Colorectal Screening Guidelines Have Changed

Submitted by Dr. Paul Ricketts on March 13, 2019

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Why the new colon cancer screening guidelines should matter to all adults

The American Cancer Society's colon screening guidelines have been updated in response to a worrisome new trend in young adults. More adults under the age of 40 are getting, and dying from, colon cancer than ever before.

Americans born in 1990 are now two times more likely to develop colon cancer than those born around 1950. This same generation is also four times more likely to develop rectal cancer than their senior counterparts, according to an ACS study published in 2018.

A man in his 40's with a doctor

The reason for this increase is currently unknown, but what we do know is this: colorectal screening saves lives. Roughly one-third of colon and rectal cancers are discovered during screening, before these patients have experienced any symptoms. That’s why screening, for everyone, is so vital.

New guidelines reduce age of initial screening

As a result of this new research, earlier screening has been advised. Routine screening should now begin at age 45 (previously age 50) for both men and women. Anyone with an increased risk of colon cancer, which includes a family history of colon cancer in a first-degree relative or a family history of pre-cancerous (adenomatous) colorectal polyps, should begin regular screening at age 40, or 10 years prior to the age that your family member was diagnosed, whichever is earlier. Adults should continue screenings through age 75 if they are in good health and have a life expectancy of more than 10 years. After age 75, you should consult with your physician about your individual benefit from screening, which is calculated based on overall health, personal preferences and history.

The new findings are troubling because the overall rate of colon cancer in adults was actually on a slight decline, likely because the numbers of life-saving screenings, like colonoscopy, were on an upswing in older adults. Colonoscopies can both detect and prevent colon cancer.

Don’t sit on your symptoms or health history

While the cause of this recent uptick in younger-than-ever colorectal cancers is unknown, research has shown that adults under age 40 tend to delay contacting a physician even when they are experiencing symptoms, which can be deadly.

If you have any of the following symptoms, no matter your age, be sure to visit a doctor as soon as possible:

  • Diarrhea or constipation that endures for longer than two weeks
  • A change in the look of your stool
  • Blood in your stool, no matter the reason
  • Persistent abdominal pain
  • Unplanned weight loss of more than 10 pounds
  • Any unexplained and ongoing stomach or bowel discomfort 

There is a correlation between colorectal cancer and inflammatory bowel disease, Crohn's disease and ulcerative colitis, as well as inherited syndromes, like Lynch syndrome. Be open with your physician about your unique history and continue follow-up care for any stomach or bowel issues, as advised by your doctor.

Screenings are a requirement for good health

Detection and polyp removal through colonoscopy is still the most effective way to prevent colon cancer, because it is the only colon cancer screening test that both can detect and remove precancerous polyps, potentially eliminating abnormal cells before they become cancerous.

If you are not sure what to expect during a colonoscopy, here is a brief overview. During the exam your gastroenterologist will insert a small tube into your rectum so that he or she can see inside the colon and large intestine with a flexible camera called a colonoscope. If necessary, your doctor can also remove abnormal tissue or polyps through this same tube during the exam. Preparation for the exam, which has improved over the last several years, typically consists of a special diet the day before, as well as a prescription laxative regimen. During the exam you’ll be given a sedative to help you sleep.  It may sound a bit scary, but most patients report that the test is quick and relatively painless. The actual procedure only takes about 30 minutes.

Possible colonoscopy alternatives, which can be minimally-invasive, are good/viable options for patients who may be nervous about getting a colonoscopy or for those who have other risk factors. It is important to note that the following screenings can require invasive follow up with a positive result and the decision to forego colonoscopy is one that needs to be made in partnership with your physician.

  • Fecal blood tests: There are two versions of this non-invasive assessment, which essentially tests for blood in the stool. Patients take home a kit to provide the sample to the testing lab or physician.
  • Stool DNA tests, including Cologuard®: Cologuard is an at-home test which examines whether there is cancerous DNA in the stool. A similar stool-based DNA test can also be ordered via your physician.
  • CT colonoscopy (virtual colonoscopy): This is a type of X-ray that provides physicians with 3- and 4-D pictures of your colon and surrounding areas. These in-depth photos allow polyps and other abnormalities to be detected.
  • Flexible sigmoidoscopy: During a sigmoidoscopy your physician can look at the rectum and part of the colon to spot any abnormality. This type of test does not allow the provider to view the full colon, so it is less widely used than colonoscopy.

Prevent colon cancer with good habits

Dig.HealthBlogInfographic 2-19-1

Colonoscopies aren’t the only proven defense against colorectal cancer. It isn’t known exactly what causes colon cancer, but your overall risk of all cancers, including colorectal, can be reduced by making changes to your lifestyle. In fact, the World Cancer Research Fund estimates that approximately 20 percent of cancer diagnoses in the U.S. can be attributed to destructive, yet adjustable, lifestyle factors, like being overweight and smoking.

Make the following changes to reduce your risk of colorectal cancer, as well as other cancers:

  • Eat a diet high in fiber
  • Exercise regularly
  • Keep your weight at a healthy level
  • Quit smoking 
  • Reduce your alcohol intake

Download the Infographic

Don’t skip screening out of fear

Testing can cause a lot of anxiety, but if you've been hesitant about screening, the following fact might convince you to take the leap: When detected early, the five-year survival rate for colon cancer is 90 percent—it’s really a great reason to follow screening guidelines and report any symptoms promptly.

If you are still fearful about getting tested, you should know that most of our patients report that the anxiety about their screening is the hardest part. Colonoscopy patients typically describe little discomfort, thanks to better available preparation techniques, and the majority of them leave the procedure with a clean bill of health, as well as a 10-year gap until their next screening.

All the facts add up. Screening and awareness are the best (and easiest ways) to prevent death by colon or rectal cancer for anyone at any age. Make an appointment with your gastroenterologist or primary care physician or learn more about Digestive Health at Chesapeake Regional to get the ball rolling on prevention today.

Dr. Paul Ricketts is a Gastroenterologist with the Gastroenterology Associates in Chesapeake, VA. He is on staff at Chesapeake Regional Medical Center.