45 is the new 50 when it comes to Colon Cancer Screening

This week, the U.S Preventive Services Task Force lowered the recommended age for a screening colonoscopy from 50-45.

Screening means that a healthy individual with no symptoms or concerns should get a colonoscopy at age 45. Those who get a colonoscopy sooner may be due to symptoms, risk factors, genetics, a family member with cancer, and others.

It is important to recognize the difference between screening and colonoscopy because of symptoms.

The Task Force

The task force is a group of individuals that makes up a panel of professionals that give guidelines for those providers treating patients. The initial guideline was discussed back in October of 2020 but the recommendation comes this week.

“We think by screening, starting at age 50, we prevent about 50 cases of colorectal cancer in a population of 1,000 people and avoid about 25 deaths. If we drop to age 45, we’ll prevent two or three additional cases and maybe one death,” Dr. Michael Barry, vice-chair of the task force, told news outlets. “We thought it was appreciable enough that it was time to change the recommendation to go down to age 45.”

Colorectal Cancer

Colorectal cancer is the third leading cause of cancer death in the United States.  Approximately 52,000+ individuals in the US are projected to die from it in 2021. Though most cases are diagnosed in people ages 65 to 74, the recommendation reflects a trend in recent years of cases among younger people.

Around 10% of new colorectal cancers are seen in those younger than age 50. Treatment is far better when the cancer is found in the early stages.

“It’s a major area of concern and investigation theories abound,” Dr. Benjamin Lebwohl, a gastroenterologist with New York-Presbyterian and Columbia University Medical Center. “To some extent, it may be driven in part by obesity, but there are plenty of people younger than 50, who are not obese, who are developing colorectal cancer, without any discernible risk factors.”

Dr. Lebwohl, along with Alfred Neugut did a study back in 2013 and has updated his findings compared to that research time. These new cases and the trend of younger individuals diagnosed have been seen in the last five years or so. The new recommendations reflect those findings.  His paper from 2013 –  Colonoscopy and colorectal cancer mortality: both sides of the story.

Colorectal Cancer in Black Adults

The task force, along with the American Cancer Society has recommended the lower age of 45 for Black men and women as far back as 2018. Research has shown that in America, Black Adults are more likely to get and die from Colorectal Cancer.

Cases from 2013 – 2017 confirmed this finding. Approximately 37.8 cases per 100,000 were seen in White Adults while 43.6 per 100,000 were seen in Black Adults.  Right now, the task force did not make any changes to specifically target Black Adults. Therefore the changes to age 45 are for All Adults regardless of race or color.

“No one knows the definitive answer to why African Americans seem to have a disproportionately higher amount of colorectal cancers,” Dr. Carl Crawford, a gastroenterologist with New York-Presbyterian and Weill Cornell Medicine. “It’s not clear whether the reason for this is lower screening rates, the follow-up after the screening, or the kind of treatments that these patients get. “It may not be genetic factors alone. There may be more environmental or health system access issues that we really haven’t been able to put our finger on.”
It is clear, more research needs to be done to understand the large difference in cases per 100,000.

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