancer Society to make a change in guidelines.

This new guideline could be as effective against colon cancer for the young as it was for those who are older.

People who are at a higher risk of colorectal cancer "might need to start colorectal cancer screening before age 45, be screened more often and/or get specific tests".

Weinstein said if Exact can eventually get the U.S. Food and Drug Administration to expand approval of Cologuard to screen people starting at age 45, it could add as many as 25 million patients to the current 85 million Americans in the recommended age group.

Most colon cancer occurs in adults 55 and older, and the good news is rates of cases and deaths have been falling for decades.

"While the causes of this increase are not understood, it has been observed in all adult age groups below the age when screening has historically been offered, and is contributing significantly to the burden of suffering imposed by premature CRC mortality", the report says. The change is based on new predictive modeling studies that were done using updated estimates for the CRC risk in the young.

"In people born more recently, they're at four times the risk for rectal cancer than people born in the '50s (at the same age), for example, and double the risk of colon cancer", he said. Fritsche went in for his first screening colonoscopy at 50 but discovered he already had advanced colon cancer.

Because it is almost impossible to ask large cohorts of people to start colorectal cancer screening at different ages and then follow the outcomes of these cohorts, determining the best age to start and stop screening, and the optimal frequency of screening, depends on sophisticated mathematical models.

The Federal Joint Committee (G-BA) is considering to abolish these fixed age limits for this screening.

Recommended options for colorectal cancer screening include: fecal immunochemical test (FIT) annually; high sensitivity guaiac-based fecal occult blood test (HSgFOBT) annually; multi-target stool DNA test (mt-sDNA) every 3 years; colonoscopy every 10 years; CT colonography (CTC) every 5 years; and flexible sigmoidoscopy (FS) every 5 years. Death rates in this age group have also begun to rise in recent years, indicating that increased incidence rates do not appear to be exclusively the result of increased use of colonoscopy.

"This is a very, very big deal", said Weber, who is director of surgical oncology for the northwest region of Northwell Health. The ACS has more information on colorectal cancer risk factors on its website.

If you are in your mid-40s and have not been screened for colorectal cancer, it may be time to do so. With that, we've noted that the incidence is going up in younger people, even younger than 45.