Colorectal cancer is the third leading cause of cancer deaths in the US. It is a cancer that occurs in the colon or rectum, and is sometimes known as colon cancer. The colon is the large intestine, and the rectum is the passageway that connects the colon to the anus. At times, abnormal growths called polyps may form in the colon or rectum. But not all polyps become cancer, it depends on the type of polyp.
Unfortunately, a study showed that people under the age of 55 are 58% more prone to be diagnosed with late-stage colorectal cancer. This is why the US Preventive Services Task Force (PSTF) issued guidelines which include that screening for the cancer should start at age 45. Prior to this directive, doctors suggested to start screening at the age of 50, until the age of 75.
Though the new guidelines are not yet official, a bulletin stated, “Overall, people ages 45 to 75 should be screened to reduce their risk of dying from this disease.” According to the PSTF, these guidelines apply to “adults without symptoms and who do not have a personal history of colorectal polyps, or a personal or family health history of genetic disorders that increase the risk of colorectal cancer.”
The American Cancer Society (ACS) estimates that there will be over 104,000 new cases of colon cancer, and about 43,000 new cases of rectal cancer diagnosed this year. It is important to note that the cancer does not always exhibit symptoms right away…but as it progresses, it can cause abdominal pain, a change in bowel habits, rectal bleeding, blood in the stool, and unintended weight loss. The PSTF says, “Despite strong evidence that screening for colorectal cancer is effective, about a quarter of people ages 50 to 75 have never been screened.”
So what drove the PSTF to suggest that the screening should start earlier, at the age of 45? “I believe the new draft guidelines are justified and an important step in diagnosing and preventing colorectal cancer in younger patients,” explains Dr. Joshua Meyer, vice-chair of translational research in the Department of Radiation Oncology at Fox Chase Cancer Center. “A lot needs to change in terms of mindset around screening at a younger age.”
While the number of people diagnosed with the cancer is dropping in those who are 65 or older, unfortunately, it has increased in younger people. An estimated 12% (about 18,000 people) of colorectal cancer cases will be diagnosed in people under the age of 50. This is not a recent development, colon cancer in adults younger than 50 has been happening since the mid-80s. And the younger age groups are seeing the biggest increases. They are also being diagnosed at later stages.
So why is this happening? According to the authors of a study published in the Journal of the National Cancer Institute, it is “largely due to delayed follow-up of symptoms, sometimes for years, because cancer is typically not on the radar of young adults of their providers.” So, earlier screening is “a move in the right direction,” explains Dr. Hisham Hussan, gastroenterologist with The Ohio State University Comprehensive Cancer Center. He stresses that the new guidelines will help doctors get approval from the insurance companies to make screening more affordable for the younger patients.
However, there are also racial differences. Sadly, Black Americans have one of the worst colon cancer survival rates of any ethnic group in the US, based on a report this year from the ACS. Colorectal cancer in African-Americans is 20% higher than in non-Hispanic whites, with death rates 40% higher. But the hardest hit are Alaska natives, with a death rate double that of Black Americans. It is not clear as why this disparity happens among different races, but one meta-analysis of previous research suggests Black Americans have a higher risk of being diagnosed at later stages due to inadequate access to healthcare, and lower screening rates.
A gastroenterologist at Moffitt Cancer Center, Dr. Mark Friedman, says he hopes that earlier screening will help pinpoint those most at risk for developing the cancer. He says, “The majority of colorectal cancers in these younger individuals appears to be sporadic and we have yet to identify who is at the greater risk and who should be more aggressively screened.” It goes without saying that earlier screening will give doctors a better chance of detecting colorectal cancer at an earlier, easier-to-treat stage.
However, Dr. Meyer stresses that just because the screening should start at the age of 45, it does not mean that younger people are not at risk. “If a person in their 20s, 30s, or 40s has persistent rectal bleeding, change in bowel habits, or abdominal/pelvic pain that persists, they should discuss further workup with their doctor, including a possible colonoscopy,” he stresses.
Given this, the PSTF recommends two forms of screening tests for colorectal cancer: stool based tests, and direct visualization tests ( which study the structure of the colon and rectum for abnormalities). The ACS recommends the following:
A stool DNA test – this test looks for hidden blood and abnormal sections of DNA from cancer or polyps
A fecal immunochemical test (FIT) – this looks for blood in the stool
A guaiac-based fecal occult blood test (gFOBT) – finds hidden blood in the stool through a chemical reaction
A colonoscopy – doctors examine the entire length of the colon and rectum with a colonoscope, a flexible tube with a light and a video camera on the end
A flexible sigmoidoscopy – similar to a colonoscopy, but it does not examine the entire colon
A CT colonography – uses a CT scan and X-ray of the colon and rectum to look for abnormalities
Having an earlier screening seems logical, and essential. Cancer is a terrible disease which afflicts lots of people. Some because they were diagnosed too late. So if you experience any of the symptoms presented here, go to your doctor for a screening. But even if you don’t exhibit any symptoms, having a screening won’t hurt you. Be safe.
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