Early Colorectal Screening and Detection Starts Younger

Changes to colorectal cancer screening guidelines may impact when you need screening

By Katie Ressler

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This year at your annual physical, don’t be surprised if your doctor suggests a colonoscopy, even if you’re still in your 40s. In 2018, the American Cancer Society (ACS) changed its guidelines for colon cancer screening, recommending that a person with average risk of colorectal cancer begin screening at age 45.

“The increasing incidence of colorectal cancer in adults in their 20s and 30s is alarming to many of us,” says Eyal Meiri, MD, Interim Chief of Medical Oncology at Cancer Treatment Centers of America® (CTCA), Atlanta. “The decreasing incidence of colorectal cancer in older adults who have undergone screenings suggests that colonoscopy has value. This message needs to get across.”

For colorectal cancer patient Scott D., symptoms appeared at the age of 49, just before he turned 50. He believes these screening guidelines are a step in the right direction, based on his experience.

“If I’d had no signs or symptoms, I wouldn’t have done anything about it,” Scott says. “Since I was only 49 when my symptoms began showing, my doctor thought at first that the problem was my diet or fitness regimen. When changes to my diet and exercise didn’t improve my symptoms, he told me I needed a colonoscopy.”

What you need to know about the updated guidelines

The ACS revised colorectal cancer screening guidelines last year to address the increase in colorectal cancer incidence in young adults. For people at average risk, starting regular screenings at 45, rather than 50 as was the prior recommendation, may help detect precancerous polyps or cancer cells in people who have no symptoms.

For those at a higher risk of colorectal cancer, screening should begin before 45.

“Individuals with family history of colorectal cancer, inflammatory bowel disease such as Crohn’s disease or ulcerative colitis, prior radiation exposure to the abdomen or pelvic area and those with known or suspected uterine cancer syndromes are high risk individuals.  They should begin testing much earlier,” explains Dr. Meiri.

The guidelines also suggest that for people in good health with a life expectancy of more than 10 years should continue screening through the age of 75. For people 76 to 85, the decision for screening depends on personal preferences, life expectancy, overall health and prior screening history. After the age of 85, colorectal cancer screening is no longer necessary.

Screening Test Options

In recent years, screening options for colorectal cancer have expanded. For those at average risk for colorectal cancer, screening options include:

Structural exams, such as:

  • Colonoscopy every 10 years
  • CT Colonography every 5 years
  • Flexible sigmoidoscopy every 5 years

High-sensitivity stool-based tests:

  • Fecal immunochemical test (FIT) every year
  • High sensitivity guaiac-based fecal occult blood test (HS-gFOBT) every year
  • Multi-target stool DNA test (mt-sDNA) every 3 years

From Scott’s perspective, the stool-based tests may make people more comfortable with the screening process.

“The worst part of a colonoscopy is the prep. There’s stigma associated with it and you assume it’s terrible,” Scott says. “The stool tests are more private since you can do it at home, and you don’t have to do the prep. If that helps more people take the time get screened for colorectal cancer, that’s a good thing.”

Dr. Meiri points out that colonoscopies are the gold standard and If you receive a positive result from non-colonoscopy test, you should follow up with a colonoscopy in a timely manner.

“Stool-based testing does not replace the need for colonoscopy.  It is appropriate for individuals who are unable to undergo colonoscopy. However, any positive results require colonoscopy.”

Preparing for Screening

Stool-based tests require little preparation and can be completed at home. Colonoscopies require more preparation, but if the results are negative, there’s no need to repeat the test for 10 years unless symptoms change or if someone is at high risk for colon cancer.

“The most complicated aspect of having to go through a colonoscopy is the prep, which requires a liquid diet and cathartic drink. The procedure itself takes only a few minutes,” explains Dr. Meiri. 

From Scott’s vantage, a screening is one of the best things you can do for yourself.

“I’ve had somewhere around 12 colonoscopies now, after having gone through treatment for colorectal cancer. I tell people that it’s important to make time for screenings. Take a day off work and do the prep needed for a colonoscopy. After the screening, go enjoy a good meal,” explains Scott. “One thing I ask all my friends is, ‘do you want to live with the doubt, or do you want to know?’ If you know, you can act quickly. And if your results show no signs, then you can rest easy.”