Start screening for colorectal cancer 5 years earlier: experts

Guidelines in Canada and the U.S. recommend screening start at age 50. But stats suggest rates are rising among younger people.

Monika Warzecha 4 minute read October 28, 2020
colorectal cancer

Black men and women are at particular risk of colorectal cancer. Getty

For the first time, the U.S. Preventive Services Task Force is recommending doctors should start screening for colorectal cancer at age 45 — five years earlier than current guidelines.

“Overall, people ages 45 to 75 should be screened to reduce their risk of dying from this disease,” the task force, an independent, volunteer panel of national experts, said in a statement Tuesday. The recommendation is still in the draft phase, meaning after a four-week public comment period from Oct. 27, 2020, to Nov. 23, 2020, the recommendation will replace current guidelines that suggest regular screening for colorectal cancer among those aged 50 to 75.

Screening has been proven to save lives, though many Americans within the age range don’t get checked out.

“New science about colorectal cancer in younger people has enabled us to expand our recommendation to screen all adults starting at age 45, especially Black adults who are more likely to die from this disease,” says Task Force member Michael Barry. The goal, ultimately, is to prevent more people from dying.

According to the American Cancer Society, colorectal cancer is the third most common cancer diagnosed in both men and women in the United States, excluding skin cancers. Between 2006 and 2017, rates fell by 3.6 per cent per year for those aged 55-years and older thanks to screening and lifestyle changes. However, colorectal cancer rates rose by 2 per cent each year for those under 55. A few years ago, the society lowered its colorectal cancer screening recommended starting age to 45.

The American Cancer Societys Society estimates colorectal cancer will cause 53,200 deaths in the U.S.

The stats are fairly similar north of the border. The Canadian Cancer Society says colorectal cancer is expected to be the third most commonly diagnosed cancer in Canada in 2020 (excluding non-melanoma skin cancers). The society estimates 9,700 Canadians will die from colorectal cancer, or 12 per cent of all cancer deaths this year. Health Canada’s current guidelines recommend regular screening for those aged 50 to 74 years old.

Barry Stein, president of Colorectal Cancer Canada, says the U.S. draft recommendation to lower the screening age makes sense given the American studies that support it.  He thinks it would be the right thing to do in Canada, long-term.

“However, what we have to do in Canada is analyze our data on a provinicial basis to see what the impact of that change would be. It has done in such a manner that we can handle the capacity …  We have problems with not having enough capacity to deal with those people who already have symptoms.” He notes that the pandemic has created a backlog for colonscopies.

Early screening for colorectal cancer is both a personal and professional issue for him: Stein was diagnosed with metastatic colorectal cancer at the age of 41, roughly 25 years ago.

“There’s education on two sides: one, for the young adults who have to understand that if they have the signs, don’t ignore them,” he says. “The second thing is for the physicians. Don’t push away young people just because you think they’re young and they may not have colon cancer. We’re see this very big, developing incidence rate both in the U.S. and Canada [with people under 40].”

In 2016, the Canadian task force made a weak recommendation for colorectal cancer screening among adults aged 50 to 59 and a strong recommendation for adults aged 60 to 74.

“We monitor all new evidence on an ongoing basis and review and update recommendations when warranted,” says  Dr. Brett Thombs, Chair, Canadian Task Force on Preventive Health Care.

In an interview with Stat News, U.S. task force member John Wong noted that “Black men and women are disproportionately affected both in terms of the development of colorectal cancer and unfortunately they have lower survival rates with colorectal cancer.”

FILE PHOTO: Premiere of “Avengers: Infinity War” - Arrivals - Los Angeles, California, U.S., 23/04/2018 - Actor Chadwick Boseman. REUTERS/Mario Anzuoni/File Photo TPX IMAGES OF THE DAY ORG XMIT: SIN

Actor Chadwick Boseman died on Friday, August 28, 2020 after a private four-year battle with colon cancer. REUTERS/Mario Anzuoni/File Photo

In August, actor Chadwick Boseman died of colon cancer at the age of 43. He had been diagnosed with stage 3 colon cancer in 2016. African-American men are more likely to be diagnosed and more likely to die from colorectal cancer than any other ethnic group in the U.S., according to research.

Colorectal cancer starts in the colon or rectum, parts of the digestive system. Colon and rectum cancers are often grouped together since the body parts are made of the same tissues and there isn’t a clear border between them.

If you or someone you care about is living with cancer, connecting with a support network can help to not only learn ways to better manage their health, but also share experiences with others. Some Canadian resources include the WellspringCancer Connect at the Canadian Cancer Society, and Colorectal Cancer Canada.

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