Colorectal cancer is the second leading cause of cancer deaths in the United States, with almost 52,000 deaths in 2019. In general, however, it is a slow growing cancer that is treatable if caught early enough, and in fact it can actually be prevented. That’s where screening comes in. In the past, screening was advised starting at age 50, but prompted by an alarming increase in colorectal cancers in younger patients, an independent expert panel has recommended that individuals at average risk for the disease start the screening process at age 45. This change in guidelines advocated by the U.S. Preventative Services Task Force (USPSTF) now aligns with that of the American Cancer Society, which made the recommendation for a lower screening age of 45 in 2018. The task force recommendation means that insurers will be required to cover preventative procedures such as stool tests and colonoscopies that can detect colorectal cancer at an early stage.
In 2020 11% of colon cancers and 15% of rectal cancers occurred in patients younger than 50 years, compared to 5% and 9%, respectively, in 2010. Colorectal cancer is even being seen in increased frequency in patients in their 20s and 30s and by 2030 is expected to be the leading cause of death from malignancy for people in their twenties through forties.
The reasons for this increase are unclear though there are several known risks factors: environmental toxins, poor diet, sedentary lifestyles, and obesity.
In addition, another major study has found that continuing colorectal cancer screening past the age of 75 is felt to be beneficial for some people, whereas previously it was generally advised to stop screening in these patients.
Colonoscopy is considered to be the “Gold Standard” of colorectal cancer screening. This is because the test physically looks at the lining of the intestine, and also because pre-cancerous polyps can be removed before they ever get the chance to turn into malignant growths. There aren’t many cancers where we can intervene in such a way. Another benefit is that with a normal exam, the next one will not be necessary for ten years, depending on one’s personal and family history.
Are you afraid to get a colonoscopy? If so, you are not alone. Many people think the exam will be painful or embarrassing. In fact, in spite of the preventative benefits of colorectal cancer screening, only around 70% of eligible individuals in the United States undergo screening. But colonoscopy is not something to be feared. It is quick and painless, you will be covered up during the procedure, and you can be back to normal life the following day.
In addition, there are other methods of screening available, including stool tests which need to be done every one to three years. These are all effective screening methods and some are quite inexpensive. If you are unsure which test is best for you, discuss it with your healthcare provider.
Our current guidelines for screening are:
Average risk, start at age 45
People in good health with a life expectancy more than 10 years should continue regular 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, overall life expectancy, overall health, and prior screening history.
People at higher risk may need earlier and more frequent screening. This includes people with a personal or a strong family history of colorectal cancer or certain kinds of polyps; a history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease); hereditary colorectal cancer syndromes; or a history of radiation to the abdomen or pelvis.
With all of the alternatives available, there is no reason not to get screened for colorectal cancer. No test is perfect, but there is a test that is right for you. So whatever one you choose, just get screened. It is one of the best decisions you can make for your future health.