American Cancer Society urges colon cancer screening starting at 45, not 50
In response to an alarming increase in colon cancer among younger people, the American Cancer Society now recommends starting screening at age 45 rather than 50. The issue has been the target of vigorous advocacy by young cancer survivors who report that their symptoms didn't get enough attention by doctors who didn't suspect colon cancer.
The American Cancer Society on Wednesday recommended that people start screening tests for colorectal cancer at age 45, rather than 50, a change prompted by rising rates of the disease among younger people.
The revision was immediately cheered by advocacy groups.
"This recommendation will cover many of the people with early onset disease. It will save lives," said Dawn Eicher, 41, of Kailua-Kona, Hawaii, whose colon cancer was diagnosed at age 36 — 15 years after she began complaining of classic symptoms such as bleeding.
Erika Hanson Brown, 74, of Falls Church, Va., founder of the online support group colontown.org, said the change should help dispel the misconception that people under 50 are somehow protected from the cancer.
"The world in general thinks there's something magical that happens at 50, but it was kind of an arbitrary number," she said. "I'm passionate about reducing the age even more."
The cancer society called the new guidance a "qualified recommendation," but said it was based on studies and mathematical models that showed lowering the screening age to 45 would save lives.
Colorectal cancer is still very much linked to aging. But it has steadily declined among older adults mostly because of widespread screening colonoscopies, which can detect and remove precancerous polyps before they turn malignant. In contrast, incidence has increased 51 percent since 1994 among adults under 50.
Adults born around 1990 have twice the risk of colon cancer and four times the risk of rectal cancer as adults born in the 1950s, the cancer society said.
Other groups continue to recommend starting screening tests at 50. The influential U.S. Preventive Services Task Force decided not to lower the age when it reviewed available data two years ago, concluding such a change would have only a "modest" benefit.
Richard Wender, the cancer society's chief cancer control officer, said the new recommendations were sent to many experts for critical review before being finalized.
"It's fair to say the initial responses were not universal endorsement," said Wender, who is also a Thomas Jefferson University family physician. "But here's what I say: The evidence is the evidence and you should follow what it tells you."
One of the issues the society considered was whether the U.S. health-care system "would be unduly strained" if millions more people sought screening. But its analysis showed that would not be a problem. Furthermore, the new guidance says the initial test at age 45 could be a home stool test or one of several other screening methods that are less invasive and costly than a colonoscopy, the gold-standard test, which requires a bowel-cleansing drug regimen.
However, "all positive results on non-colonoscopy screening tests should be followed up with timely colonoscopy," the organization said.
Wafik S. El Deiry, a colorectal cancer specialist at Fox Chase Cancer Center, praised the flexibility in the new guidance: "Most people hate getting colonoscopies because it's so unpleasant. The bottom line is, if you catch it early, it can be cured."
People at high risk of colon cancer because of family history are already advised to start screening early.
In 2018, the cancer society estimates about 140,000 colon and rectal cancers will be diagnosed, and about 50,000 people will die of the disease.
Eicher, who underwent surgeries, radiation and chemotherapy, said she is grateful for each day of her four-year remission. She hopes the cancer society will expand research into genomic factors that drive early-onset colon cancer, because obesity, diabetes, and unhealthy diets cannot fully explain the ominous trend.
"For younger people, it's not the same risk factors — not the same anything," she said.