Updated guidelines suggest screening for colon cancer at 45


Dear Doctor: Can you please explain why we keep hearing different things about when to get screened for colon cancer? I think it just changed again, and it’s kind of confusing. I’m 47 years old and thought I didn’t need to be tested for three more years. Now, all of a sudden, I’m late.

Dear Reader: You’re correct that the guidelines for screening for colorectal cancer have been recently updated. The new advice states that adults who are at average risk of developing colorectal cancer should begin having routine screenings at age 45. Previously, as you noted in your letter, the recommended age to begin these screenings had been 50. However, due to a marked increase in the number of younger adults being diagnosed with these types of cancers, the screening age has been lowered. This recommendation comes from the United States Preventive Services Task Force, an independent panel of nationally recognized experts in disease prevention. The group bases its guidelines on recent research, data and statistics.

It’s true that screening guidelines can change over time. This is to keep up with emerging health data. In the past 15 years, the incidence of colorectal cancer in younger adults has risen by almost 15%. The updated screening guidelines address that trend and are meant to save lives. And, because the task force recommendations are followed by insurers, private health insurance companies will now cover colorectal cancer screenings from age 45 to 75 without a copay.

This is all important because colorectal cancer is the third leading cause of cancer death for both men and women in the U.S. And, yet, when it’s caught early, it’s also highly curable. Screening for the cancer can take several forms. These include sigmoidoscopy, colonoscopy and at-home fecal tests. The specific type of test that someone needs depends on their risk factors for developing the disease. Health data collected over the course of decades has found that Black adults, Native Americans and Alaska Natives have higher rates of colorectal cancer than the rest of the population. The reasons for this are not yet clear. People with a family history of the disease are at higher risk. So are people who are obese, who have diabetes and those with a history of smoking or alcohol abuse.

Elizabeth Ko, MD and Eve Glazier, MD

Even when someone starts out screening for colorectal cancer with at-home fecal tests, they will be expected to also undergo a colonoscopy. That’s a procedure in which a flexible scope is used to physically examine the colon. When no sign of cancer is found in someone of average risk, the recommended frequency of colonoscopy is every 10 years. At-home fecal tests can be conducted annually. The hope is that these updated guidelines will catch more colorectal cancers, and at earlier stages.

When the disease is found localized in the bowel, the five-year relative survival rate is 91%. In localized rectal cancer, it’s 89%. When these cancers spread to nearby lymph nodes or metastasize to other regions of the body, survival rates drop. All of which makes adhering to the updated screening guidelines so much more important.

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