Early detection key

American Cancer Society recommends colorectal cancer screening beginning at age 45

Dr. Ross Siemers, medical oncologist at UP Health System-Marquette Cancer Care, speaks with a paitent in a medical suite. (Photo courtesy of U.P. Health System-Marquette)

MARQUETTE — The American Cancer Society is now recommending average-risk adults start colorectal cancer screening at age 45, rather than age 50, after a recent retrospective study done by American Cancer Society Researchers showed the incidence of colorectal cancer is rising in average-risk adults under 50 years of age.

The new study, which was a retrospective analysis of approximately 500,000 people 20 years old and above who were diagnosed with colon cancer between 1974 and 2013, suggests screening for colorectal cancer at age 45 could be beneficial, as the study found new cases of colorectal cancer are occurring at an increasing rate amongst adults below 50.

“They looked at retrospective data on certainly a huge number of people and discovered the incidence of colorectal cancer, particularly rectal caners, is going up in younger people,” said Dr. Ross Siemers, medical oncologist at UP Health System-Marquette Cancer Care.

Colorectal cancers, which are the third-leading cause of cancer-related deaths, typically begin as a growth, called a polyp, on the inner lining of the rectum or colon, according to the American Cancer Society.

Many types of polyps are benign, but adenomatous polyps polyps, often referred to as pre-cancerous polyps, have the potential to become cancerous.

“Ideally, you want to find cancers in the early stage or you want to find them when they’re pre-cancerous polyps,” Siemers said.

Colonoscopies can both detect and remove the pre-cancerous polyp, preventing it from becoming cancerous.

“The theory is, you find pre-cancerous polyps and take them out before they have a chance to turn into cancer and that’s kind of the goal of doing colonoscopies,” Siemers said, noting “colonoscopy is the best” if a person undergoes screening.

These polyps become more common as people age — to catch and remove these pre-cancerous polyps early, many medical groups have recommended colorectal cancer screening begin at age 50, which is a well-established guideline in the field, according to National Cancer Institue.

“The detection and subsequent removal of precursor lesions detected during screening and the detection of (colorectal cancer) at an earlier, more favorable stage have been shown to significantly reduce incidence and mortality,” according to the American Cancer Society.

However, the new recommendation from the American Cancer Society comes in light of increasing rates of colorectal cancer in younger people — they believe screening earlier may be beneficial.

In adults 20 to 39, colon cancer incidence rates increased 1 to 2 percent a year through 2013, while rates increased 0.5 percent to 1 percent a year from the mid-1990s through 2013 in adults 40 to 54, according to the 2018 American Cancer Society study.

While colorectal cancer has been increasing in younger populations, it has declined in older populations, which is largely credited to increased screening and improved treatments.

“Subsequent accelerated declines in incidence and mortality since 2000 are largely attributable to increased uptake of screening, with improved treatment also contributing to mortality reductions,” the 2018 American Cancer Society study states.

However, the incidence in that population is still far less than the incidence older adults.

“The incidence is still very, very low in that age group, 45-50, compared to 60- or 70-year-olds,” Siemers said.

Due to the retrospective nature of the study’s design, it is not yet clear if screening average risk adults between 45 and 49 will decrease mortality from colorectal cancer in that group, which Simmers says is an important measure when considering implementation of the recommendation in the health care field.

“Screening (in people over 50) makes people live longer, it cuts down mortality from the disease, which is really the goal of the screening test, the goal is to keep people alive, its not necessarily to diagnose something, it’s to show that the pople who get screened live longer than the people who dont get screened, and that’s something that hasn’t been done in the 45-50 age group yet,” Siemers said.

He says further research is needed to show screening for colorectal cancer in average-risk adults aged 45-49 is beneficial, noting a randomized clinical trial that assesses patient outcomes with screening versus no screening would help inform the medical community about the true benefit of starting screening earlier.

“It’s intriguing data, but it’s got to be proven,” Siemers said, noting that it’s important to recognize the recommendation is only coming from one organization at this point and that other cancer organizations still have yet to change their recommendations.

It’s also important to consider insurance coverage for starting screening at 45 for average-risk adults — not all insurances may cover screening beginning at 45 years of age for average-risk adults, so Siemers recommends checking with the insurance provider before scheduling a procedure.