Colorectal Cancer Screenings Should Start at 45, New Guidelines Say

The American Cancer Society released new colorectal cancer screening guidelines today, suggesting that testing begin at age 45 rather than 50 for people at average risk of the disease.

The change comes just over a year after ACS researchers reported a dramatic uptick in colorectal cancer cases in younger adults: Compared to people born in 1950, people born in 1990 have double the risk of ever developing colon cancer and four times the risk of ever developing rectal cancer, they found.

Starting screening earlier will hopefully limit the impact of colorectal cancer on this younger population, explains Nancy You, MD, an associate professor in the department of surgical oncology at the University of Texas MD Anderson Cancer Center. Not only are more younger people being diagnosed with colorectal cancer, they’re being diagnosed at later stages of the disease, when it’s more difficult to treat. “Hopefully, lowering the age [for screening] will have a long-term impact over the generations,” she says, in terms of detecting colorectal cancer at earlier stages and lowering death rates.

Other groups continue to recommend that colorectal cancer screening begin at age 50. “There’s a lot of attention being paid to this issue and a lot of discussion,” Dr. You says. “It may be that other societies follow suit, but I think the big impact of this guideline change is it will raise awareness and offer options to patients.”

Awareness is a big deal for the young adults, who are still years away from the new suggested starting age for screening, she adds. Those folks are tasked with monitoring themselves for potential colorectal cancer symptoms—and bringing those symptoms to a doctor. “Sometimes we’re too busy or don’t think about it potentially not being hemorrhoids,” Dr. You says.

If you’re concerned about your risk, keep an eye out for colorectal cancer symptoms including blood in your stool, unexplained stomach cramps or weight loss, constipation or diarrhea that doesn’t get better, and a change in the timing, frequency, or amount of your poop.

If you’ve reached the age to start colorectal cancer screening, here’s some good news: You don’t have to get a dreaded colonoscopy. The ACS and other leading groups suggest six different colorectal cancer screening options, including three at-home kits that test your poop. “If we give patients a choice and let them factor in what’s available to them, then maybe those things will contribute to higher adherence and therefore greater practical impact of the screening recommendation,” Dr. You explains.

Talk to your doctor to help you determine which screening method is right for you and to get the details on how often to screen, which varies by test. You’ll also need to check which tests your insurance will cover, keeping in mind that insurance plans may not start covering screening at age 45 right away. Colorectal cancer screening should continue through age 75. After that, you’ll need to discuss what makes the most sense for you with your doctor. No one needs to screen for colorectal cancer after age 85.

These recommendations are for people with an average risk of developing colorectal cancer. People with a higher risk may need to start screening even earlier, be screened more often, or use a specific type of test, according to the ACS. Factors that put you at higher-than-average risk include a strong personal or family history of colorectal cancer or some types of polyps, as well as previously being diagnosed with inflammatory bowel disease.

The ACS estimates that more than 97,000 new cases of colon cancer and more than 43,000 new cases of rectal cancer will occur in American adults in 2018; an estimated 50,630 people will die from the disease this year. That makes it the third leading cause of cancer death, according to the ACS—yet only about two-thirds of people actually get screened for colorectal cancer. Fortunately, death rates for colorectal cancer have been dropping for several decades, thanks to improvements in screening and treatment.

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Experts aren’t sure why there’s been a rise in colorectal cancer rates in younger adults. Up to 20% of those diagnosed have some kind of genetic component, Dr. You says, so it’s crucial to know your family history of the disease. Some experts wonder if younger adults are at greater risk of colorectal cancer because they’ve grown up eating more processed foods or are more likely to be obese, but these theories haven’t been proven, she says.

That said, it certainly can’t hurt to take healthy steps that might lower your lifetime colorectal cancer risk, such as cutting back on red meat and alcohol, eating plenty of high-fiber produce, getting regular exercise, maintaining a healthy weight, and quitting smoking if you haven’t already.

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