Colorectal cancer screening should begin at age 45, five years earlier than currently recommended, says design guidelines of the US Preventive Services Task Force.
The update was prompted by recent studies showing that colorectal cancer rates are on the rise in younger people, according to the draft published Tuesday.
“Recent studies showing an increasing incidence in individuals ages 45 to 49 drew our attention to that age group,” said Dr. John Wong, a member of the task force and the Chief Scientific Officer of Tufts Medical Center.
Colorectal cancer is the third leading cause of cancer deaths in the US
It is estimated that 10.3 percent of new colorectal cancers occur in people under age 50, and recent data suggests that average-risk 45-year-olds are getting colon cancer at a rate now comparable to 50-year-olds, Wong said.
The draft guidelines are in line with: recommendations from the American Cancer Society two years ago. But with the added task force imprimatur, colonoscopies and other colon cancer tests for people ages 45 to 49 will be much more covered by insurance, experts say.
dr. Otis Brawley, professor of oncology and epidemiology at the Johns Hopkins School of Medicine and the Johns Hopkins Bloomberg School of Public Health, said the new recommendations were “exciting.”
“The USPSTF tends to be the most conservative and orthodox group in their interpretation of the scientific literature, and they rarely make a big change like this,” said Brawley, who is not part of the task force. “They see the same thing as the American Cancer Society.”
The task force also highlighted the fact that black Americans are more likely to develop and die from colorectal cancer than other racial and ethnic groups. From 2013 to 2017, the incidence rates for colorectal cancer were 43.6 cases per 100,000 black adults, compared with 37.8 cases per 100,000 white adults and 33.7 cases per 100,000 Hispanic/Latino adults.
Over the same period, the death rates were 18.5 deaths per 100,000 black adults, 13.6 deaths per 100,000 white adults, and 11.1 deaths per 100,000 Hispanic/Latino adults.
These differences are probably not a function of differences in biology, Brawley said, but are likely caused by factors such as obesity and poverty.
“There is a lot of data indicating that obesity causes colon cancer in black women,” Brawley said, adding that 60 to 65 percent of black women in their 20s and 30s are obese compared to 35 percent of white women.
There is also the issue of access to care.
“There is data showing that screening with colonoscopy is not as good in poor people as it is in middle-class people,” Brawley said, and black Americans are more likely to fall below the poverty line.
The explanation: Colonoscopists who treat poor people often have to do more procedures per day than those who treat middle-class patients, Brawley said. Further, he said, they tend to look at fewer lymph nodes — places where cancer spreads most quickly — in black people than in white people. “That means blacks are often not so well staged,” he said. So a black patient with advanced cancer is diagnosed with a disease that is less advanced.
According to the draft guidelines, a quarter of adults between the ages of 50 and 75 had never been screened for colon cancer. In part, that may be because people don’t want to get colonoscopies, Brawley said. That could be remedied if the doctors suggested? stool tests as an option.
“The data shows that stool tests save lives every year,” Brawley said, adding that “the data on stool tests are actually stronger than the data on colonoscopy.”
The task force’s recommendations support screening through colonoscopy or stool-based testing. There’s no question that both can prevent colon cancer deaths, Wong said, adding that it simply comes down to patient preference which method is used.
While the new guidelines are more likely to catch more colon cancers, they won’t catch all cases, as some people develop the disease at a much younger age. The actor Chadwick Boseman, for example, died of the cancer at age 43.
The guidelines are for screening people without symptoms, said Dr. John Rhee, a clinical assistant professor at the University of Pittsburgh and a medical oncologist at the UPMC Hillman Cancer Center. In younger people, paying attention to symptoms may be key to getting the disease earlier, he said.
“While most cases are in people over the age of 50, we definitely see it in younger people,” Rhee said. “Symptoms of colon cancer can include blood in the stool, abdominal pain, unexplained weight loss, fatigue and anemia. If you have symptoms, don’t blow them away. You should discuss them with your provider to determine if it’s anything serious or warrants testing.”
CORRECTION (October 27, 2020, 1:30 p.m. ET): An earlier version of this article featured the title of Dr. John Wong wrong. He is Chief Scientific Officer at Tufts Medical Center, not Chief Medical Officer.